In-depth profiling of COVID-19 risk factors and preventive measures in healthcare workers

PURPOSE To determine risk factors for coronavirus disease 2019 (COVID-19) in healthcare workers (HCWs), characterize symptoms, and evaluate preventive measures against SARS-CoV-2 spread in hospitals. METHODS In a cross-sectional study conducted between May 27 and August 12, 2020, after the first wave of the COVID-19 pandemic, we obtained serological, epidemiological, occupational as well as COVID-19-related data at a~quaternary care, multicenter hospital~in Munich, Germany. RESULTS 7554 HCWs participated, 2.2% of whom tested positive for anti-SARS-CoV-2 antibodies. Multivariate analysis revealed increased COVID-19 risk for nurses (3.1% seropositivity, 95% CI 2.5-3.9%, p = 0.012), staff working on COVID-19 units (4.6% seropositivity, 95% CI 3.2-6.5%, p = 0.032), males (2.4% seropositivity, 95% CI 1.8-3.2%, p = 0.019), and HCWs reporting high-risk exposures to infected patients (5.5% seropositivity, 95% CI 4.0-7.5%, p = 0.0022) or outside of work (12.0% seropositivity, 95% CI 8.0-17.4%, p < 0.0001). Smoking was a protective factor (1.1% seropositivity, 95% CI 0.7-1.8% p = 0.00018) and the symptom taste disorder was strongly associated with COVID-19 (29.8% seropositivity, 95% CI 24.3-35.8%, p < 0.0001). An unbiased decision tree identified subgroups with different risk profiles. Working from home as a preventive measure did not protect against SARS-CoV-2 infection. A PCR-testing strategy focused on symptoms and high-risk exposures detected all larger COVID-19 outbreaks. CONCLUSION Awareness of the identified COVID-19 risk factors and successful surveillance strategies are key to protecting HCWs against SARS-CoV-2, especially in settings with limited vaccination capacities or reduced vaccine efficacy

Early Detection of Richter’s Transformation: Stable Disease with Dose-Reduced Gemcitabine and Local Radiation

Background: The occurrence of Hodgkin’s lymphoma (HL) as a second aggressive lymphoid malignancy (known as Hodgkin’s disease variant of Richter’s transformation) is rarely observed. Response rates, even with highly aggressive therapy such as stem cell transplantation, are limited, ranging from 4 to 43%, and the medium survival time ranges from 5 to 8 months. Case Report: A 72-year-old patient with a history of chronic lymphatic leukemia (CLL) was admitted with thoracic back pain and assumed progression of the CLL. The patient showed no fever, night sweats or weight loss. A computed tomography (CT) scan confirmed the progression of axillary and cervical lymph nodes. In addition, an intraspinal infiltration at the 8th thoracic vertebra (Th8) was detected. Surprisingly, histology of an extirpated lymph node demonstrated the existence of 2 tumors in the same lymph node. Infiltrates of small lymphocytes representing the pre-existing CLL (CD5-, CD20-, CD23-positive) coexisted with Reed-Sternberg Hodgkin’s cells (CD30-, CD15-positive). Chemotherapy was started, combined with palliative radiation of vertebrae Th7–Th10. 12 months after diagnosis of Richter’s transformation the patient is still alive without any progression of the underlying disease. Conclusion: We present a unique case of a Hodgkin’s disease variant of Richter’s transformation and CLL in the same lymph node, which was detected early because of spinal infiltration and was subsequently stabilized with reduced-dosage gemcitabine and local radiation. Additionally, we show unique pictures of 2 tumors coexisting in the same lymph node.Hintergrund: Das Auftreten eines Hodgkin-Lymphoms als zweite aggressive, bösartige, lymphoidzellige Erkankung (bezeichnet als Hodgkin-Variante einer Richter-Transformation) wird sehr selten beobachtet. Selbst mit Hochdosis- Regimen bewegen sich die Ansprechraten etwa zwischen 4 und 43%. Die mittlere Überlebenszeit beträgt 5–8 Monate. Case Report: Wir berichten über einen 72- jährigen Patienten, der bei bekannter chronischer lymphatischer Leukämie (CLL) aufgrund zunehmender Schmerzen im Bereich des Rückens unter der Annahme eines Progresses der CLL stationär aufgenommen wurde. Fragen nach Fieber, Nachtschweiß und Gewichtsverlust wurden verneint. Computertomogramm (CT)-Aufnahmen zeigten eine Größenzunahme axillärer und zervikaler Lymphknoten. Zudem zeigte sich eine intraspinale Raumforderung in Höhe des achten Brustwirbels (Th8). Histologisch konnten in der durchgeführten Lymphknotenbiospie 2 Tumore in ein und demselben Lymphknoten festgestellt werden. Es zeigten sich Infiltrate der vorbestehenden CLL (CD5-, CD20-, CD23-positiv) in Koexistenz mit Reed-Sternberg-Hodgkin-Zellen (CD30-, CD15-positiv). Eine Chemotherapie in Kombination mit lokaler Bestrahlung wurde begonnen. 12 Monate nach der Erstdiagnose einer Richter-Transformation ist der Patient am Leben ohne Zeichen von Progress. Schlussfolgerung: Wir präsentieren hier das Auftreten eines Morbus Hodgkin mit einer CLL als eine seltene Variante einer Richter-Transformation, die durch die frühe Diagnosestellung mit subtherapeutischer Dosis von Gemcitabin und lokaler Bestrahlung nun über 12 Monate stabilisiert werden konnte. Zudem können wir anhand dieses Falles ein Bild zweier Lymphome in ein und demselben Lymphknoten zeigen

IgG4 immune response in Churg–Strauss syndrome

Objective: T-helper type 2 responses are crucial in Churg–Strauss syndrome (CSS) and may enhance the production of IgG4 antibodies. The authors assessed the IgG4 immune response in CSS patients. Methods: The authors included 46 consecutive patients with CSS (24 with active and 22 with quiescent disease), 26 with granulomatosis with polyangiitis (GPA, Wegener's), 25 with atopic asthma and 20 healthy controls and determined serum IgG, IgM, IgA, IgE and IgG subclass levels. Tissue infiltration by IgG4 plasma cells was assessed in nine patients with CSS, 10 with GPA, 22 with chronic sinusitis (11 with and 11 without eosinophilia). Results: IgG4 levels were markedly higher in active CSS patients than in controls (p<0.001 vs all control groups). Serum IgG4 correlated with the number of disease manifestations (r=0.52, p=0.01) and the Birmingham vasculitis activity score (r=0.64, p=0.001). Longitudinal analysis in 12 CSS cases showed that both the IgG4 level and IgG4/IgG ratio dropped during disease remission (p=3×10−5 and p=6×10−4, respectively). Tissue analysis did not show an increased IgG4 plasma cell infiltration in CSS biopsies compared with control groups. Conclusions: Serum IgG4 levels are markedly elevated in active CSS and correlate with the number of organ manifestations and disease activity