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Erythema nodosum leprosum (ENL) is an immune complex mediated type III hypersensitivity reaction seen in patients of borderline lepromatous and lepromatous leprosy. It can be caused by a wide array of triggers and can be seen before, during, or after completion of anti-leprosy therapy. There are multiple well-known triggers for type 2 reactions like the initiation of multidrug therapy, Mantoux testing, vaccination, mental and physical stress, and physiological states like pregnancy. Herein, we report a case of exacerbation of ENL in a middle-aged woman, probably due to COVID-19 vaccine while she was well-controlled on immunosuppressive therapy. The episode was treated with non-steroid anti-inflammatory drugs and oral steroids and the symptoms resolved within 2 weeks. Although causality was highly possible between the occurrence of ENL and COVID-19 vaccine, physicians should be aware that it can be easily managed with proper care and medicines and this should not be a basis for deferring the vaccine.
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Background & objectives: Vaccination against COVID-19 induces spike protein-binding IgG antibodies, a robust correlate of protection against COVID-19. This study was undertaken to assess the humoral response after completion of both the doses of ChAdOx1 nCoV vaccine in healthcare workers (HCWs) at a tertiary care health centre in India. Methods: A cross-sectional COVID-19 vaccine-induced antibody study was conducted among HCWs. IgG antibodies against spike protein were measured at least 28 days after the first dose and the second dose of vaccination in both SARS CoV-2 naïve and recovered HCWs. Mean and median antibody titre following each dose of vaccine and its association with age, gender, co-morbidities and factors such as exercise, stress and sleep deprivation were also explored. Results: Among the 200 vaccine recipients, 91.5 per cent showed seroconversion after the first dose and 99.5 per cent after the second dose. The mean titre after the second dose was significantly higher when compared to the first dose (12.68±4.17 vs. 9.83±6.3, P=0.001). More than half (54%) had high antibody titre ?12 S/Co (Signal/cut-off). Previous COVID-19 infection was the single most important factor influencing antibody production, where the mean titre just after a single dose [mean-17.81±5.94, median-20.5 (interquartile range [IQR]-3.7)] surpassed the titre after the second dose in SARS CoV-2 naïve individuals [mean-12.29±4.00, median-12.8 (IQR-3.7), P=0.001]. Furthermore, 28 per cent of vaccinees showed a reduction in titre after the second dose. The mean fall in titre was 2.25±1.40 and was more pronounced in males, the younger age group and those with previous COVID-19 infection. Interpretation & conclusions: ChAdOx1 nCov-19 vaccine after two doses elicited an excellent immune response. However, greater immunogenicity after the first dose was seen among those with previous COVID-19 infection, even surpassing the titre achieved by the second dose of vaccine in SARS CoV-2 naïve recipients. A fall in antibody titre after the second dose is a matter of concern and requires further studies.
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Background:Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was initially reported as a culprit for many unexplained cases of pneumonia in Wuhan, China. Since then, COVID-19 vaccine is highly recommended as a protective measure of this pandemic. This study aimed to measure the safety profile of theCOVID-19 vaccine among Qassim University members.Methods:This is a cross-sectional observational study conducted among Qassim University members, Saudi Arabia. A pre-specified questionnaire was distributed among prospective members of the campus using an online survey. Participants who were vaccinated by either one or two doses were the subjects of this study. Consent was sought from the participants or next of kin and the data collection were lasted for over three months.Results:The 604 respondents were able to recruit (51.7% males versus 48.3% females). 55.6% of respondents were in the younger age group (age ?25 years). The most commonly received vaccine was Pfizer (67.3%) while the most common side effect was local pain at the site of injection (89.4%) and tiredness (76.7%). Females were significantly more being associated with having COVID-19 vaccine side effects, while complained about fever was significantly higher in the AstraZeneca vaccine (p<0.001).Conclusions:Our findings were consistent with literatures, our study finds local pain at the site of injection, tiredness, muscle pain, headache and fever as the most common side effects of the COVID-19 vaccine. The side effects of the COVID-19 vaccine had a greater impact on female respondents than their male counterparts.
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Introducción: Después de la COVID-19, surgieron luego de muchas investigaciones un suministro de vacunas aprobadas a nivel mundial, dichas vacunas deben conferir una protección eficaz por un tiempo prolongado, poseer un buen perfil de seguridad, ser asequible y ser fácilmente accesible para todos, un reto difícil de conseguir por el tiempo y las características del virus. Objetivo: determinar la concentración de anticuerpos neutralizantes (A. N.) post vacunación en una población de trabajadores del Banco de Sangre Material y métodos: Se realizó un estudio prospectivo, descriptivo, transversal, tomando como población de estudio a todo el personal del Banco de Sangre, varones y mujeres con un rango de edad entre 26 y 72 años, se evaluó el aumento de A. N. después de inoculada la segunda dosis de Sinopharm en fecha 19/05/21, luego se midió la cantidad de anticuerpos generados en fecha 20/10/21 previo a la tercera dosis de refuerzo de Astrazeneca, evaluando nuevamente a los 35 días luego de la tercera dosis 02/12/2021 para finalmente evaluar estos niveles en fecha 26/01/2022. La técnica utilizada fue (ELISA) de la marca EUROIMMUN Anti-SARS- CoV-2 S1 del tipo IgG. Resultados y conclusiones: Se puede verificar que la concentración de A. N. producidos por la vacunación desde Sinopharm y el refuerzo con Astrazeneca favoreció a que dichos anticuerpos se mantengan altos en el tiempo (322 días luego de la primera dosis) llegando a un 80% de la concentración máxima en la lectura final. Concluimos que con cada refuerzo de vacuna anti SARS-CoV-2 el título de A.N. sube de manera significativa, motivo por el cual consideramos importante en nuestro pais una cuarta dosis como método preventivo y de inmunidad.
Introduction: After COVID-19, emerged after much research a supply of vaccines approved worldwide, these vaccines must confer effective protection for a prolonged time, possess a good safety profile, be affordable and be easily accessible to all, a challenge difficult to achieve due to the time and characteristics of the virus. Objective: to determine the concentration of neutralizing antibodies post vaccination in a population of Blood Bank workers; Material and methods: A prospective, descriptive, observational, cross-sectional study was carried out, taking as study population all the Blood Bank personnel, among men and women with an age range between 26 and 72 years old. the increase of Neutralizing Antibodies was evaluated after inoculation of the second dose of Sinopharm on 05/19/21, then the amount of antibodies generated was measured on 10/20/21 prior to the third booster dose of Astrazeneca, evaluating again 35 days after the third dose on 12/02/2021 and finally evaluating these levels on 01/26/2022. The technique used was the EUROIMMUN Anti-SARS-CoV-2 S1 ELISA. Results and conclusions: It can be verified that the concentration of N.A. produced by vaccination from Sinopharm and the booster with Astrazeneca favored that these antibodies remained high over time (322 days after the first dose) reaching 80% of the maximum concentration in the final reading. We conclude that with each booster of anti SARS CoV 2 vaccine, the titer of N.A. rises significantly, which is why we consider important in our country a fourth dose as a preventive and immunity method.
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Antibodies, Neutralizing , SARS-CoV-2ABSTRACT
Resumen: Introducción: la vacunación contra SARS-CoV-2 es una herramienta imprescindible en el combate contra la pandemia de COVID-19. La vacuna desarrollada en colaboración entre la Universidad de Oxford y el laboratorio de productos farmacéuticos AstraZeneca (AZN) ha demostrado buena eficacia, pero ha habido reporte de trombosis venosas. Caso clínico: se presenta el caso de un paciente de 70 años, de sexo masculino, que 7 días después de la administración de la primera dosis de la vacuna AZN desarrolla trombosis venosa profunda de ambos miembros inferiores y tromboembolismo pulmonar. Coincide con trombocitopenia de 15.000/mm3, descenso del fibrinógeno y elevación de los D-dímeros. La situación clínica evoca el planteo de trombocitopenia trombótica inducida por vacuna (VITT). Se realizó tratamiento con inmunoglobulinas intravenosas, metilprednisolona y crioprecipitados. Requirió colocación de un filtro de la vena cava inferior. Una vez mejorado el recuento plaquetario se instaló tratamiento anticoagulante con apixaban. Evolucionó favorablemente. Discusión: se trata del primer reporte nacional de VITT. Las trombosis subsiguientes a la vacuna de AZN pueden verse con las vacunas que comparten la misma plataforma vacunal (adenovirus inactivado). Se han reportado casos fundamentalmente en menores de 60 años y en topografías inhabituales. Este caso tiene la particularidad de que se trata de un paciente mayor de 60 años, que ya había tenido COVID-19 cinco meses antes y que se presenta con una trombosis en sitios habituales. El manejo terapéutico se adecuó a las pautas internacionales. El caso deja un aprendizaje relevante tanto en lo que refiere al diagnóstico precoz como al manejo terapéutico.
Abstract: Introduction: vaccines against SARS-CoV-2 are an essential tool against the COVID-19 pandemic. The vaccine developed in collaboration with the University of Oxford and the AstraZeneca (AZN) laboratory has proved to be effective, although venous thrombosis have been reported. Clinical case: the study presents the case of a 70 year old male patient who, 7 days after receiving the first dose of the AZN vaccination develops deep vein thrombosis (DVT) in the lower extremities and pulmonary embolism. Simultaneously, thrombocytopenia is 15.000/mm3, fibrinogen levels drop D-dimer levels are elevated. The clinical situation leads to the suspicion of vaccine-associated immune thrombosis and thrombocytopenia (VITT). The patient was treated with intravenous immune globulin, methylprednisolone and cryoprecipitates, requiring a filter to be placed in the inferior vena cava. Once platelets count improved, anti-coagulation therapy including apixaban was commenced, evolution being good. Discussion: this is the first national report on VITT. Thrombosis after the AZN vaccination may be seen in other vaccines that use the same vaccine platform (inactive adenovirus). Cases have been reported mainly in patients younger than 60 years old and in unusual topographies. In particular, this case presents a male patient that is older than 60 years old, who had already been infected with COVID-19 five months before and who currently consults with thrombosis in regular sites. Therapeutic handling observed international guidelines. The case contributes relevant data both in terms of early diagnosis and therapeutic handling.
Resumo: Introdução: a vacinação contra a SARS-CoV-2 é uma ferramenta essencial na luta contra a pandemia de COVID-19. A vacina desenvolvida pela colaboração entre a Universidade de Oxford e o laboratório farmacêutico AstraZeneca (AZN) tem demonstrado boa eficácia, mas foram relatados casos de trombose venosa. Caso clínico: apresenta-se o caso de um paciente do sexo masculino, 70 anos, que 7 dias após a administração da primeira dose da vacina AZN desenvolveu trombose venosa profunda de ambos os membros inferiores e tromboembolismo pulmonar. Coincide com trombocitopenia de 15.000 / mm3, diminuição do fibrinogênio e aumento dos D-dímeros. A situação clínica lembra a trombocitopenia trombótica induzida por vacina (VITT). O tratamento foi realizado com imunoglobulinas intravenosas, metilprednisolona e crioprecipitados. Foi necessário colocar um filtro de veia cava inferior. Uma vez que a contagem de plaquetas melhorou, o tratamento anticoagulante com apixaban foi instalado. O paciente favoravelmente. Discussão: este é o primeiro relatório nacional de VITT. As tromboses subseqüentes à vacina AZN podem ser vistas com vacinas que compartilham a mesma plataforma (adenovírus inativado). Os casos foram relatados principalmente em pessoas com menos de 60 anos de idade e em topografias incomuns. Este caso tem a particularidade de se tratar de um paciente com mais de 60 anos, já com COVID-19 há cinco meses e que apresenta trombose em sítios comuns. O manejo terapêutico foi adaptado às diretrizes internacionais. O caso deixa um aprendizado relevante tanto no que diz respeito ao diagnóstico precoce quanto ao manejo terapêutico.