ABSTRACT
Heart transplant (HT) patients have a higher risk of severity after SARS-CoV-2 (COVID-19) infection than general population. Serological response to the initial vaccination regimen is lower. The clinical impact of the booster vaccination regimen in HT patients is unknown. The INMU_TC study analyze the immunogenicity after the COVID19 vaccination schedule and the clinical impact in patients with HT in Galicia. : To analyze the clinical events related to COVID-19 infection after receiving the booster dose in a population of patients with CT. Prospective observational study. HT recipients followed in the Galician Health System who had received a booster dose of COVID-19 vaccine according to the regional protocol were consecutively included. Serum anti-SARS-COV2 IgG concentration was determined between 14-30 days after the last vaccination dose. A value ≥33 BAU/ml was considered positive. COVID-19 clinical events were recorded. : We included 275 HT recipients, median age 64.5 years (IQR:55.1-70.7), and 21.8% female. Median time since HT was 7.4 years (IQR:2.5-14.9). Of these, 41 patients (14.9%) had COVID-19 after the booster dose, with an incidence rate of 300.6 per 1000 patient-year. Fourteen patients (34.2% of those infected) required hospital admission, and 4 died from the infection (9.8%). No significant differences were found between infected and non-infected patients after the third dose, except for renal function, more deteriorated in infected patients (creatinine 1.8±1.6 vs 1.4±0.8;p=0.008) and treatment with RAASi (12(29.3%) vs 123(52.6%);p=0.005). There were no significant differences in immunosuppression. A higher percentage of patients with infection, admission, and death had a negative serologic test. Serum concentration of antiSARSCoV2 IgG was lower in infected patients (735.8±895.0 vs 1318.1±847.9;p<0.001) and in patients requiring admission (266.9±581.8 vs 1282±862.2;p<0.001). Patients admitted to ICU and those who died had undetectable titers (<4.81 BAU/ml). HT patients with COVID-19 after the booster vaccine dose had lower serum concentration of anti-SARS-COV2 IgG, being even lower in those who presented a more unfavorable evolution. These data could suggest the importance of monitoring the response to vaccination in these patients in order to evaluate other therapeutic options. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
Since the start of the pandemic, over 400 million COVID-19 swab tests have been conducted in the UK with a non-trivial number associated with skull base injury. Given the continuing use of nasopharyngeal swabs, further cases of swab-associated skull base injury are anticipated. We describe a 54-year-old woman presenting with persistent colourless nasal discharge for 2 weeks following a traumatic COVID-19 nasopharyngeal swab. A ß2-transferrin test confirmed cerebrospinal fluid (CSF) rhinorrhoea and a high-resolution sinus computed tomography (CT) scan demonstrated a cribriform plate defect. Magnetic resonance imaging showed radiological features of idiopathic intracranial hypertension (IIH): a Yuh grade V empty sella and thinned anterior skull base. Twenty-four hour intracranial pressure (ICP) monitoring confirmed raised pressures, prompting insertion of a ventriculoperitoneal shunt. The patient underwent CT cisternography and endoscopic transnasal repair of the skull base defect using a fluorescein adjuvant, without complications. A systematic search was performed to identify cases of COVID-19 swab-related injury. Eight cases were obtained, of which three presented with a history of IIH. Two cases were complicated by meningitis and were managed conservatively, whereas six required endoscopic skull base repair and one had a ventriculoperitoneal shunt inserted. A low threshold for high-resolution CT scanning is suggested for patients presenting with rhinorrhoea following a nasopharyngeal swab. The literature review suggests an underlying association between IIH, CSF rhinorrhoea and swab-related skull base injury. We highlight a comprehensive management pathway for these patients, including high-resolution CT with cisternography, ICP monitoring, shunt and fluorescein-based endoscopic repair to achieve the best standard of care.