Reinforcement of the Standard Therapy with Two Infusions of Convalescent Plasma for Patients with COVID-19: A Randomized Clinical Trial.

BACKGROUND: The aim was to evaluate the reinforcement of the standard therapy with hyperimmune plasma (HP) in Coronavirus-19 disease (COVID-19) patients. METHODS: Open-label, multicenter, randomized clinical trial performed in three hospitals in the Balearic Islands. Non-severe COVID-19 hospitalized patients with clinical time evolution equal to/less than 7 days were included, and randomized in: plasma group (PG) (n = 37), receiving 600 mL divided into two doses from convalescent plasma donor, administered on days 1 and 2 after the enrollment; and control group (CG) (n = 17). Primary outcome was the time for clinical improvement within 21 days, defined as patient achievement of categories 8, 7, and 6 in the Adaptive COVID-19 Treatment Trial scale (ACTT). The trial was terminated early due to the impossibility of recruitment due to the pandemic. RESULTS: PG presented better scores on the ACTT scale at 7 days after HP infusion, whereas CG was needed 14 days to achieve similar results. The plasma infusion was safe. CONCLUSIONS: Despite the tendency observed in the plasma group to achieve slightly earlier better physical condition compared with the standard treatment alone. The administration of HP has been shown to be a safe therapy. No robust evidence was found to affirm a therapeutic effect of the early administration of two infusions of HP for non-severe COVID-19 infected patients. The interpretation is limited by the early termination of the trial, which resulted in a small sample size.

Seroprevalence of SARS-CoV-2 antibody among healthcare workers in a university hospital in Mallorca, Spain, during the first wave of the COVID-19 pandemic.

OBJECTIVE: To estimate the SARS-CoV-2 antibody seroprevalence in healthcare workers (HCWs) at a university hospital in Mallorca, Spain. METHODS: All HCWs received an e-mail inviting them to take part in the study. Participants had a nasopharyngeal swab test performed for reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) and serological tests to detect SARS-CoV-2 antibodies (primary study). Additionally, they were invited to complete a questionnaire on their exposure to COVID-19 individuals and their COVID-19-related symptoms (secondary study). Prevalence of antibodies (IgG, IgM, or both) and 95% confidence intervals (CIs) were calculated. RESULTS: Seventy-nine percent of the hospital's HCWs (N = 2210) took part in the primary study. Antibodies were detected in 61 participants, a prevalence of 2.8% (95% CI: 2.5-3.1). The prevalence was slightly higher in nurses (3.4%), registrars (3.9%), and wardens (3.4%). Thirty-nine percent of the primary study participants completed the secondary study questionnaire. Those with positive antibody test results had closer contact with COVID-19 individuals (60% vs. 92%; p < 0.001). CONCLUSION: After the first wave of the COVID-19 pandemic in Spain, the seroprevalence of SARS-CoV-2 antibodies in our university hospital HCWs was around 2.8%, which is slightly higher than the seroprevalence in the general population in our region. We believe it would be advisable to perform additional seroprevalence studies during the second wave of the epidemic.

Polyserositis: a diagnostic challenge.

BACKGROUND: Polyserositis (PS) is the inflammation, with effusion, of different serous membranes. It has been associated with different aetiologies, but the aetiology of PS remains unknown in a high percentage of patients. AIMS: The general objective of this retrospective study was to analyse the aetiology of PS cases seen at Son Llàtzer Hospital in an 11-year period. Other objectives were to determine the epidemiological, clinical and analytical characteristics of these patients. METHODS: An observational, descriptive and retrospective study to analyse the aetiology of PS cases seen at Son Llàtzer Hospital. The inflammation of two or more serous membranes confirmed by an imaging test was required and at least one of the serous fluid should be an exudate. RESULTS: A total of 92 patients was included in the study. The most common diagnosis was neoplasm (nearly one-third of cases) followed by infectious and autoimmune diseases. PS aetiology was unknown in more than one-third. Pleura and pericardium were the most common sites of serosal involvement (83%). Antinuclear antibodies' positivity in serum and increased levels of adenosine deaminase in pleural effusion were significantly associated with a final diagnosis of autoimmune disease. Increased pleural lactate dehydrogenase levels were significantly associated with a final diagnosis of neoplasm. In 9 of 14 patients with a previous cancer, PS represented a recurrence of their cancer. Cases of unknown aetiology presented most frequently as pleural and pericardial involvement, and the majority resolved. In very few patients, an infectious aetiology could be proven. CONCLUSION: PS is a frequent clinical entity that is associated with different diseases and its diagnosis could be challenging, with a high rate of unknown aetiologies.

IGRA testing in patients with immune-mediated inflammatory diseases: which factors influence the results?

Diagnosis of latent tuberculosis infection in patients with immune-mediated inflammatory chronic diseases (IMIDs) can be challenged as diagnostic test reliability could be impaired by immunosuppression. We retrospectively analyzed the Quantiferon Gold-Test in-Tube (QFT-G-IT) results of all patients with IMIDs seen at the Department of Internal Medicine of Son Llàtzer Hospital, Palma de Mallorca (Spain), looking for the factors related to QFT-G-IT indeterminate results. During the study period (2008-2015), 520 patients met the inclusion criteria. Factors associated with indeterminate QFT-G-IT results in a univariate analysis were inflammatory bowel disease, disease activity, lymphopenia, and medium-to-high doses of corticosteroids. In a subsequent multivariate analysis, only lymphopenia (defined as < 1500 cells) was associated with indeterminate QFT-G-IT results. Lymphocyte count was the only factor independently associated with an increased number of indeterminate QFT-G-IT results in patients with different autoimmune diseases. Others factors such as the use of medium-to-high doses of corticosteroids should be considered before testing with QFT-G-IT.

Role of QuantiFERON(®)-TB Gold In-Tube in tuberculosis contact investigation: experience in a tuberculosis unit.

BACKGROUND: Interferon-γ release assays (IGRAs) are increasingly used for the diagnosis of latent tuberculosis infection (LTBI). Because of the lack of a gold standard for the diagnosis of LTBI, IGRAs are compared to the tuberculin skin test (TST) and yield conflicting results. We assessed the usefulness of an IGRA test, QuantiFERON(®)-TB Gold In-Tube (QFT-G-IT), for diagnosing LTBI compared with TST in the setting of a contact screening study. METHODS: A prospective comparison between the QFT-G-IT and the TST in TB contact subjects in a low TB burden area was conducted sequentially between January 2006 and December 2012. RESULTS: A moderate concordance between the two tests (κ = 0.44 for TST cut-off of 5 mm and κ = 0.56 for TST cut-off of 15 mm) was found. A better agreement was shown in younger contacts and in non-vaccinated contacts when using a TST of 15 mm. Independent risk factors for a TST(+)/QFT-G-IT(-) discordance were history of BCG vaccination and age between 31 and 59 years. Discordance was also more frequent using a TST cut-off value of 5 mm. QFT-G-IT(+)/TST(-) was infrequent and was found in older contacts. CONCLUSIONS: Based on our data, we cannot recommend the use of QFT-G-IT as the only test to rule out LTBI, especially in older patients.

Fiebre Q aguda sintomática: 87 casos en un área de Mallorca / Symptomatic acute Q fever: A series of 87 cases in an area of Mallorca

INTRODUCCIÓN: La fiebre Q (FQ) es una zoonosis de distribución mundial causada por Coxiella burnetii ( C . burnetii). La infección aguda puede cursar asintomática o producir síndrome febril, hepatitis o neumonía y la infección crónica se suele presentar como endocarditis. Los datos sobre FQ en las islas Baleares son escasos. Métodos Se presenta una serie de casos con información retrospectiva desde marzo de 2003 a diciembre de 2011 de los casos con serología y cuadro clínico compatible con FQ aguda en el Hospital Son Llàtzer de Palma de Mallorca. Se consideró FQ aguda cuando, en un paciente con sospecha clínica, el título de IgM en fase II fue positivo (≥ 1/40), con IgG positiva (≥ 1/80) o cuando existió en fase de convalecencia seroconversión del título de IgG a C. burnetii. Se diagnosticaron 87 casos de FQ aguda. La mediana de edad fue de 50 años (rango intercuartílico: 21-89) y 69 (79,3%) eran hombres. La fiebre y la cefalea fueron los síntomas más frecuentes. El diagnóstico fue de: neumonía en 39 (44,8%) pacientes, síndrome febril aislado en 21 (24,1%), hepatitis aguda en 19 (21,8%) y el resto otras entidades. En 52 casos (59,8%) existió alguna elevación de enzimas hepáticas. El tratamiento con doxiciclina (solo o en combinación) fue prescrito en 29 (33,4%). El seguimiento se realizó en 57 (65,5%) de los pacientes. La evolución fue favorable en la mayoría, solamente un paciente con FQ aguda presentó durante el seguimiento títulos compatibles con FQ crónica. CONCLUSIÓN: La FQ aguda sintomática es frecuente en nuestro medio. La afectación pulmonar fue predominante. Solo un tercio de los pacientes fueron tratados con doxiciclina. No hubo ningún seguimiento tras la primera determinación serológica en 30 pacientes (34,5%). No se evidenciaron complicaciones significativas en el curso de la infección

INTRODUCTION: Q fever is a widespread zoonotic infection caused by Coxiella burnetii (C. burnetii). Acuteinfection varies from a self-limited flu-like illness to pneumonia or hepatitis. METHODS: A retrospective case study from March 2003 to December 2011 was conducted in the Hospital Son Llàtzer in Palma de Mallorca. Acute Q-fever was diagnosed in a patient with clinical suspicion and IgMin phase II positive (≥ 1/40), with a positive IgG (≥1/80), or when IgG seroconversion was observed during convalescence. A total of 87 cases of acute Q fever were diagnosed. The median age was 50 years (range21-89), and 69 (79.3%) were male. Fever and headache were the most common symptoms. Pneumonia was diagnosed in 39 (44.8%) patients, febrile episode in 21 (24.1%), and acute hepatitis in 23 (25.6%).Increased serum transaminases were observed in 19 (21.8%). Doxycycline was prescribed in 29 cases(33.4%). There were 30 (34.5%) patients lost to follow up after hospital discharge. A favorable outcome was observed in all other cases. Only one new case progressed to chronic Q fever. RESULTS: A total of 87 cases of acute Q fever were diagnosed. The median age was 50 years (range 21-89), and 69 (79.3%) were male. Fever and headache were the most common symptoms. Pneumonia was diagnosed in 39 (44.8%) patients, febrile episode in 21 (24.1%), and acute hepatitis in 23 (25.6%). Increased serum transaminases were observed in 19 (21.8%). Doxycycline was prescribed in 29 cases (33.4%). There were 30 (34.5%) patients lost to follow up after hospital discharge. A favorable outcome was observed in all other cases. Only one new case progressed to chronic Q fever. CONCLUSION: Acute Q fever acute is common our environment. Pneumonia was the most common clinical presentation. Even although doxycycline was prescribed in a small number of patients, a favorable outcome was observed in all cases

[Symptomatic acute Q fever: a series of 87 cases in an area of Mallorca]. / Fiebre Q aguda sintomática: 87 casos en un área de Mallorca.

INTRODUCTION: Q fever is a widespread zoonotic infection caused by Coxiella burnetii (C. burnetii). Acute infection varies from a self-limited flu-like illness to pneumonia or hepatitis. METHODS: A retrospective case study from March 2003 to December 2011 was conducted in the Hospital Son Llàtzer in Palma de Mallorca. Acute Q-fever was diagnosed in a patient with clinical suspicion and IgM in phase ii positive (≥ 1/40), with a positive IgG (≥1/80), or when IgG seroconversion was observed during convalescence. A total of 87 cases of acute Q fever were diagnosed. The median age was 50 years (range 21-89), and 69 (79.3%) were male. Fever and headache were the most common symptoms. Pneumonia was diagnosed in 39 (44.8%) patients, febrile episode in 21 (24.1%), and acute hepatitis in 23 (25.6%). Increased serum transaminases were observed in 19 (21.8%). Doxycycline was prescribed in 29 cases (33.4%). There were 30 (34.5%) patients lost to follow up after hospital discharge. A favorable outcome was observed in all other cases. Only one new case progressed to chronic Q fever. RESULTS: A total of 87 cases of acute Q fever were diagnosed. The median age was 50 years (range 21-89), and 69 (79.3%) were male. Fever and headache were the most common symptoms. Pneumonia was diagnosed in 39 (44.8%) patients, febrile episode in 21 (24.1%), and acute hepatitis in 23 (25.6%). Increased serum transaminases were observed in 19 (21.8%). Doxycycline was prescribed in 29 cases (33.4%). There were 30 (34.5%) patients lost to follow up after hospital discharge. A favorable outcome was observed in all other cases. Only one new case progressed to chronic Q fever. CONCLUSION: Acute Q fever acute is common our environment. Pneumonia was the most common clinical presentation. Even although doxycycline was prescribed in a small number of patients, a favorable outcome was observed in all cases.

Genetic diversity of clinical Pseudomonas aeruginosa isolates in a public hospital in Spain.

BACKGROUND: Pseudomonas aeruginosa is an important nosocomial pathogen that exhibits multiple resistances to antibiotics with increasing frequency, making patient treatment more difficult. The aim of the study is to ascertain the population structure of this clinical pathogen in the Hospital Son Llàtzer, Spain. RESULTS: A significant set (56) of randomly selected clinical P. aeruginosa isolates, including multidrug and non-multidrug resistant isolates, were assigned to sequence types (STs) and compared them with their antibiotic susceptibility profile classified as follows: extensively drug resistant (XDR), multidrug resistant (MDR) and non-multidrug resistant (non-MDR). The genetic diversity was assessed by applying the multilocus sequence typing (MLST) scheme developed by Curran and collaborators, and by the phylogenetic analysis of a concatenated tree. The analysis of seven loci, acsA, aroE, guaA, mutL, nuoD, ppsA and trpE, demonstrated that the prevalent STs were ST-175, ST-235 and ST-253. The majority of the XDR and MDR isolates were included in ST-175 and ST-235. ST-253 is the third in frequency and included non-MDR isolates. The 26 singleton sequence types corresponded mainly to non-MDR isolates. Twenty-two isolates corresponded to new sequence types (not previously defined) of which 12 isolates were non-MDR and 10 isolates were MDR or XDR. CONCLUSIONS: The population structure of clinical P. aeruginosa present in our hospital indicates the coexistence of nonresistant and resistant isolates with the same sequence type. The multiresistant isolates studied are grouped in the prevalent sequence types found in other Spanish hospitals and at the international level, and the susceptible isolates correspond mainly to singleton sequence types.

Use of Quantiferon-TB-Gold in Tube ® test for detecting latent tuberculosis in patients considered as candidates for anti-TNF therapy in routine clinical practice

Background/methods Quantiferon-TB-Gold in Tube® test (QFT-G-IT) may have advantages if combined with TST when screening for Latent Tuberculosis Infection (LTBI) prior to initiating anti-TNF therapy in an area of intermediate tuberculosis incidence such as Spain. In a small-scale prospective study, we evaluate the use of QFT-G-IT in combination with the screening recommended in Spain (Tuberculin-Skin Test, TST retest, clinical data, and Chest X-Ray (CXR)) for LTBI in patients considered as candidates for anti-TNF a treatment. Results From June 2008 to October 2010, 123 patients from a 300-bed hospital in Palma de Mallorca (Spain) were included in the study. The majority of patients were under immunosuppressive therapy. A positive TST and TST booster were found in 22 and 17 patients, respectively. Thus 39 (31.7%) of the 123 patients had a positive TST. QFT-G-IT was positive in 16 patients (13.6%), indeterminate in 4 (3.2%), and negative in 103 (83.7%). One of the two tests was positive and LTBI was diagnosed in 34.1% of patients. The agreement between TST and QFT-G-IT among vaccinated patients was low and not statistically significant (Kappa=0.15) and was almost perfect among non-BCG vaccinated patients (K=0.81). TST positive responses were significantly related to BCG-vaccination (p<0.05) and QFT-G-IT positive response rates were related to older age (p<0.05).Conclusion QFT-G-IT may have advantages when combined with TST in immune suppressed patients especially in older patients with a negative TST; in BCG vaccinated patients with a positive TST, QFT-G-IT could avoid unnecessary treatments and toxicities related to a false-positive TST result (AU)

Introducción/método Quantiferon-TB-Gold in Tube® (QFT-G-IT) en combinación con la Prueba de la tuberculina (PT) puede ser útil para el diagnóstico de infección tuberculosa latente (ITL) en pacientes candidatos a tratamiento con anti-TNF en un país de incidencia intermedia de tuberculosis como España. Se evalúa en un estudio piloto prospectivo QFT-G-IT en combinación con las pruebas recomendadas en España (PT, PT-booster, datos clínicos y radiografía de tórax) para el diagnóstico de ITL en pacientes con enfermedades inmunológicas candidatos a tratamiento con fármacos anti-TNFa. Resultados Se incluyeron 123 pacientes desde junio de 2008 a octubre de 2010 en el hospital Son Llàtzer de Palma de Mallorca. La PT inicial y la PT booster fueron positivas en 22 y 17 pacientes, respectivamente, el 31,6% tuvo una PT positiva, QFT-G-IT fue positivo en 16 (13,6%), indeterminado en 4 (3,2%) y negativo en 103 pacientes (83,7%). En 34,1% al menos uno de los dos tests fue positivo y se diagnosticó ITL. La concordancia entre PT y QFT-G-IT fue baja en pacientes vacunados con BCG (Kappa=0,15) y excelente en no vacunados con BCG (K=0,81). La positividad de la PT se relacionó con la vacunación con BCG (p<0.05) y la de QFT-G-IT con una mayor edad (p<0.05).Conclusión El uso de QFT-G-IT puede optimizar el diagnóstico de ITL en estos pacientes especialmente en los más añosos con una PT negativa. En pacientes vacunados de BCG con una PT positiva, QFT-G-IT podría evitar tratamientos innecesarios de ITL relacionados con un falso positivo (AU)

Use of Quantiferon-TB-Gold in Tube(®) test for detecting latent tuberculosis in patients considered as candidates for anti-TNF therapy in routine clinical practice.

BACKGROUND/METHODS: Quantiferon-TB-Gold in Tube(®) test (QFT-G-IT) may have advantages if combined with TST when screening for Latent Tuberculosis Infection (LTBI) prior to initiating anti-TNF therapy in an area of intermediate tuberculosis incidence such as Spain. In a small-scale prospective study, we evaluate the use of QFT-G-IT in combination with the screening recommended in Spain (Tuberculin-Skin Test, TST retest, clinical data, and Chest X-Ray (CXR)) for LTBI in patients considered as candidates for anti-TNFα treatment. RESULTS: From June 2008 to October 2010, 123 patients from a 300-bed hospital in Palma de Mallorca (Spain) were included in the study. The majority of patients were under immunosuppressive therapy. A positive TST and TST booster were found in 22 and 17 patients, respectively. Thus 39 (31.7%) of the 123 patients had a positive TST. QFT-G-IT was positive in 16 patients (13.6%), indeterminate in 4 (3.2%), and negative in 103 (83.7%). One of the two tests was positive and LTBI was diagnosed in 34.1% of patients. The agreement between TST and QFT-G-IT among vaccinated patients was low and not statistically significant (Kappa=0.15) and was almost perfect among non-BCG vaccinated patients (K=0.81). TST positive responses were significantly related to BCG-vaccination (p<0.05) and QFT-G-IT positive response rates were related to older age (p<0.05). CONCLUSION: QFT-G-IT may have advantages when combined with TST in immunosuppressed patients especially in older patients with a negative TST; in BCG vaccinated patients with a positive TST, QFT-G-IT could avoid unnecessary treatments and toxicities related to a false-positive TST result.

Valor de QuantiFERON-TB Gold Test in Tube en el diagnóstico de tuberculosis pulmonar y extrapulmonar / Quantiferon-TB-gold in tube test in the diagnosis of pulmonary and extra-pulmonary tuberculosis

Introducción Los test de detección in vitro de Interferón-gamma frente a Mycobacterium tuberculosis (MTB) podrían ser una herramienta útil en el diagnóstico de enfermedad tuberculosa activa. Métodos Se realiza el test QuantiFERON-TB-Gold test in Tube (QFG-IT) en la sangre de 118 pacientes con tuberculosis pulmonar activa y se compara el resultado con la prueba de tuberculina. Resultados El estudio de QFG-IT fue positivo en 94 casos (79,7%), negativo en 17 (14,4%) e indeterminado en 7 (5,9%). QFG-IT negativo o indeterminado fue más frecuente en pacientes más ancianos (p=0,017) y en los casos de baciloscopia (..) (AU)

Introduction: The Interferon-gamma in vitro detection tests could be a useful tool in the diagnosis of active tuberculosis compared to Mycobacterium tuberculosis (MTB). Methods: The QuantiFERON-TB-Gold in Tube (QFG-IT) test was performed on the blood of 118 patients with active tuberculosis and the results compared with the tuberculin test. Results: The QFG-IT test was positive in (..) (AU)

[Quantiferon-TB Gold In-Tube test in the diagnosis of pulmonary and extra-pulmonary tuberculosis]. / Valor de QuantiFERON-TB Gold Test in Tube en el diagnóstico de tuberculosis pulmonar y extrapulmonar.

INTRODUCTION: The Interferon-γ in vitro detection tests could be a useful tool in the diagnosis of active tuberculosis compared to Mycobacterium tuberculosis (MTB). METHODS: The QuantiFERON-TB-Gold in Tube (QFG-IT) test was performed on the blood of 118 patients with active tuberculosis and the results compared with the tuberculin test. RESULTS: The QFG-IT test was positive in 94 cases (79.7%), negative in 17 (14.4%) and indeterminate in 7 (5.9%). A negative or indeterminate QFG-IT test was more common in older patients (P=0.017) and in cases with negative smear tests (P=0.041). The kappa agreement between the tuberculin and QFG-IT tests was 74.5% with a kappa value of 0.45 (SE:0.136). Thirteen of the patients studied were infected with HIV and the tuberculin was positive in 5 of the 12 cases (38.5%) in whom it was performed, with the QFG-IT being positive in 9/13 (69.2%). CONCLUSIONS: The QFG-IT test may be a useful complimentary tool to the tuberculin test in the diagnosis of tuberculosis.