Implementation of a Case Investigation and Contact Tracing Program at an Academic Medical Center in New York City.

PROBLEM: In the spring of 2020, New York City was an epicenter of COVID-19 infections, hospitalizations, and mortality. One of the hardest hit areas in New York City was central Brooklyn, where State University of New York (SUNY) Downstate is located. As the severity of the initial wave of the COVID-19 pandemic waned in New York City, SUNY Downstate Health Sciences University planned to institute COVID-19 surveillance on campus to limit its spread among employees and students. APPROACH: In collaboration with university leadership and students across schools, the SUNY Downstate Contact Tracing Corps was established in July 2020. Using guidance from the Centers for Disease Control and Prevention and the New York State Department of Health, protocols for case and contact investigations, including scripts, were developed. Students were recruited and trained in remote and confidential case and contact investigations. OUTCOMES: From August 1, 2020, to March 23, 2021, there were 185 COVID-19 cases referred to the contact tracing program; of these, 180 were successfully investigated and isolated (97%). Case investigations identified 111 Downstate close contacts; 105 were investigated and quarantined (94.5%). There were 122 exposure-only investigations referred to the program, and 121 were successfully investigated and quarantined (99%). NEXT STEPS: The SUNY Downstate Contact Tracing Corps transitioned to a core group of tracers in January 2021 and has been maintained at 4 to 6 tracers since that time. With the emergence of COVID-19 variants, the threat of new variants, and variable COVID-19 vaccination rates across Brooklyn, Downstate employees and students remain vulnerable to COVID-19 transmission. Given this, the SUNY Downstate Contact Tracing Corps will continue to conduct case and contact investigations.

Cocaine-induced vasculitis with cutaneous manifestation: A recurrent episode after 2 years.

Cocaine is a popular recreational drug in the United States, and up to 70% of the seized cocaine contains levamisole which is an antihelminthic that can cause cutaneous vasculitis with necrosis and positive antineutrophil cytoplasmic antibodies (ANCAs). Here, we report a unique case of recurrent cocaine-induced vasculitis in a patient who smokes cocaine for more than 20 years. A 38-year-old woman complained of painful erythematous rash in her right arm and right thigh which appeared some hours after smoking cocaine. Physical examination revealed tender, erythematous base, retiform purpura with necrosis and bullae. Serological test showed high atypical perinuclear ANCA titer of 1:320 and antimyeloperoxidase antibody level of 20.4 U/mL. Cocaine-induced vasculitis should be one of the differential diagnoses in cocaine abusers who present with painful rash and areas of necrosis. Early diagnosis is important since it is an emerging public health concern.

Cocaine-induced delayed recurrent vasculitis: a 4-year follow-up.

BACKGROUND: Cocaine is a highly abused substance in United States with almost 70 % of cocaine adulterated with levamisole. It is known to cause vasculitis involving multiple organs due to its direct toxic effect and by the contribution of levamisole or a combined effect of both. CASE REPORT: A 51-year-old woman complained of painful erythematous rash in her hands and lower extremities that started few hours after smoking cocaine and progressed to blistering dark lesions in her lower extremities. She denied any other systemic complaints. Although she has been smoking cocaine for more than 35 years, these skin eruptions started only 4 years ago. Examination revealed tender retiform purpura in the hand and tender retiform purpura with hemorrhagic bulla in the legs. Initially, she had only a significantly positive atypical p-ANCA and later developed combined positivity of both Myeloperoxidase (MPO) and Anti-proteinase-3(PR3) antibodies with a p-ANCA pattern on immunofluorescence. We report a unique case of cocaine (likely contaminated with levamisole)-induced delayed recurrent vasculitis with varying vasculitic antibodies over the years. CONCLUSIONS: This case highlights the fact that patients can develop cocaine-related vasculitis after many years of uneventful abuse. Cocaine, with its adulterant levamisole, has the propensity to trigger diverse immunological reactions, which is evident by the varying antibody profile seen in the same patient over time.