Impact of SARS-CoV-2 pandemic among health care workers in a secondary teaching hospital in Spain.

BACKGROUND: The COVID-19 pandemic has posed a huge challenge to healthcare systems and their personnel worldwide. The study of the impact of SARS-CoV-2 infection among healthcare workers (HCW), through prevalence studies, will let us know viral expansion, individuals at most risk and the most exposed areas in healthcare organizations. The aim of this study is to gauge the impact of SARS-CoV-2 pandemic in our hospital workforce and identify groups and areas at increased risk. METHODS AND FINDINGS: This is a cross-sectional and incidence study carried out on healthcare workers based on molecular and serological diagnosis of SARS-CoV-2 infection. Of the 3013 HCW invited to participate, 2439 (80.9%) were recruited, including 674 (22.4%) who had previously consulted at the Occupational Health Service (OHS) for confirmed exposure and/or presenting symptoms suggestive of COVID-19. A total of 411 (16.9%) and 264 (10.8%) healthcare workers were SARS-CoV-2 IgG and rRT-PCR positive, respectively. The cumulative prevalence considering all studies (IgG positive HCW and/or rRT-PCR positive detection) was 485 (19.9%). SARS-CoV-2 IgG-positive patients in whom the virus was not detected were 221 (9.1%); up to 151 of them (68.3%) did not report any compatible symptoms nor consult at the OHS for this reason. Men became more infected than women (25% vs 18.5%, p = 0.0009), including when data were also classified by age. COVID-19 cumulative prevalence among the HCW assigned to medical departments was higher (25.2%) than others, as well as among medical staff (25.4%) compared with other professional categories (p<0.01). CONCLUSIONS: The global impact of the COVID-19 pandemic on HCW of our centre has been 19.9%. Doctors and medical services personnel have had the highest prevalence of SARS-CoV-2 infection, but many of them have not presented compatible symptoms. This emphasizes the performance of continuous surveillance methods of the most exposed health personnel and not only based on the appearance of symptoms.

Acquired Pelger-Huët anomaly in a patient treated with valganciclovir.

A follow-up blood count was performed on a 74-year-old woman diagnosed with colitis due to cytomegalovirus and under treatment with valganciclovir. The automated complete blood count revealed an abnormal white blood cells (WBC) scattergram together with WBC alert flags. The peripheral blood smear showed neutrophils with markedly hyposegmented nuclei or bilobed nuclei and very condensed chromatin or clumping chromatin all consistent with Pelger-Huët anomaly (PHA). We checked previous blood counts, ruling out an inherited PHA. We assessed the haematological, infectious and iatrogenic aetiologies for an acquired PHA. Once the valganciclovir treatment was completed and the drug was withdrawn, without changing the rest of the treatment, the morphological abnormalities of neutrophils were completely resolved. We conclude therefore that the acquired PHA presented by our patient is probably related to valganciclovir treatment.

Diagnostic model of visceral leishmaniasis based on bone marrow findings. Study of patients with clinical suspicion in which the parasite is not observed.

BACKGROUND: Visceral Leishmaniasis (VL) is a serious protozoal disease endemic in diverse areas, including the southern area of Madrid (Spain), where an outbreak was detected in 2009. The objective of this work is to analyze bone marrow alterations in VL patients and elaborate a diagnostic model with the aim to improve the early detection of this disease. The usual diagnostic methods, as the observation of the parasite on a bone marrow aspirate, have frequent false negatives, and the high sensitivity methods, as PCR and ELISA, are delayed or are not always available. METHODS: This observational study evaluated bone marrow parameters of adult patients with clinical suspicion of VL, in which a bone marrow aspiration was performed but Leishmania was not directly observed, during the period 2009-2014. The patients finally diagnosed of VL by other methods (VL group, n=41), and the patients in which the VL was not diagnosed (non-VL group, n=20) were compared. A multivariant model was elaborated and externally validated. RESULTS: The final multivariant model includes percentage of myeloid series, percentage of plasma cells and quantification of megakaryocytes in the bone marrow, with an area under the ROC curve of 0.87 (0.78-0.96). The model performed well in the external validation. CONCLUSION: In cases of VL suspicion and when the parasite is not observed in the bone marrow aspiration, the proposed model could be useful in discriminating between patients with and without VL, allowing to take a therapeutic decision while awaiting the definitive diagnosis.