J.M. Díaz García

In 1997, an outbreak of human tularemia associated with hare-hunting in central Spain affected 585 patients. We describe the identification of Francisella tularensis biovar palaearctica in a second outbreak of ulceroglandular tularemia associated with crayfish (Procambarus clarkii) fishing in a contaminated freshwater stream distant from the hare-associated outbreak. The second outbreak occurred 1 year after the first.

In 1997, an outbreak of human tularemia associated with hare-hunting in central Spain affected 585 patients. We describe the identification of Francisella tularensis biovar palaearctica in a second outbreak of ulceroglandular tularemia associated with crayfish (Procambarus clarkii) fishing in a contaminated freshwater stream distant from the hare-associated outbreak. The second outbreak occurred 1 year after the first.

<bold>Introduction:</bold> SARS-CoV-2 (COVID-19) infection results in endothelial dysfunction favored by cytokines and hypoxemia, leading to a state of hypercoagulability with microvascular damage and thromboembolic complications. There is little data available so far in the incidence of pulmonary embolism (PE), as well as its clinical and radiological features. <bold>Objectives:</bold> Describe the incidence of PE and characterize the clinical and radiological findings of a cohort of patients hospitalized by COVID-19. <bold>Methods:</bold> A retrospective, observational study was performed at a single centre, evaluating patients diagnosed with COVID-19, who were diagnosed with PE through computed tomography pulmonary angiography (CTPA) from 11 March to 20 April,2020. <bold>Results:</bold> Overall, 1268 patients were registered and 185 CTPA was performed(15%). PE was confirmed in 40 cases (21.6%) with an incidence of 3.2%. Median age was 66 years(IQR: 58-75), and 60% were men. The Charlson Comorbidity Index was calculated which was 2,5(1-5). Thromboprophylaxis was performed at 26(65%). The value of D-dimer testing(DD) at admission was 2 (0.9-8.1) and the diagnosis of 6.3(3-12.5) mg/L respectively; p<0.007. They had intermediate-low risk of 70% (PESI), with unilateral thrombus at 40% and main artery involvement in 12,5%. There was no association between thrombotic load and severity of radiological involvement by COVID. <bold>Conclusions:</bold> The incidence of PE in COVID during admission was 3.2% and it does not appear very high, being mostly intermediate-low risk. Monitoring of DD levels should be considered for early performing of diagnostic ACTP.