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CASE REPORT
Year : 2001  |  Volume : 19  |  Issue : 2  |  Page : 33-34
 

First documented transmission of HIV infection in a health care worker in West Bengal


Department of Virology, Calcutta School of Tropical Medicine, C.R. Avenue, Kolkata, India

Correspondence Address:
Department of Virology, Calcutta School of Tropical Medicine, C.R. Avenue, Kolkata, India

 ~ Abstract 

This is a case report of HIV infection in a nursing staff in Kolkata. She got the infection through needle stick injury while transferring blood from a syringe to specimen collection tube without taking any precaution and no post-exposure prophylaxis (PEP) was advised. This is the first documentation of transmission of HIV infection in a worker engaged in health care delivery system in Bengal.

How to cite this article:
Neogi D K. First documented transmission of HIV infection in a health care worker in West Bengal. Indian J Med Microbiol 2001;19:33-4


How to cite this URL:
Neogi D K. First documented transmission of HIV infection in a health care worker in West Bengal. Indian J Med Microbiol [serial online] 2001 [cited 2019 Jun 24];19:33-4. Available from: http://www.ijmm.org/text.asp?2001/19/2/33/6932


Health care workers (HCWs) are exposed to the increasing risk of acquiring Human Immunodeficiency Virus (HIV) infection with the progression of HIV epidemic throughout the world. The risk is more to the persons like doctors, nurses, laboratory technicians, those who are engaged with invasive procedures with known/unknown patients of HIV infection/AIDS. However, needle stick injury is the most common cause for which the HCWs seek advice from the author. Recapping of the needle is the most frequent cause of exposure of HIV (86%).[1] The risk of transmission of HIV through infected blood by percutaneous route is 0.3% (95% Confidence Interval=0.2-0.5%) [2] and by mucosal route is 0.09% (95% C.I.=0.006%-0.5%).[3] As of June, 1997, there were 52 U.S. HCWs with documented HIV seroconversion of which 47 were exposed to HIV infected blood. Further, 45 exposures were percutaneous, 5 were mucocutaneous, one with both and another was exposed to concentrated virus.[4] Ravikumar et al described the first report on HIV infection in a HCW in India.[5]

 ~ Case Report Top

One male patient was under treatment at a nursing home in north Kolkata during September, 1998. While transferring his blood from syringe to the specimen collection tube a female nurse aged 28 years got needle stick injury on her left palm. She did not use gloves, the penetration was deep and her right thumb was on the piston of the syringe. There was frank bleeding from the injury for which she was provided first aid. The patient's blood was sent for detection of HIV antibody and it was found positive. But the nurse came in the last week of October, 1998 for HIV test as advised by doctor of the said nursing home. She was found HIV seronegative by Immunocomb and ELISA test, but on subsequent test in the 2nd week of January, 1999 she was found seropositive by Immunocomb and ELISA and confirmed by Western Blot test. She was unmarried and had no risk behaviour (not exposed to any other risk).

 ~ Discussion Top

HCWs are exposed to the risk of HIV infection and the number of accidental exposures may increase in future if the universal precautions are not followed. HIV infection in this particular case could be averted if the standard protocol had been followed after a severe needle stick injury with exposure code 3.[4] This particular case was supposed to take extended regimen of antiretroviral post exposure prophylaxis (PEP), but she was not even properly advised. For PEP among workers of health care delivery system the first step is to judge the exposure code and the baseline testing of the exposed HCW. Simultaneously arrangement should be made to know the HIV status code of the patient (it may not be possible in every case). The authorities must be informed about the incident immediately, who should also react sympathetically and promptly for considering PEP, so that the PEP may be started within 4 hours after exposure and continued for 4 weeks.[6] In a country like India where Zidovudine resistant strains are likely to be low, even monotherapy may be sufficient for PEP.[6] However ZDV and 3TC (Zidovudine & Lamivudine) offer greater antiretroviral activity and are also effective against ZDV resistant strains without substantial increase in toxicity. [7]
A great emphasis must be laid on the practice of universal precautionary measures. Prompt and proper action should be taken by the authorities for initiation of PEP. The author also suggests for simplification of the procedure for procuring antiretroviral drugs for HCWs at government institutions and establishment of post exposure registry in every state headquarters in India. 

 ~ References Top

1.Fulm DR, Wallack MK. The surgeons database on AIDS; a collective review. J Am Coll Surg 1997;184:403-412.  Back to cited text no. 1    
2.Bell DM. Occupational risk of human immunodeficiency virus infection in health care workers: an overview Am J Med 1997; 102 (supp 5B): 9-15.  Back to cited text no. 2    
3.Ippolito G, Puro V, De Carli G, the Italian study group on occupational risk of HIV infection. The risk of occupational human immunodeficiency virus infection in health care workers. Arch Intern Med 1993; 153:1451-58.  Back to cited text no. 3    
4.MMWR, Morbidity and mortality weekly report (1998) May-15, 47(7). Risk for occupational transmission of HIV to HCWs and assessment of infection risk.  Back to cited text no. 4    
5.Ravikumar B, Kumarasamy N, et al. Human immunodeficiency virus infection in a health care worker (HCW) Indian J Med Microbiol 1999;17(2):96  Back to cited text no. 5    
6.Ghate MV, Paranjape RS. Chemoprophylaxis after occupational exposure to HIV. AIDS Research & Review 1999;2(3):139-143.  Back to cited text no. 6    
7.CDC Update: Provisional public health service recommendations for chemoprophylaxis after occcupational exposure to HIV. MMWR 1996;45:468-72.  Back to cited text no. 7    
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