HTLV-III/LAV Seroconversion Following a Deep Intramuscular Needlestick Injury

Abstract

The authors report a case of human T-lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV) seroconversion after an occupational injury. The subject a female health care worker in the US received a deep intramuscular needlestick injury with a large-bore unit that was visibly contaminated with blood from a patient with acquired immunodeficiency syndrome (AIDS). 14 days after injury fever chills myalgias and arthralgias developed. Examination revealed an enlarged right axillary lymph node. On day 17 an erythematous macular rash appeared on the abdomen and lasted 5 days. The health care worker continued to have cramps diarrhea and weight loss. A diagnosis of Clostridium difficile colitis was made and oral vancomycin therapy was followed by a complete resolution of symptoms. Since then the health worker has had intermittent oral candidiasis a persistent postcervical lymph node and transient enlargement of suboccipital and inguinal lymph nodes. Serum collected 9 days after the injury was negative for HTLV-III/LAV antibody but samples collected on days 184 and 239 were positive. The health workers husband was seronegative when tested 239 days after injury. The results of virus culture for HTLV-III/LAV performed on blood from both the health care worker and her husband were negative at 239 days. The only 2 documented cases of HTLV-III/LAV antibody seroconversion in health care workers have occurred after highly unusual parenteral exposure to blood. In the other case blood from an AIDS patient may have been injected into a health care workers finger. These 2 cases emphasize the need for strict adherence to recommended infection control precautions especially those regarding the handling of needles and other sharp objects.