An anesthesiologist was diagnosed as having acute hepatitis C 3 days after providing anesthesia during the thoracotomy of a 64-year-old man (patient A). Eight weeks later, patient A was diagnosed as having acute hepatitis C.
We performed tests for antibody to hepatitis C virus (HCV) on serum samples from the thoracotomy surgical team and from surgical patients at the 2 hospitals where the anesthesiologist worked before and after his illness. We determined the genetic relatedness of the HCV isolates by sequencing the quasispecies from hypervariable region 1.
Of the surgical team members, only the anesthesiologist was positive for antibody to HCV. Of the 348 surgical patients treated by him and tested, 6 were positive for antibody to HCV. Of these 6 patients, isolates from 2 (patients A and B) were the same genotype (1a) as that of the anesthesiologist. The quasispecies sequences of these 3 isolates clustered with nucleotide identity of 97.8% to 100.0%. Patient B was positive for antibody to HCV before her surgery 9 weeks before the anesthesiologist's illness onset. The anesthesiologist did not perform any exposure-prone invasive procedures, and no breaks in technique or incidents were reported. He denied risk factors for HCV.
Our investigation suggests that the anesthesiologist acquired HCV infection from patient B and transmitted HCV to patient A. No further transmission was identified. Although we did not establish how transmission occurred in this instance, the one previous report of bloodborne pathogen transmission to patients from an anesthesiologist involved reuse of needles for self-injection.
Genetic relatedness obtained by pairwise analysis of the nonstructural coding region 5b sequences from investigation-related cases (the anesthesiologist and patients A and B) and from 8 hepatitis C virus (HCV)–infected persons from the general population not related to the investigation (shown as numbers). The percentage of nucleotide identity between isolates is measured by the horizontal distance connecting the isolates. Isolates from patients A and B and the anesthesiologist cluster in a single group. The sequences from patient A and the anesthesiologist are identical and differ from that of patient B by 5 nucleotides. The sequences from the 8 unrelated HCV RNA–positive persons vary by 3.9% to 20.0% and fall into 3 clusters.
Unrooted tree of phylogenic distances of all HVR1 quasispecies. This unrooted tree shows the HVR1 sequences of all quasispecies identified from 8 NHANES III samples (shown as numbers) and those of the anesthesiologist and patients A and B. The quasispecies of the anesthesiologist and patients A and B cluster on a single branch, with a nucleotide identity of 97.8% between sequences of the anesthesiologist and patient A and of 100.0% between those of the anesthesiologist and patient B. The nucleotide identity was 46% to 75% between the 8 NHANES III participants and between the NHANES III participants and the anesthesiologist and patients A and B. HVR1 indicates hypervariable region; NHANES III, Third National Health and Nutrition Examination Survey.
Temporal sequence of surgical procedures and illnesses in patients A and B and the anesthesiologist, by week. Anti-HCV indicates antibody to the hepatitis C virus.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 47
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.