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.
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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.
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