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Needlestick - Cliff Notes Version
Dec 7, 2003

Hi Dr. Bob. This is a much shorter version of a previous letter I sent. I had a needlestick injury on 10/2/03, but found out the source was likely to be positive when it was too late for prophylaxis. The stick was from a moderately bloody spinal needle since the patient was on aspirin. (I don't know if you're familiar with these needles but it was a Whitacre 25 gauge pencil point needle which is of course hollow but with the hole about a millimeter from the tip of the needle. They are designed to be used with an introducer needle). It was sticking up in the tray at an angle and my hand hit it as I withdrew my hand from the tray. I didn't have to pull it out of my skin, and I didn't see any of my blood unless it got wiped off by my glove when I removed it. After the procedure I couldn't tell where the stick had been. I'm a person of color so I might not have seen it anyway. At the time I didn't think it went very deep, but about a week later I saw a tiny scab in the area. I freaked out. The Infectious Disease doctor at my institution, and the doctor at an anonymous testing site I later went to both feel that by my description of the accident I'm most likely ok. Anyway, at about the 16 th day I started getting sharp pains in my lymph nodes and muscles. I also had extreme muscle burning and fatigue, and loss of appetite. I still get some lymph node pain, intermittent headaches which change location and itching off and on even to this day. On the 27 th day I took an ELISA test at the site mentioned above which was negative. When the doctors saw how freaked out I still was, they suggested a DNA test. My Qualitative DNA PCR test from Quest at 33 days was "Not Detected." Is this at all helpful? I just know I'm one of the 5 out of 100 that would get a false negative on the DNA test. Please help. I'm going insane with worry. Thank you so much for your time. You are doing a great service here.

Response from Dr. Frascino

Hello,

Not sure if I've answered your question before or not. There has been a flurry of needlestick concerns of late. I'll at least give you a "Cliffs Notes" reply, OK?

From what you've written, I would agree with the assessment of the ID doctor and the physician at the anonymous testing site: Your risk sounds very low. Your HIV tests to date ELISA negative at 27 days and DNA-PCR negative at 33 days are extremely encouraging!

What should you do next? Since you are a healthcare worker and this was an occupational exposure, I would suggest following the well-established CDC guidelines put out by the U.S. Public Health Service for evaluation and management of occupational exposures. You can find the full 38-page document on the CDC website. I also hope you completed an incident report about the exposure. Also, since you know the source patient, perhaps he/she would consent to HIV testing.

Please note, statistically, the odds are very much in your favor.

Good luck.

Dr. Bob



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