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Occupational Exposure
Apr 23, 2007

Hi there,

I'll try to make this short(ish). I've been toying with the idea of seeking your counsel for a while since finding you on the web and reading that your transmission was occupational, and I am worried that I may be in the same boat.

Basically, I am a medicine resident who had a percutaneous exposure (hollow bore 25 g needle) from unknown status in early July 06. Did not take PEP, and did not think much of it over the next couple of months. Then in early November started having unusual symptoms, with a number of them continuing to this day. Started with small maculopapular rash on upper arm that lasted 3 weeks. Also had pharyngitis, myalgias, arthralgias and peripheral neuropathy in ulnar distribution bilaterally. No fever or adenopathy. Within a month of these symptoms (Dec) also had nausea, vomiting, fatigue, some weight loss, night sweats, and diarrhea that lasted for a few weeks. In late Dec I noticed desquamation of my soles with a small red rash on the balls of my feet B/L (this was very disconcerting). The problems with my soles lasted about 2 weeks but then came back again in early Feb. Over the past few months Ive also had tender axilla B/L and the neuropathy, sore throat, and arthralgias/myalgias continue to this day. Ive also noticed over the past few months what can be described as increasing sebborheic dermatitis on my face with otitis externa and occasional ear pain, as well as multiple oral lesions (apthous ulcers) whitish areas on my buccal mucosa and variable tongue burning. I also just noticed some posterior cervical lymphadenopathy. I know these are a lot of symptoms.

Ive had non-reactive elisas at the 4, 4.5, and 6.5 month marks. The tests have all been for HIV-1. Also non-reactive Hep C at 4.5 months. I have been tested for other disorders, including a non-reactive RPR. My personal physician, as well as others, believe that my fears are unwarranted and the symptoms are caused by something else, most notably stress. I have sought psychiatric therapy for my fears, but the thoughts persist. My questions to you are as follows:

(1) Should I have another Hep C done? As I did not test out to 6 months for it. (2) Should I get another antibody test for HIV considering that my symptoms persist? Or should I test for other strains? (3) Should I just get a viral load instead or in combination with another elisa? (4) Am I being irrational, as shouldnt the elisa be positive (if I was indeed infected) if I was having symptoms for over 2 months? (5) Can I just let this all go and look to other avenues for my symptoms?

My reasoning for repeating these tests are generally due to the documented cases of late seroconversion where Hep C and HIV were acquired at the same time (thus causing a delay in seroconversion for both). I hope I do not fall into this category.

My other fear is that I have possibly infected my wife, as she is pregnant and having unusual symptoms for a pregnancy. She tested negative at the end of Nov 06, but has not retested since.

Please respond as I am extremely worried.

Thank you, Medicine Resident

Response from Dr. Frascino

Hi Medical Resident,

Immediately after your possible occupational exposure, I'm assuming you reported and documented the incident. If not, you should have. Often it's possible to review the source patient's chart to ascertain if they have any known bloodborne pathogens (hepatitis, HIV). Patients are often very willing to undergo routine screening if asked and if the situation is explained to them.

That aside, your repeatedly negative ELISA tests out to 6.5 months and negative hep C at 4.5 months are definitive and conclusive. HIV and hep C are not your problem. No way. No how.

To specifically answer your questions:

1. No. Not necessary or warranted.

2. No. Not necessary or warranted.

3. No. Not indicated.

4. Yes. Absofrickinlutely!

5. Same as #4 above.

My advice is that you continue to work with a psychiatrist to address your irrational HIV fears. You'll need to conquer these to become an effective physician.

Good luck.

Dr. Bob



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