Dr. Shubadeep Debabrata Sinha
Infectious Diseases
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
Two years back, I had my first ever dirty needle stick exposure, which has caused me great mental distress. I accidentally poked myself on my right index finger. I noticed bleeding, but I did not clean it right away. I started my infectious disease protocol that night, and the urgent care I was sent to did not want me to take PEP.
My initial tests were all negative. About a week after the injury, I developed a mild fever, vertigo for two days that caused me to vomit, and a swollen left armpit lymph node. This lasted for about four days before subsiding. The following symptoms that developed were rashes on my body. I developed liver spots on my back and a no-itchy rash on the back of my neck that almost looked like shingles but was not. It took weeks for it to heal after applying multiple creams. The following symptom I had was left eye blurry vision, which no eye drops helped. Eventually, I was sent to a specialist who said I had herpes and gave me antivirals, which relieved the issue. The next odd sign was a CBC draw that showed a slight decline in total WBC and a neutrophil count of about 200 per microliter of blood below the normal cutoff. About a week and a half ago, I developed body aches, chills, fever, dry cough, and sore throat. I was tested for Covid using rapid PCR. All were negative, and the flu and streptococcus were also negative. All the symptoms subsided except for the dry hacking cough that was still going on for eight days. I have attached a file of my test results since the injury occurred. All the HIV tests are the 4th generation tests.
I have struggled to believe the results of any of these tests due to all the symptoms I have dealt with and never received an answer for. What scares me, too, is these tests are never 100 % conclusive. I have had tattoos done after the injury. The tattoo shop is clean. My concern is I have had reoccurring herpes in the eye that required antivirals. Also, I have had skin rashes and abnormal spots pop up throughout my body.
Please help.
Hi,
Welcome to icliniq.com.
I understand your concern.
I went through your reports (the attachments removed to protect the patient's identity).
Your signs and symptoms do not suggest any transmission of disease from needle stick injury, particularly HIV (human immunodeficiency virus), since you followed the PrEP protocol (pre-exposure protocol) after the exposure and HIV tests (4th generation) tested negative. The herpes infection that you took treatment for must have been contracted from another disparate exposure from a healthcare setting or personal life. Herpes is a notoriously recurring disease since it stays hidden in the tissues such as neurological tissues and often develops multi-drug resistance. You need to monitor and watch for immunological status and ensure that you do not get immunocompromised, as this is when you are prone to get a new episode.
Risk of HIV from needle stick injury, if the exposure was to intact skin only, there is no risk of HIV transmission. However, if the exposure was to the mucous membrane or integrity-compromised skin, whether the volume of fluid was small (few drops, short duration) or large (several drops or major splash, long duration) one of the following codes can be applied:
Most importantly, since you had an HIV-negative report, your HIV risk is minimal and you did not require PrEP.
Hope it helps.
Thanks and regards.
Patient's Query
Hi doctor,
Thank you for your answer.
What about Hepatitis C?
I have noticed that my poop seemed to be yellow at times. Not the typical brown look. Also, I have been getting bumps and random rashes on my skin, especially my chest and upper back. I have also been itchy more than usual. It is making me a bit worried. I am also terrified my Hepatitis C will not be cured. I have had plenty of tests done showing it is negative. A year out, but still, I have had a few tattoos done after the needle stick, but the shop was very clean and followed all regulations.
Please help.
Hi,
Welcome back to icliniq.com.
Yellow stool does not indicate hepatitis C. People with newly acquired HCV (hepatitis C virus) infection usually are asymptomatic or have mild symptoms. When symptoms do occur, they can include fever, fatigue, dark urine, clay-colored stool, abdominal pain, loss of appetite, nausea, vomiting, joint pain, and jaundice. You could run the following diagnostic tests to screen or confirm the disease.
You may require the following diagnostic tests,
I) Screening tests for antibodies to HCV (anti-HCV).
2) Enzyme immunoassay (EIA).
3) Enhanced chemiluminescence immunoassay (CLIA).
4) Chemiluminescence microparticle immunoassay (CMIA).
5) Microparticle immunoassay (MEIA).
6) Electrochemiluminescence immunoassay (ECLIA).
7. Immunochromatographic assay (rapid test)
8) Qualitative nucleic acid tests to detect the presence of HCV RNA.
9) Quantitative nucleic acid tests to detect levels of HCV RNA.
People with acute hepatitis C (for example, those with measurable HCV RNA) should be treated for their infection. There is no need to wait for the potential spontaneous viral resolution. The Infectious Diseases Society of America (IDSA) and the American Association for the Study of Liver Diseases (AASLD), in collaboration with the International Antiviral Society, developed evidence-based, expert-developed recommendations for hepatitis C management. These include,
1. A daily fixed-dose combination of Elbasvir (antiviral) 50 milligrams or Grazoprevir (antiviral) 100 milligrams for 12 weeks if no baseline nonstructural protein 5A (NS5A) resistance-associated substitutions (RASs) for Elbasvir are detected
2. A daily fixed-dose combination of Glecaprevir (300 milligrams) or Pibrentasvir (antiviral) 120 milligrams for eight weeks.
3. A daily fixed-dose combination of Ledipasvir 90 milligrams or Sofosbuvir 400 milligrams for 12 weeks.
4. A daily fixed-dose combination of Ledipasvir 90 milligrams or Sofosbuvir (antiviral) 400 milligrams for eight weeks for non-black patients, non-HIV-infected persons, and those whose HCV RNA level is below 6 million IU/mL
5. A daily fixed-dose combination of Sofosbuvir 400 milligrams for 12 weeks. If you are a treatment-experienced Hepatitis C patient, there is a different treatment. Your chances of contracting Hepatitis C are very low. Many Hepatitis C patients also have concomitant HIV infection (which you do not seem to have) and immunocompromised conditions such as renal compromise and treatment with autoimmune drugs, none of which you are currently undergoing.
Kindly consult a specialist, talk with them, and take medicines with their consent.
Hope it helps.
Thanks and regards.
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Infectious Diseases
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