Acute hepatitis C virus infection related to capillary blood glucose meter

Case Report

A 25-year-old, unmarried, previously healthy male medical student was pricked on the first finger of the left hand when he accidently pressed the button of the lancing device of BeneCheck™ Premium GLU Monitoring System CBGM (General Life Biotechnology Co. Ltd., Taipei, Taiwan) while collecting the blood specimen of his father for glucose monitoring on January 25, 2013.

The patient who was the source was a 54-year-old diabetic male, positive for hepatitis C antibodies (anti-HCV), and had a quantitative HCV-RNA level of 1,757,964 IU/mL (COBAS^®AmpliPrep/COBAS^®TaqMan^® HCV Test v2.0.) with a genotype of HCV-3a (The Linear Array HCV Genotyping Test, Roche Molecular Diagnostics, CA, USA). The medical student had been evaluated for HCV 2 months prior, and again, at the time of accidental exposure to the lancet of CBGM. The nucleic acid amplification test results for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and HCV were negative on both evaluations. Furthermore, he reportedly had no history of injection drug use, irresponsible sexual behavior, recent hospital admission, blood transfusion, previous percutaneous needlestick injury, or a potentially non-sterile tattoo in recent past, except for this injury with the lancet of CBGM. On laboratory evaluation, aspartate transaminase (AST) and alanine transaminase (ALT) were within normal limits. It strongly implicated that the injury with the lancing device of CBGM was the most likely cause of seroconversion in our patient. Furthermore, the same laboratory investigations were carried out at 3 months time, and then again on 6th month after the exposure.

On April 25, 2013, a marked increase was observed in the serum levels of transaminases and a clear HCV seroconversion in terms of HCV antibodies was detected. The subject had a viral load of 450 IU/mL. Moreover, on HCV genotyping, he was found to be 3a, which was consistent with the genotype of the source patient. The student did not manifest any of the symptoms of infection; however, diagnosis of acute HCV infection was made based on the laboratory and molecular evaluation. From October 25, 2013 onwards, ALT and AST were tested regularly and HCV-RNA (HCV-RNA positive, <15 IU/mL) was detected in the serum of the medical student.

Subsequently, on November 25, 2013, a marked rise in the levels of serum transaminases and HCV-RNA was evident, and the medical student was initiated on the antiviral therapy consisting of 180 µg pegylated interferon α-2a (PEGASYS^®, Hoffmann-La Roche Inc., Basel, Switzerland) subcutaneously once a week and 800 mg ribavirin (COPEGUS^®, Hoffmann-La Roche Inc., Basel, Switzerland) (adjusted for weight), per oral daily. The subject tolerated the treatment well in the beginning; however, ALT and AST were constantly elevated. After one month of treatment, HCV-RNA evaluation revealed that the patient was well on the way towards recovery. He complained of severe generalized weakness and body aches, which were treated with acetaminophen. Complete blood count, hematocrit and hemoglobin were all within normal range. On the twenty third week of the therapy, the patient complained of severe joint pains that did not resolve with acetaminophen and slightly responded to other pain killer agents. He completed the therapy in 24 weeks period.

At one- and 6-month post-therapy follow-ups, he recovered well and showed a sustained viral response (SVR) with normal levels of serum ALT and AST without any signs of the relapse. The subject has been on annual evaluation of HCV-RNA and serum transaminases, and found to be disease free to date. The source HCV patient had been previously initiated on peginterferon-2a 180 ug as a once-weekly subcutaneous injection plus ribavirin 800 mg daily, for a total of 24 weeks. On subsequent follow-ups, the source patient responded well to the treatment and achieved SVR with normalization of ALT and AST, and became disease free afterwards.