Abstract
A 52-year-old female hemodialysis patient developed acute hepatitis. She felt fatigue and nausea during the early phase and serum GOT, GOT, total bilirubin reached at maximum to 1, 136IU/L, 1, 254IU/L, 11.2mg/dL, respectively. Serum HCV RNA was positive, and HCV antibody was negative, showing acute HCV hepatitis. She was admitted and serum data gradually returned to normal in 2 months. Due to high viral RNA value and viral genotype 1b, interferon therapy was not indicated. Considering that she had not previously received any blood products, nosocopmical infection was strongly suggested. There had been 9 other genotype 1b-positive patients dialyzed at our facility during the previous 3 months. Base sequence determination of the E1 region of the viral RNA demonstrated that a male patient carried viral RNA 98.8% homologous to the present case, clearly indicating that his blood was the source of the infection. However, the two patients had not shared the same dialysis machine at any time. There were five occasions that both patients received dialysis on the same day. The present case started dialysis about 1 hour later than the source patient in all five sessions. Once among the five occasions, the two patients were located next to each other. However, there was no bleeding accident during these dialysis sessions. After careful review of the regular procedure, several possible opportunities for infection were considered, 1: through venous side injection port; 2: through vascular access either at the start or at the end of dialysis. Contaminated gloves, hands, or syringes could have been involved. Since the source patient finished dialysis 1 hour before the present patient, the plastic bag containing the used dialyzer and blood line tube remaining after dialysis at the bedside, had likely been mishandled to cause contamination. Strict adherence to universal precautions should be utilized to prevent further nosocomical hepatitis infection.
