Abstract
BackgroundNo recognized risk factors can be identified in 10-40% of hepatitis C virus (HCV)-infected patients suggesting that the modes of transmission involved could be underestimated or unidentified. Invasive diagnostic procedures, such as endoscopy, have been considered as a potential HCV transmission route; although the actual extent of transmission in endoscopy procedures remains controversial. Most reported HCV outbreaks related to nosocomial acquisition have been attributed to unsafe injection practices and use of multi-dose vials. Only a few cases of likely patient-to-patient HCV transmission via a contaminated colonoscope have been reported to date. Nosocomial HCV infection may have important medical and legal implications and, therefore, possible transmission routes should be investigated. In this study, a case of nosocomial transmission of HCV from a common source to two patients who underwent colonoscopy in an endoscopy unit is reported.ResultsA retrospective epidemiological search after detection of index cases revealed several potentially infective procedures: sample blood collection, use of a peripheral catheter, anesthesia and colonoscopy procedures. The epidemiological investigation showed breaches in colonoscope reprocessing and deficiencies in the recording of valuable tracing data. Direct sequences from the NS5B region were obtained to determine the extent of the outbreak and cloned sequences from the E1-E2 region were used to establish the relationships among intrapatient viral populations. Phylogenetic analyses of individual sequences from viral populations infecting the three patients involved in the outbreak confirmed the patient pointed out by the epidemiological search as the source of the outbreak. Furthermore, the sequential order in which the patients underwent colonoscopy correlates with viral genetic variability estimates.ConclusionsPatient-to-patient transmission of HCV could be demonstrated although the precise route of transmission remained unclear. Viral genetic variability is proposed as a useful tool for tracing HCV transmission, especially in recent transmissions.
Highlights
No recognized risk factors can be identified in 10-40% of hepatitis C virus (HCV)-infected patients suggesting that the modes of transmission involved could be underestimated or unidentified
HCV is predominantly transmitted by the parenteral route in procedures such as unscreened blood transfusions, injections related to intravenous drug use (IDU), injections related to health-care procedures, invasive medical and surgical interventions and, to a lesser extent, other percutaneous exposures [1,2,3]
A similar dilemma could not be resolved in the pioneering case report of HCV transmission during colonoscopy [11] in which the authors were unable to completely rule out the possibility that HCV transmission occurred during the anaesthesia procedure previous to the colonoscopy
Summary
No recognized risk factors can be identified in 10-40% of hepatitis C virus (HCV)-infected patients suggesting that the modes of transmission involved could be underestimated or unidentified. Invasive diagnostic procedures, such as endoscopy, have been considered as a potential HCV transmission route; the actual extent of transmission in endoscopy procedures remains controversial. A nosocomial HCV mode of transmission that remains controversial is diagnostic or therapeutic digestive endoscopy (gastroscopy and colonoscopy) These infection routes are not even mentioned in recent reviews dealing with the epidemiology of HCV infection [4,5], they receive varying attention in others [3,6]
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