Human immunodeficiency virus transmitted through sheep brain anti-rabies vaccination

摘要

Though transmission of human immunodeficiency virus (HIV) through injection equipment has been documented widely on the basis of socio-epidemiological findings, the detailed sequence of events and specific cases are not reported. Here, we would like to report a case of HIV transmission through injection equipment used for sheep brain rabies vaccination and manifestations of HIV associated opportunistic infections within 6 months of this event. A 40-year-old male presented with burning in micturition, loose motions and fever for 3 weeks followed by distention of abdomen for the last 15 days. On clinical examination, he had bilateral crepitations in the chest and free fluid in the abdominal cavity. He also had scar marks of Herpes zoster in the right gluteal region, right popliteal region and right side of the face. His ultrasound of abdomen confirmed ascites with haemangioma in the right lobe of the liver. On X-ray examination of the chest he had bilateral basal haziness and obliteration of costo-phrenic angles with moderate pleural effusion. His personal history revealed that he was a group D staff in the Police Force of India since 1979 and was married in 1990 with two children aged 11 and 7 years. His 31-year-old spouse was a housewife. Past history revealed that in 1981 he had jaundice for which he was managed conservatively. There was no history of blood transfusion, surgery or pre- or extra-marital exposure. However, he gave an interesting history of dog bite in 1998 for which he was given seven injections of indigenous sheep brain anti-rabies vaccine in May 1998. In November 1998, he developed painful blisters in the right gluteal region which was diagnosed as Herpes zoster which healed with conservative treatment. Again in May 2002, he suffered from similar painful lesions in the right popliteal region including the thigh and calf area. The third episode of the Herpes zoster reactivation he had on the same right side of the face was in December 2002. After the third attack, his general condition continued to deteriorate and was referred to this tertiary care hospital in March 2003, Due to repeated attacks of herpetic episodes his blood was tested to rule out HIV infection, which was found positive by all screening and confirmatory tests. His CD4+ cell counts at this time was only 87 mu l~(-1) and CD8+ cells 693 mu l~(-1). His total protein was 8g% with albumin and globulin levels as 2,9 and 5.1g%. His liver enzymes and renal function tests were essentially normal but serum cholesterol was only 105 mg%, His haemoglobin was only 7 g/dl and erythrocyte sedimentation rate was ex-pectedly 64mm for first hour. He was also found HBsAg positive. His ascitic fluid grew Mycobacterium tuberculosis in Bactec-MGIT-960 system. Therefore, the final diagnosis of disseminated tuberculosis with ascitis with haemangioma liver with HIV infection was made in this patient, His wife, however, repeatedly tested HIV negative.