針刺事故により急性C型肝炎を発症し, その後のインターフェロン(IFN)治療にてC型肝炎ウイルスを排除し得た2症例

Abstract

Transmission of hepatitis C virus (HCV) via accidental injuries in a problem for health care workers. We encountered two cases of acute hepatitis C, in whom HCV transmission was caused through accidental exposure to blood drawn from HCV- infected patients. Both of them pricked their fingers with a needle contaminated with blood from HCV-infected patients with liver cirrhosis. Case 1 was a 52-year-old nurse, who developed jaundice (T.Bil 3.3 mg/dl) with transaminase elevation (AST 1262 IU/ml, ALT 1348 IU/ml) at Day44 after the needle-stick accident. Case 2 was a 37-year-old nurse, who developed jaundice (T.Bil 5.5) with transaminase elevation (AST 863, ALT 872) at Day47 after the needle-stick accident. Both of them were negative for anti-HCV before the accidents and became positive in the association with jaundice and prominently elevated transaminases. We made a diagnosis of acute hepatitis C. Although their transaminase levels gradually decreased, they re-elevated and then fluctuated above the upper limit of normal range. Liver biopsies, performed on Day144 in Case 1 and on Day77 in case 2, presented piecemeal necrosis. Lymphoblastoid IFNa was introduced in Case 1, and recombinant IFNα-2a in Case 2. IFNs were given at a daily dose of 6 and 9 million units (MU), respectively, daily for the initial two weeks and three times a week for following 10 weeks. HCV-RNA in serum was not detected at the end of the daily treatment period with IFNα in each of the patients by RT-PCR. Serum HCV-RNA by repeated RT-PCR was thereafter negative in both patients. We believe that IFNα treatment should be introduced to the patients of acute hepatitis, in whom a chronic course of disease is suspected from persistent abnormal liver function and viremia.