Journal of Clinical Virology 46 (2009) 374–377 Contents lists available at ScienceDirect Journal of Clinical Virology journal homepage: www.elsevier.com/locate/jcv Case report HIV-1 infection of a nurse from a newborn with an unknown HIV infection: A case report Davide Gibellini a,∗ , Marco Borderi b , Isabella Bon a , Carlo Biagetti b , Elisa De Crignis a , Maria Carla Re a,c a Section of Microbiology of the Department of Hematology and Oncologic Science, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy b Section of Infectious Diseases, Department of Internal Medicine, Geriatric Medicine and Nephrology, University of Bologna, Italy c Interuniversity Consortium, National Institute Biostructure and Biosystem (INBB), Rome, Italy article info Article history: Received 22 July 2009 Accepted 21 August 2009 Keywords: HIV-1 transmission Needle-stick injury Newborn abstract Background: HIV infection of healthcare workers by injury is an important issue in the management and prophylaxis of HIV-related disease. Objectives: To describe a case where a nurse has been HIV-1 infected by needle-stick whilst taking blood from a newborn with an unknown HIV infection. Study design: Virological, immunological and clinical analysis of a peculiar case of HIV transmission from newborn to nurse has been reported. Results: The nurse has been infected by needle-stick injury whilst taking blood from a newborn with an unknown HIV infection. The delayed declaration of accident by nurse and the inaccurate medical management of pregnant woman determined the subsequent absence of correct prophylaxis measures and then the impossibility to tackle the HIV transmission. Conclusion: This case indicates that HIV serological screening of pregnant women and prompt accident notification by health-care workers represent basic preventive measures that should effectively tackle the spread of HIV infection. © 2009 Elsevier B.V. All rights reserved. 1. Why this case is important 1.1. Human immunodeficiency virus Human immunodeficiency virus (HIV) is the aetiologic agent of acquired immune deficiency syndrome (AIDS), which remains a major challenge in the management of infectious disease. 1 Besides sexual transmission, vertical or perinatal HIV infection from mother to child and HIV infection of health-care workers by injury are important issues in the management and prophylaxis of HIV- related disease. 2,3 Health-care workers are well known to be at risk of acquiring HIV by accident such as percutaneous injury occurring generally by needle-stick injury during the blood sampling from HIV-positive patients. The average risk of HIV transmission has been estimated as 0.3% 3 and prompt antiretroviral post-exposition prophylaxis (PEP) should decrease the transmission rate even though the real effectiveness of PEP has still not been determined. 4 The mother-to-child transmission affected 15–40% of newborns in the highly active antiretroviral therapy (pre-HAART) era and only the antiretroviral treatment of mother and newborn coupled to ∗ Corresponding author. Tel.: +39 051 636 4932; fax: +39 051 307397. E-mail address: davide.gibellini@unibo.it (D. Gibellini). elective caesarean section for women with high viral loads reduced the HIV transmission rate to 2% or less. This article describes the case of a nurse who was infected with HIV-1 by needle-stick injury during blood sampling from a 2-week-old newborn with an unknown HIV infection. HIV infection of both nurse and newborn were related to incorrect clinical management that failed to avoid the HIV transmission. 2. Case report A 35-year-old nurse sustained a deep hand injury with a needle- stick whilst taking blood with a 0.25-inch needle attached to a syringe from a newborn hospitalised in a Neonatal Unit for several signs correlated to human cytomegalovirus (HCMV) infection. The baby’s mother was a 40-year-old Italian woman and the father was her Namibian partner. The pregnancy was diagnosed in Zimbabwe in June 2006 and 3 weeks later the woman displayed an influenza-like syndrome that resolved in a few days, but was followed by an undocumented bacterial urinary infection. In Octo- ber 2006, after 20 weeks of pregnancy, the woman moved to Italy where she underwent a serological enzyme-linked immunosor- bent assay (ELISA) test focussed only on Rubella virus, human Cytomegalovirus and Toxoplasma gondii, as indicated by her physi- cian. The woman showed a previous immunity to Rubella virus and 1386-6532/$ – see front matter © 2009 Elsevier B.V. All rights reserved. doi:10.1016/j.jcv.2009.08.016