September 4, 2006

Autopsy led to chickenpox outbreak

NEW YORK (Reuters Health) - Researchers in India describe a
hospital outbreak of chickenpox in which the source of
infection was a cadaver.

The deceased patient was a 36-year-old male renal
transplant recipient who had developed what looked like
varicella-zoster virus infection (chickenpox) affecting not
only the skin but also internal organs, Dr. Navin Paul and Dr.
Mini E. Jacob, from Christian Medical College in Vellore,
India, report.

Despite prompt treatment with intravenous antibiotics
agents, the patient's condition worsened and 12 hours after
being hospitalized he went into cardiac arrest and died.

Twelve hours later, an autopsy was performed, which was
attended by a pathologist, two assistants, and 19 medical
students. The pathologist and assistants reported a prior
history of chickenpox, whereas the medical students were not
questioned regarding chickenpox history or vaccination status.

Masks and aprons were worn by all the attendees, but during
the autopsy, cutting into the liver released blood that
splashed on to the skin of some of the attendees.

Twelve days later, the first of four cases of chickenpox
was reported among the attendees. In all cases, the subjects
reported being exposed to the splashed blood. Conversely, none
of the unaffected participants reported such exposure.

Two of the affected attendees reported a prior history of
chickenpox, while two did not. To prevent further spread of the
disease, three of the patients were isolated in the hospital,
while the fourth agreed to home confinement.

Eight persons were identified who had come in close contact
with the three hospitalized patients prior to diagnosis. Five
of these patients reported no prior history of chickenpox.
Although they didn't acquire chickenpox during the outbreak,
four of the five patients would develop the disease in the next
5 years, "implying that they lacked immunity to the
varicella-zoster virus at the time of their exposure to the
primary contacts," Drs. Paul and Jacob state.

"Our unique case series demonstrates the importance of
assessing healthcare workers' susceptibilities to the
varicella-zoster virus before exposing them to situations with
increased risk of infection acquisition," the researchers

SOURCE: Clinical Infectious Diseases September 1, 2006.