- The time between infection and death is EXTREMELY rapid.
Normally, one becomes infected with HCV and it could take decades for the
virus to be identified. One is asymptomatic and feels fine for decades.
- Hepatitis C Fatality In Baltimore Shrouded
- By Michael Stroh
- The Baltimore Sun
- Jan 4 2005
- As thousands of other patients do every year, a patient
walked into a Glen Burnie cardiology clinic last October  for a routine
cardiac stress test. But what happened over the next 2 months wasn't so
routine: The 79-year-old retired ironworker developed a hepatitis C infection
that ultimately took his life on Christmas Day [25 Dec 2004]. The patient's
death -- one of just 6 hepatitis C-related fatalities officially recorded
in Maryland since 1999 -- is drawing new attention to an unusual medical
mystery under investigation by the Maryland Department of Health and Mental
- Officials have traced the patient's infection to a single
vial of technetium-99m, a radioactive isotope injected into the bloodstream
during stress tests and other routine diagnostic procedures. Investigators
won't say how many people have been infected, or where they live. However,
the company whose Timonium pharmacy prepared the suspect isotope said the
state has identified at least 12 people in the Baltimore area. The 79-year
old patient, who lived in Brooklyn Park, is the only fatality.
- (The only fatality, thus far! - P. Doyle)
- The case has baffled physicians and nuclear medicine
experts, who say they can recall no other instance in which a common radioactive
isotope has become contaminated with [a] hepatitis [virus]. "It's
very unusual and not expected at all," says Fadia Shaya of the University
of Maryland School of Pharmacy, who chairs the state's advisory council
on hepatitis C. "This kind of thing should not happen."
- (But it did happen! P. Doyle)
- Hepatitis C, a liver disease caused by a virus of the
same name, is typically transmitted through infected blood or semen. The
disease kills as many as 10 000 people in the U.S. each year. The majority
of new infections are contracted through illicit drug use. The vial of
technetium-99m that officials suspect as the cause of the infection here
was prepared at a so-called nuclear pharmacy in Timonium. Operated by Cardinal
Health of Dublin, Ohio, the pharmacy specializes in preparing radioactive
"tracers" for a variety of diagnostic tests. The company has
temporarily closed the business until investigators have pinpointed the
source of the virus.
- John Hammond, a spokesman for the Department of Health
and Mental Hygiene, said the hepatitis C outbreak does not pose a public
health risk and was confined to the small number of people injected with
serum from the tainted vial. Maryland, he said, recorded 26 cases of hepatitis
C in 2004, including those in the recent outbreak. The state reported 9
cases the previous year and 14 cases in 2002.
- (How many "unrecorded cases"?? -- P. Doyle
- One of the central mysteries is how the radioactive isotope
could have become contaminated, especially since the preparation of technetium-99m
is considered to be a straightforward process. "How in the world did
this happen?" says Nicki Hilliard, a nuclear pharmacist at the University
of Arkansas for Medical Sciences. "It's bizarre." Hilliard said
that the isotope is typically produced in a pinkie-sized container known
as a radionucleotide generator. To create a dose, technicians pass standard
saline solution through the generator, a process known as "milking."
As a result, the generators themselves are sometimes known as "cows."
Technicians capture the saline in a small vial and stir in a powdered chemical
tracer. The tracer binds to the isotope and ferries it through the patient's
bloodstream to the specific organ or tissue that needs to be examined.
- The victim's widow said her husband received the isotope
during a cardiac stress test at Arundel Heart Associates in Glen Burnie.
Before the test, she said, he was in good health, and the procedure was
considered routine. As part of the test, doctors typically inject the isotope
into the patient's bloodstream and ask the patient to walk on a treadmill
for a short period to increase the pulse rate. Then they examine the patient's
heart using a radiation-sensitive camera to track blood flow and spot potential
- Dr. Paul Young-Hyman, a cardiologist at the Glen Burnie
clinic, said the suspect isotope arrived at the clinic in October 2004
in 8 individually prepared syringes, each in a lead-lined container. All
8 patients who received the isotope on 15 Oct 2004 have since tested positive
for hepatitis C, he said. Young-Hyman said that when word started filtering
back that several patients who had stress tests that day had been diagnosed
with hepatitis, the clinic notified county health officials, who ultimately
contacted the state.
- The cardiologist said all the clinic's employees have
tested negative for the virus, and health officials have examined the clinic's
laboratory and found it contamination free. As a precautionary measure,
however, stress tests at the clinic are now being performed with a different
radioactive tracer. "I'm just hoping that people who need the study
don't hold back on getting it," says Young-Hyman. "This case
really does fall into the category of bizarre."
- Hepatitis C has an average incubation period of 6 to
8 weeks, and the victim was fine until mid-November 2004, when he lost
his appetite and started to feel nauseous, family members said. His wife
initially chalked it up to stomach flu, from which she was just recovering.
But when he didn't improve, he went to see the doctor. A few days later,
tests came back positive for hepatitis C. Around this time, state health
officials began notifying hospitals and physicians to watch for signs of
the disease, including fatigue, jaundice, abdominal pain and nausea. As
his condition deteriorated in the following weeks, he was admitted to North
Arundel Hospital twice before finally being taken to Harbor Hospital on
23 Dec 2004, and he died on Christmas Day.
- [Hepatitis C virus is classified as the type species
of the genus _Hepacivirus_ in the family _Flaviviridae_. It is transmitted
almost exclusively by parenteral exposure to blood, blood products and
substances contaminated with blood. Sexual and perinatal transmission occur
rarely. Screening and inactivation procedures now ensure safety of the
blood supply. Blood-contaminated syringes, however, have become a significant
- The circumstance whereby 8 patients receiving isotope
from 8 individually prepared syringes delivered from a single pharmacy
points to the contamination occurring at the pharmacy preparing the isotope
rather than at the hospital administering the isotope to the patients.
The level of contamination of the isotope must have been considerable to
result in infection of all 8 patients. The staff of the cardiology clinic
have tested hepatitis C-negative, which further suggests that the contamination
occurred during preparation of the isotope at the pharmacy. - Mod.CP]
- Patricia A. Doyle, PhD
- Please visit my "Emerging Diseases" message
- Zhan le Devlesa tai sastimasa
- Go with God and in Good Health