3 year-old daughter-community needlestick

[scareddadplease]

Hello and thank you for taking my question.  8 weeks ago my 3 year old daughter picked up a discarded Novafine insulin pen needle off the floor of a hotel elevator and poked herself drawing blood from the tip of her finger.  The needle was capped and the part she stuck herself with was the bottom portion where the needle enters the pen device, not where it enters the skin, although it is a single 30 gauge hollow bore from what I found on the internet.  At 24 days post needlestick, she had an HCV RNA PCR <50 copies and an HIV RNA PCR <400 copies performed.  Both came out negative.  At 6 weeks she developed a rash on one face cheek and shoulder which went away in about 3-4 days.  At 8 weeks she has now gotten a red slightly raised spot type rash in the crease of her elbow about the size of a 50 cent piece.  Neither of them ever itched and she has had no other symptoms such as fever or lymph node swelling.  My questions are:  1. How reliable are the 2 PCR's at 24 days?  2. Is there any chance that the rashes are a result of the needlestick (ie HCV or HIV)?  3. When will antibodies for HCV and HIV show up in a 3 year old so that antibody testing can be performed? 4. What is the risk from this type of exposure?  Thank you very much for taking my question, this is one of the most difficult things I have ever experienced as a parent.

[H. Hunter Handsfield, M.D.]

I understand your anxiety and fears on behalf of your daughter.  Nevertheless, this sounds like an overreaction.  Most injection drug users do not use the injection equipment pre-loaded with insulin for diabetics; and there is no obvious reason to asssume the diabetic user had other blood-borne infections.  And even if the needle was in fact HIV contaminated, the risk of transmission probably was less than 1 in 1000.

Having said that, your daughter is obviously under the care of a provider--presumably her pediatrician--who ordered all the tests.  That is where to go for answers to your questions.  My quick assessment is that with the test results to date, there is no chance she has HIV.  HCV also is low risk, but I have less knowledge about that possibility.

Good luck--  HHH, MD

[scareddadplease]

Thanks for the response Dr.  The rash on her elbow crease is already nearly gone.  These rashes do not sound like an acute infection liklihood then?  She has had no fever, diarrhea, or lymph node swelling. Nothing other than the transient rashes which her Dr. said was probably fifths disease although it did not spread to her torso like many sites say fifths will do.  Thank you again.

[scareddadplease]

Thanks for the response Dr. The rash on her elbow crease is already nearly gone. These rashes do not sound like an acute infection liklihood then? She has had no fever, diarrhea, or lymph node swelling. Nothing other than the transient rashes which her Dr. said was probably fifths disease although it did not spread to her torso like many sites say fifths will do. Thank you again.

[scareddadplease]

Thanks for the response Dr. The rash on her elbow crease is already nearly gone. These rashes do not sound like an acute infection liklihood then? She has had no fever, diarrhea, or lymph node swelling. Nothing other than the transient rashes which her Dr. said was probably fifths disease although it did not spread to her torso like many sites say fifths will do. Thank you again.