Patient-to-patient transmission of hepatitis C virus during colonoscopy

Although rare, hepatitis C virus (HCV) has been transmitted to patients during invasive medical and surgical procedures. In this brief report, the authors show that patient-to-patient transmission of HCV can likely occur during colonoscopy. Two patients with no known risk factors for hepatitis C underwent colonoscopy on the same day in the same clinic.

Both had normal serum aminotransferase activities and negative HCV serological tests two months prior to undergoing colonoscopy. About three months after their procedures, both had serum antibodies against HCV and elevated serum aminotransferase activities. Liver biopsies several months later were consistent with chronic hepatitis C. All staff members involved in performing the colonoscopies did not have serum antibodies against HCV.

One other patient who was known to have hepatitis C underwent colonoscopy in the same clinic and on the same day as the subjects. HCV cDNA was amplified from the serum of all three patients who had colonoscopies on that day and sequencing showed that 150 nucleotides in the NS3 gene were identical in all three.

It was subsequently discovered that the biopsy-suction channel of the endoscope used in all three cases was never thoroughly cleaned with an appropriate brush. This study strongly suggests that HCV can be transmitted from patient-to-patient during colonoscopy. The transmission likely resulted from inadequate cleaning and sterilization of the endoscope between procedures.

Copyright, 1995, Columbia University Division of Gastroenterology
Hepatitis B By Howard J. Worman, M. D.

Bronowicki, P.-P., Venard, V., Botte, C., Monhoven, N., Gastin, I., Chone, L., Hudziak, H., Rhin, B., Delanoe, C., LeFaou, A., Bigard, M.-A., and Gaucher, P. 1997. Patient-to-patient transmission of hepatitis C virus during colonoscopy. New England Journal of Medicine. 337:237-240.


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