Case 1. In August 2002, a microbiologist working in a U.S. laboratory was performing
a necropsy on a blue jay submitted as part of a state's WNV surveillance program.
The microbiologist worked in a Class II laminar flow biosafety cabinet under
biosafety level 2 (BSL-2) conditions5 and
lacerated a thumb while using a scalpel to remove the bird's brain. The wound,
a superficial cut over the dorsal surface of the interphalangeal joint, was
cleansed and bandaged. Four days after injury, the microbiologist had acute
symptoms of headache, myalgias, and malaise followed by chills, sweats, dysesthesias,
recurring hot flashes, swelling of the post-auricular lymph nodes, and anorexia.
Two days later, the microbiologist noted a maculopapular rash that began on
the face; extended to the trunk, arms, and legs during the next 3 days; and
then disappeared gradually. The microbiologist continued to work during illness
and had intermittent chills, sweats, dysesthesias, and hot flashes for approximately
1 week before recovering fully. On the third day of illness (7 days post-injury),
the microbiologist sought medical care from a physician and reported no history
of recent mosquito bites, prolonged outdoor activities, or recent blood transfusion.
On physical examination, the patient was afebrile with erythema on the cheeks,
but the examination was otherwise normal. Serial serum samples taken from
the patient and submitted to CDC for WNV serologic testing revealed evidence
of an acute WNV infection. The initial specimen (collected 3 days after illness
onset) was negative for WNV-specific IgM or neutralizing antibodies. Specimens
collected 13 and 21 days after illness onset both were positive for WNV-specific
IgM antibody; the latter specimen was positive for WNV-specific neutralizing
antibody, with a titer of 160; the specimen collected 13 days after illness
onset was not tested by neutralization. The brain of the blue jay tested positive
at CDC for WNV RNA by real-time polymerase chain reaction (TaqMan®) using
two primer/probe sets.