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Infant had blood contamination incident. Why frequent runny nose, cold and cough? Will nasonex cause a wrong antibody test?

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Dr XXXXXXX
My 3 year old had a blood contamination incident and that is the reason i am very much worried is that she is falling sick all the time. It was a very unfortunate and a risky blood contamination incident in the genetic clinic.



After that incident she is continously falling sick once or twice very month with runny nose, cold, cough and sometimes fever. It has been close to one year now and we are dealing with the same situation day in and day out. Before the incident i rarely remember taking her to the doctor once every 6 month.

After three days after the day of the blood contamination incident, she had high running nose, cough, and after seven days after the blood was drawn, she has high fever from the past four days including the running nose and cough, and is taking ibuprofen to control the temperature, and an antibiotic as well.

She uses Albuterol, budesonide(oral inhalers) in her nebulizer and some antiboitics(if she has fever), she takes Nasonex shots, and she uses Waldryl allergy and Zyrtec.

My pediatrician because of the blood contamination incident, got her tested for Hep A, Hep B, Hep C and HIV after 5 months 20 days after the incident.

Now she is 4 years old.


My question to you doctor is do you think using these medications either budesonide or those antibiotics or those Nasonex shots or Waldryl,Zyrtec.

Do these medications or treatments cause a wrong HIV antibody test result or a delay. Would that in any way affect my test results/ antibody production?

They did a western blot for HIV without doing an elisa, it was negative.

1) Does budesonide have any effect on her Hepatitis A,B,C antibody test or her HIV antibody test result by delaying or hiding the antibodies?
2) The HIV antibody test(Western Blot) and the Hep A, Hep B, Hep C antibody test was done 5 months 20 days after the exposure. Is that enough window period considering she is a 3 and half year old. or do kids have longer window periods. I see everywhere for adults the window period is 3 months, and am not sure about the 3 year kid.
3) Does any antibiotics(i don't remember which antibiotics she used) have any effect on her HIV antibody test result or her Hep A, Hep B, Hep C antibody test results by delaying or hiding the antibodies.
4) Does any of her immunizations have any effect on the HIV antibody or Hep A, Hep B, Hep C test result?. She got her 3 year immunizations five months before the HIV antibody test.
5) Does her Nasonex(steroid) or waldryl alergy or zyrtec/singular have any effect on her HIV antibody test result or the Hep A, Hep B, Hep C antibody test result?
Posted Wed, 4 Jul 2012 in General Health
 
 
Answered by Dr. Aparna Kohli 3 hours later
Hi,
Thanks for writing in.
I do understand your concern but you can rest be reassured that your child is fine and is indeed free from HIV, Hepatitis A, B and C.
Let me try and explain this to you.
The budesonide that your 4 year old is using, is a steroid known to suppress the cellular mediated immunity. This immunity is mediated mainly by one type of cells in our body called T cells. Antibodies to any microbe ( disease causing organism) are formed by B cells. That is why budesonide as such will not suppress antibody formation unless used in very high doses orally.
Secondly, the window period in all people older than 18 months of age is 3-6 months. Since your child tested negative on all these tests, I would say that your child is safe and you dont need to worry that she is infected with any of these viruses.
Thirdly, antibiotics kill bacteria directly or indirectly. They have no effect on the formation of antibodies. That is why no matter what antibiotics she received, she should be good.
Next, immunization is a process where we usually give an antigen( a diluted version of a microbe ) to which our body produces antibodies and protects us. It stimulates the production of antibodies and can be expected to produce (if it does) a false positive ( which means the test is positive when the person is actually not infected) reaction. It will certainly not inhibit the formation of antibodies.
Finally, neither of these drugs can be expected to affect her test results.

As far as having recurrent infections are concerned, I would be concerned about her height and weight ( which can tell us about her nutritional status). For the recurrent cold and cough, it can be allergic ( which has a propensity to be recurrent) and would suggest that you keep a record of the time at which she falls ill and try and record what she has been exposed to during that time.
Also, plenty of vitamin C helps with allergies. Overall, a healthy and balanced diet and trying to identify and eliminate what your child is allergic to should be our first and foremost priorities.
Hope this helps.
I would be available for follow ups.
Regards
Above answer was peer-reviewed by
 
Follow-up: Infant had blood contamination incident. Why frequent runny nose, cold and cough? Will nasonex cause a wrong antibody test? 2 hours later
Dr. XXXXXXX
Thanks for your expertise and your time.

1) Could you please let me know if it is the same for the use of Nasonex(nasal shots) and so among her medications these Nasonex and budesonide(oral inhalation) are the steroids ?

2) Can you also let me know if the combination of these two Nasonex and budesonide have any effect on her HIV antibody test result and these Hep A, Hep B, Hep C test results?


The pediatrician tells us that she has allergies.

I became extremely worried because like i said before that incident, i rarely remember taking her to a doctor.

But after that incident, she is getting sick every month for so many days with runny nose and cough.

Thank you very much for all your help.
 
 
Answered by Dr. Aparna Kohli 8 hours later
Hi,
Thanks for writing back.
1) Nasonex contains mometasone which is also a steroid. So the things I mentioned above for steroids would apply to Nasonex as well
2) As I said, none of the medications that your daughter is taking can actually suppress the formation of antibodies against HIV. So if the tests are negative, you can be reassured that everything is fine.
As far as allergies are concerned, they have a propensity to be recurrent. As I said, the most important step would be to take care of the allergen. Also, humidifying the air within her room would also help. You can speak with her physician about other drugs like sodium cromoglycate and monteleukast. These drugs can help us wean her off steroids, something which I would personally recommend for your child.
Hope this helps. Please get back if you have any further questions.
I am glad I was able to help.
Regards
Above answer was peer-reviewed by
 
Follow-up: Infant had blood contamination incident. Why frequent runny nose, cold and cough? Will nasonex cause a wrong antibody test? 31 hours later
Thank you Dr. XXXXXXX

Lastly the tests were done two times one at 6 weeks after the incident and one time at 5 months 20 days. They did a western blot for HIV without doing a elisa for HIV i dont know why at 5 months 20 days. By mistake the WB was ordered instead of elisa i think.

Is a western blot test result reliable at 5 months 20 days?


Thank you.
 
 
Answered by Dr. Aparna Kohli 1 hour later
Hi,
Thanks for writing back.
A western blot test is one of the most reliable tests used in the detection of HIV AIDS. So if it is negative at 5 months and 20 days, you can be reassured that your daughter is fine.
I hope I have addressed your concerns.
Regards
Above answer was peer-reviewed by
 
Follow-up: Infant had blood contamination incident. Why frequent runny nose, cold and cough? Will nasonex cause a wrong antibody test? 2 days later
Dr. XXXXXXX
Thanks for your help. You explained it to me very clearly about the inhalation budesonie.

Finally i have some more concerns, please help me out.

I am uploading the report that i got. I tried to call the doctor office and ask the nurse if elisa was done, she says she doesn't know and that HIV AB, HIV1/HIV2, westernblot/immunoblot(final) is the panel they ordered.

If you see in the report it says HIV AB, HIV1/HIV2, westernblot/immunoblot(final).

So i don't know if an elisa or anything else was done before the westernblot, because i ready normally they do the WB only if the elisa is positive.
a) What do you think has been ordered according the report, is it just westernblot?
b) In the bottom of the HIV results it says this testing kit is not FDA approved. Should i be worried about that?
c) If you look in the second page of the report, it says under #2 for HIV2 notes in the end Testing for HIV1 should be considered. So i asked about this with the doctor when she gave me the report, she was telling me that it is a disclaimer, and that if acute HIV2 infection is suspected then testing for H1V1 should be considered. IS that what you think based on the report?
d) Since this contamination happened in a genetic clinic, what type of patients would normally come there, i am thinking problem in the genes like down syndrome etc.
Will these genetical problems be infected through a blood contamination incident?


Once again thank you for your precious time. This means a lot to me.
 
 
Answered by Dr. Aparna Kohli 45 minutes later
Hi,
Thanks for writing back.
1) yes, I think the test that has been ordered is just western blot. Immunoblot is also called Western blot and in the first panel, it reports the results for HIV-1 and then reports the results for HIV-2.
2) I think you should be concerned if the kit is not FDA approved. If your physician recommended this laboratory, then I think you can go along with the result. Else, it would be prudent to get your child tested again and make sure that the test ordered this time is an ELISA.
3) I think your daughter has already been tested for HIV-1. If you see the first page of the results, below the first result, is a disclaimer for HIV-1.
4) At a genetic clinic, we would generally have patients like women who are expecting a child and already have a child with an inherited problem like Down's syndrome or Edward's syndrome. Generally speaking, all women who are expecting are tested for HIV and can be taken as a group who is generally not infected with HIV. No, your child would not have a genetic problem if she was infected. These diseases are not transmitted in this fashion.
Given this scenario and your anxiety about this, I would suggest you take a second opinion from a paediatrician and get your child tested for HIV-1 and HIV-2. This should be done by ELISA. Also, make sure that she is tested with a kit that has been FDA approved.
Hope this helps
Regards
Above answer was peer-reviewed by
 
Follow-up: Infant had blood contamination incident. Why frequent runny nose, cold and cough? Will nasonex cause a wrong antibody test? 2 hours later
Thanks Dr. XXXXXXX
I also wanted to let you know that after the incident she was also tested at 6 weeks after the incident. The nurse practitioner called me and told that the results are negative. I do not know as to what test they did for HIV at that time.

I sent you the report of the recent test which was done at 5 months 20 days after the incident.
In that report it says "This test has been done by a kit that has not been federally approved or cleared by the FDA. The analytical performance characteristics of this test has been determined by Quest Diagnostics XXXXXXX institute San XXXXXXX Capistrano. This test should not be used for diagnosis without confirmation by other medically established means.

What does that mean? The testing was done in United States in a lab in California. Quest Diagnostics is a very big/prominent company in the United States. I do not know as to why they would use a kit that is not approved or cleared by the FDA.


Do you think i should consider testing one more time for her? Also this time do you recommend that i should give her a break like two or three months without any of these budasonide and then just get a Elisa? or Do you think just let it go and not worry about that incident?
 
 
Answered by Dr. Aparna Kohli 2 hours later
Hi,
Thanks for writing back.
“This test has been done by a kit that has not been federally approved or cleared by the FDA. The analytical performance characteristics of this test has been determined by Quest Diagnostics XXXXXXX institute San XXXXXXX Capistrano. This test should not be used for diagnosis without confirmation by other medically established means.”
This means that if this test shows a positive result for some person, we cannot be definitively sure that this particular person is HIV positive. Also, this test has not undergone rigorous testing as required by FDA and has been looked at only by their XXXXXXX institute.
If the kit is not FDA approved, I think we should be looking for a laboratory which is using a FDA approved kit. You should consider testing her one more time with this kit and you should make sure that the test done is an ELISA. Also, you need not stop her budesonide as this would not affect her test results.
Let me know if you need any more help.
Regards
Above answer was peer-reviewed by
 
Follow-up: Infant had blood contamination incident. Why frequent runny nose, cold and cough? Will nasonex cause a wrong antibody test? 6 hours later
Thank you Dr. XXXXXXX and i got worried and called the Quest diagnostics and the person on the phone told me that, All of our tests doesnt have to be approved by the FDA, but they are reliable tests. The person was also saying that FDA-approval is not a requirement for each and every test run at reference laboratories.

Do you think that the test kits that are not approved by FDA are not reliable at all especially when it is done in a prominent lab?

Now i am back to square one. Normally they use those FDA approved kits and it is a very big name laboratory here in the US. Very recently two weeks back my daughter had her four year immunizations. So i am worried to get her tested one more time. Already we had a rough one year of night mares after the incident.

But thank you very much for your help. I am not sure if i will get her tested in the near future especially with the immunizations done recently and with what we went through. But i will discuss this with our pediatrician and if my anxiety goes high then i might after couple of months. I will keep you posted either way. Thank you.
 
 
Answered by Dr. Aparna Kohli 17 hours later

Dear,

As current statistical data regarding sensitivity and specificity is performed using FDA approved kit, one cannot guarantee the results test performed using non FDA approved kit.

I understand your apprehension. In this context the decision to see your pediatrician for proper evaluation is good and should allay your fears about that incident.

It was my pleasure discussing with you. I will be glad to assist you in future too.

Thank you and Best Wishes
Above answer was peer-reviewed by
 
Follow-up: Infant had blood contamination incident. Why frequent runny nose, cold and cough? Will nasonex cause a wrong antibody test? 17 hours later
Thank you very much Dr. XXXXXXX From my first question itself, you explained me in detail and i wanted to review by giving the best review. But again i don't want to close this discussion, as i might want to ask you future questions, meaning if i want to have my daughter tested again for example after talking to my pediatrician.

When i called the Quest diagnostics, Nicols institute lab at San XXXXXXX Capistrano and the person told me that, All of our tests doesnt have to be approved by the FDA, but they are reliable tests and she was telling me that if you do not trust me, then talk to your doctor. I am waiting to talk to my pediatrician, which will happen only on Tuesday as it is the long weekend here.

But Dr. XXXXXXX because i am so concerned i was also trying to search in the internet and i found this WWW.WWWW.WW Could you check that link out? Someone else asked a similar question couple of years back.




 
 
Answered by Dr. Aparna Kohli 19 hours later
Hi,

I understand your anxiety and I am really sorry for that.

Reliability of a clinical test is understood based on the statistical data performed and maintained by FDA. Hence my earlier comments that we cannot completely guarantee the results of a clinical test performed using non standardized / non approved kits.

Your local clinicians can give you the final verdict on the reliability of the test as they after having seen reports of many patients would know whether or not to trust the standards of a particular laboratory.

Presuming this laboratory are trusted by many clinician in your locality, you can relax yourself and wait to see your doctor.

Being in India, I am not aware of the standards of Quest's laboratory, so I wish not to comment about the answer given by Dr. Fascine. However I do agree with his final statements about retesting using FDA approved kit, if that's the only means to allay your fears.

Hope this helps.

Thanks again.
Above answer was peer-reviewed by
 
Follow-up: Infant had blood contamination incident. Why frequent runny nose, cold and cough? Will nasonex cause a wrong antibody test? 16 days later
Dr. XXXXXXX
I thought i will leave it open until i talk to my pediatrician. I spoke to my pediatrician he said not to worry about the non approved FDA kit from Quest and that they are a very reliable lab here in the US.

Here are two more new things that came up.

The first time after the incident when they tested at 6 weeks, we got the result with in a day that the HIV test result and the Hepatitis test results were negative. The second time when they tested at 5 months and 20 days, the blood was sent from a Dallas lab to a California lab, and the test results took 12 days to get back. So i am thinking that the Elisa or any other screening test came as positive or they suspected something and that is why they sent it to the California laboratory. I spoke to my pediatrician about the non FDA approved kit, he said it is Quest, so there shouldn't be anything to worry about. I tried to talk to the lab, they wont answer to me, because of the HIPPA laws and they told me that if your doctor calls we can answer as to why a western blot was done? But we moved to a different city, so a different doctor.
If you see in the original report, the Hepatitis B, Hep C test and the liver test was done in a lab in Dallas.
a) So now i am even worried that (may be her elisa is positive) and western blot is negative at 5 month 20 days for my 3 and half year kid. Should i get her tested again?
b) Disregarding the FDA approval part(because they are saying that they are very reliable if it is Quest Lab), if elisa is positive and western if it is negative, is there anything i need to worry about.
c) I have noticed a white patch on her finger on the skin side(not the palm side) of the finger,


so today i took her to the pediatric dermatologist office.

My daughter has developed a small white patch on her finger two months back, the doctor told me that it is vitiligo. It is a tiny white spot.

This is the same guy who asked you the question about my 3 and half year old who had a blood contamination incident.

So now i am even more worried, as the doctor told me that Vitiligo is a autoimmune disease.

1) Is vitiligo a symptom of hiv infection?
2) Can Vitiligo get transferred through the blood contamination incident if the other patients blood has it?
3) Does Vitiligo affect her HIV antibody test result, as i heard that autoimmune conditions might delay the seroconversion and affect the HIV or the Hepatitis antibody test result? If so do i need to get a PCR done for my kid.

I just want to do what ever is best in the current situation and get it over with and see where my fate and destiny will end me up at.

I am also worried to get another antibody test because she recently got her immunizations may be a month back.

Please advise me.
 
 
Answered by Dr. Aparna Kohli 4 hours later
Hi,
Thanks for writing back.
I do understand your concern and I am glad I can help you put aside your worry.
a.)There is no need to get your child tested again. Even in the ELISA is positive , we dont confirm the presence of HIV infection. We follow it up with a Western Blot. If and only if the western blot is positive, we confirm the presence of HIV infection. This is because the Western Blot is a far more specific test than ELISA.
b) You do not need to worry about this aspect now. I can assure you that your daughter is just fine and there is nothing to worry about.
1) Vitiligo is not a manifestation of HIV infection. although cases of vitiligo have been reported in association with HIV, these cases had an advanced form of the disease. Apart from vitiligo, these people had other symptoms as well. Since your daughter does not fall into that category, there is no chance that her vitiligo is due to HIV.
2) She did not acquire vitiligo due to the blood contamination incident. It is an autoimmune condition and is not acquired like this.
3) I do not think vitiligo would affect her test results. For the test results to be affected, she would need to be severely immunodeficient or receiving some medications.
In my opinion, she does not need to be tested and your child is just fine. But I would still recommend a PCR in order to put your anxiety to rest. It would be worth the expense if it offers you some peace. You can be absolutely sure your child has no such conditions.
Hope this helps.
Regards
Above answer was peer-reviewed by
 
Follow-up: Infant had blood contamination incident. Why frequent runny nose, cold and cough? Will nasonex cause a wrong antibody test? 6 hours later
Thanks Dr. XXXXXXX Thanks for all your help and time.

I will ask the pediatrician to consider getting her tested using a PCR. Given the situation i am ready to do what ever it takes and expense was not an issue at all. The only thing i heard about PCR or viral loads is that there is a small percentage of a false positives.

a) Would you recommend any other alternate test? or if it is PCR can you tell me the name of the test?

b) If you are asking me about the other symptoms, it is the cold and cough that is frequently there. Even this white patch on her finger i noticed like 2 months ago, meaning 10 months after the contamination incident and then i noticed like it was growing a little bit, then we had it shown it to the pediatrician dermatologist, she said it is a tiny patch of vitiligo.
I do not know as to where that came from. The doctor has prescribed the topicort(steriod) cream 0.25 percent for the patch on the finger.

c) Considering her age, she got tested at 3 and half years, now she is 4 years, and the only steroid medication i can think of is her budasonide and some times Nasonex when you mentioned XXXXXXX I do not think vitiligo would affect her test results. For the test results to be affected, she would need to be severely immunodeficient or receiving some medications. XXXXXXX can i trust the reliability of her HIV antibody test result, because she was also receiving budasonide, some times Nasonex and now this vitiligo and considering her age. I know that you told me earlier that budasonide and Nasonex has no effect on the antibody production, but now with this Vitiligo and the mix of those medications is her antibody test reliable?
 
 
Answered by Dr. Aparna Kohli 31 minutes later
Hi,
Thanks for writing back.
a) Every test which is done has certain drawbacks. However, PCR remains the most sensitive test for picking up HIV. You would just need to go to a lab and tell them that you need a PCR for HIV. Different labs would be using different assays and if your physician is sure that Quest is a good lab, you can go back there.
b. Frequent cough and cold is common in children the age of your daughter. It is not something which would be attributable to HIV.
c) The steroids that she has received and the Vitiligo do not make any difference. Since she received only inhaled steroids and vitiligo is just about starting out, I dont think it would adversely affect her antibody test results. The results would remain just as reliable as before.
Hope this helps. Let me know if I can address any more concerns.
Regards
Above answer was peer-reviewed by
 
Follow-up: Infant had blood contamination incident. Why frequent runny nose, cold and cough? Will nasonex cause a wrong antibody test? 1 hour later
Thanks Dr. XXXXXXX
I know you have been very very helpful and i would like to rate a 5/5, but like i said i want to keep this query open, because i might just get my daughter retested and share the results for you.

I got very much worried when the first time they tested, we got the screening test result in a day and the second time they tested, i think there was some problem in the screening test and that is why it went to the other location and they did the next stage western blot confirmatory test. and now this white spot(vitiligo) issue.

and all these medications issues, from a month or so, the doctor has prescribed QVAR 40 mcg(beclomethasone dipropionate HFA, 40 mcg) instead of budasonide to be used with QVAR Actuator, it is like a puff, oral inhalation.

and i did not start her yet on the Topicor cream for that white spot.


Considering all these medications and the vitiligo issue and the recent immunizations, i am worried if i even want to get an HIV antibody test.

I will talk to our pediatrician requesting a PCR for HIV1 and HIV2.

Sometimes i feel like i am putting lot of stress to my wife and my child, by getting her retested and always being sad at home.

 
 
Answered by Dr. Aparna Kohli 2 hours later
Hi,
Thank you for the appreciation.
I would suggest that you get the PCR test done and get it over with once and for all. We dont want such a thing affecting your family life.
Take care
Regards
Above answer was peer-reviewed by
 
Follow-up: Infant had blood contamination incident. Why frequent runny nose, cold and cough? Will nasonex cause a wrong antibody test? 22 hours later
Thanks for the advice Dr. XXXXXXX

Is there any other test that looks for virus other than the PCR?

I am very much worried as i am reading every where that there is a 4 to 12 percent of false positive rates in a PCR test.

It has been one year now after that contamination incident, would you recommend me any other test or an antibody test?

Here the problem is that in reputed labs, the doctor has to order it, other wise they do not do it.
Any advice would help.
THank you,
 
 
Answered by Dr. Aparna Kohli 2 hours later
Hi,
Thanks for writing back.
The whole point of doing a test right now is that if in the extremely rare case that your daughter is HIV positive, we dont miss it. The sensitivity of the PCR is 100% which means this test picks up every single person with HIV. If this test is negative, I can say 100% that your daughter is not HIV positive. Routinely, this test is not used for diagnostic purposes and instead we use the regular antibody tests followed by western blots for diagnosis.
However, if in the extremely unlikely scenario that it is positive, it is not diagnostic of HIV infection. I would need to confirm it with other tests.
In my opinion, your daughter does not need the test. I would suggest that you let this go. If you are extremely stressed about this, get this test done.
Hope this helps.
Regards
Above answer was peer-reviewed by
 
Follow-up: Infant had blood contamination incident. Why frequent runny nose, cold and cough? Will nasonex cause a wrong antibody test? 4 hours later
Thanks Dr. XXXXXXX


I will decide and let you know. I will talk to the pediatrician. I will also share the results if i get this test done. I am hoping and praying that everything should be ok. Thank you very much for all your help.
 
 
Answered by Dr. Aparna Kohli 5 hours later
Hi,
Thanks for writing back.
I do hope this relieves you of your anxiety.
All the best
Regards
Above answer was peer-reviewed by
 
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