the index patient , a 26-year - old woman , was admitted to the infectious disease ward of a university hospital with a temperature of 40c and myalgias 3 days after she returned from a 3-week trip to cambodia and thailand . she was discharged in good condition after the fever subsided . on the day of admission of the index patient ( day 0i ) , a nurse sustained a needlestick injury with a hollow needle that had been used for drawing blood from the index patient . the needlestick resulted in a bleeding puncture wound that was immediately treated with an antiseptic . the index patient did not report any high - risk activity for hiv or hepatitis b virus , and the nurse had been immunized against hepatitis b virus . therefore , no specific postexposure prophylaxis was performed . the nurse had previously been in good health and had not traveled outside germany in the preceding 12 months . four days after the needlestick , headache , myalgias , and arthralgias developed in the healthcare worker , for which she took ibuprofen . seven days later , when she was experiencing an intense headache and noticed a macular rash on her trunk , she sought treatment from a local doctor ( day 0n ) . physical examination showed bilateral cervical lymphadenopathy . on day 2n , she visited our service , where dengue virus infection was diagnosed by using a light cycler ( roche diagnostics , mannheim , germany ) polymerase chain reaction ( pcr ) method . her symptoms lessened gradually over the course of 4 weeks , and she was on sick leave for 5 weeks . the time frame of the respective clinical presentation and the virologic results of the index patient and the nurse are shown in the figure ; laboratory data are presented in the table . time line of the signs , symptoms , and diagnostic tests in the index patient ( i ) and nurse ( n ) . ig , immunoglobulin ; eia , enyzyme immunosorbent assay ; pcr , polymerase chain reaction ; nd , not done . serologic studies were performed with the panbio dengue immunoglobulin ( ig ) m capture enzyme - linked immunosorbent assay ( elisa ) and panbio dengue indirect igg elisa ( panbio ltd . , brisbane , australia ) ( 3 ) ; arbitrary units relative to a simultaneously measured calibrator > rna was prepared from 140 l of serum by using the qiaamp viral rna mini kit ( qiagen , hilden , germany ) , according to the manufacturer s instructions . to detect specific dengue virus rna , we adapted a taqman - reverse transcription ( rt)-pcr ( 4 ) to detect any of the four serotypes by using the following : degenerated forward primer ( den fp ) , reverse primer ( den rp ) ; and probe ( den p ) : den fp 5aaggactagaggttakaggagaccc3  , den rp 5ggccytctgtgcctggawtgatg3  and the probe den p 5  fam - aacagcatattgacgctgggaragacc - tamra-3  . rt - pcr conditions for the light cycler ( roche diagnostics ) were : rt at 61c for 20 min , activation at 95c for 5 min , and 40 cycles of pcr at 95c for 15 s , 60c for 60 s. we used the rna master hybridization probes kit ( roche diagnostics ) with 500-nm primers and 200-nm probes . the kit includes an aptamer - blocked thermus thermophilus dna polymerase , which performs rt and , once the aptamer drops out at activation , hotstarts pcr amplification . this is the fourth reported case , to our knowledge , of nosocomial dengue virus transmission ( 57 ) and the first in which taqman rt - pcr was used to provide evidence of nosocomial transmission before the detection of an antibody response . the index patient had acquired a dengue virus infection in southeast asia and experienced typical symptoms . in particular , she was febrile on admission , when the needlestick injury of the nurse occurred . in the health care worker who sustained the injury , cephalgia and myalgias developed after an incubation period of 4 days . a typical rash appeared after 11 days , when she also had a severe headache . the absence of fever , the most common sign of dengue fever , is likely due to the administration of ibuprofen . however , the healthcare worker was on sick leave for 5 weeks with resulting socioeconomic consequences . the diagnosis was confirmed in both cases by both seroconversion and detection of dengue viral rna by taqman rt - pcr ; the latter gave positive results in both cases 3 and 6 days , respectively , before serum specimens were shown to contain antibody . dengue viremia is known to correlate well with the presence of fever ( 8) , which was the case in the index patient . our report illustrates the potential of percutaneous nosocomial transmission of dengue viruses . this risk is likely to increase with the increase in the number of dengue infections imported to countries where dengue viruses are not endemic