Possible exposure to Creutzfeldt-Jakob disease

[P_RN, ADN, RN]

http://www.kyw1060.com/news_story_detail.cfm?newsitemid=40812

An Atlanta Hospital Warns of Possible Infection Spread

Emory University Hospital in Atlanta is telling more than 500 patients they may have been exposed to a fatal brain disease though the actual risk is "remote."

The advisory comes after a brain surgery patient tested positive for a mad-cow like condition called Creutzfeldt-Jakob disease.

Officials say they are contacting 98 brain or spinal surgery patients who may have had contact with the surgical instruments that were used on the infected patient. They are also informing 418 patients who had other types of surgery.

The concern involves the naturally occurring, or sporadic, form of Creutzfeldt-Jakob disease -- not the variant form caused by eating mad cow-infected meat. Sporadic CJD, which has no known cause, causes dementia, loss of muscle coordination, and eventually death. Emory officials say they routinely sterilize all surgical equipment and have implemented even more thorough sterilization procedures.

I hope they are wrong. This is terrible

[Tweety, BSN, RN]

I took care of a patient that died of Creutzfeldt-Jakob disease a few years ago. I'd never heard of it until then and haven't seen it since. It's a horrible way to go. I hope those patients at risk are o.k.

[talaxandra]

We've had a similar case here - over 1000 patients were exposed, but there has apparently not been a case of non-variant CJD transmitted this way in over 30 years. In the Royal Melbourne Hospital case the patient had two neurosurgeries for an unrelated conditio, and developed CJD some months after the second op. If you think about it, given that the instruments have to be destroyed (because autoclaving etc doesn't destroy prions) this is only the first time authorities have been aware of exposure. Odds are that there's been contamination before, and there hasn't been a CJD outbreak, so I think the risk they describe (close enough to zero) is accurate.

Plus: there's no cure, and no way of detecting it before it becomes symptomatic.

I've looked after two patients with CJD and I agree with Tweety - not nice.

[Town & Country]

Officials say they are contacting 98 brain or spinal surgery patients who may have had contact with the surgical instruments that were used on the infected patient. They are also informing 418 patients who had other types of surgery.

Good grief, don't they autoclave surgical instruments?

[Elenaster]

Good grief, don't they autoclave surgical instruments?

I believe that CJD is caused by prions, which are primitive proteins that are not destroyed by standard sterilization techniques.

[babynursewannab]

Prions is correct, autoclaving doesn't kill them, and Emory is one of the top hospitals in the nation...they don't cut corners...it would risk their "image." (Not that this helps them). In fact Emory has the CDC next door. literally...out one door and you are on the CDC campus. These are hooked-up people.

I feel for the patient. Luckily, transmission chances are so low.

[lapappey]

If I am correct, a prion is a misshapen protein that induces other proteins in the body to conform it's shape to theirs. Unlike all other pathogens, there is no genetic information in a prion (like there are in viruses & bacteria), so conventional methods of sterilization, which are designed to destroy DNA or RNA, fail miserably.

Working in the OR and recovery room as a tech, I've seen a few of these cases ... seems like a terrible way to go. I can remember one incident, too, in which the regular instruments made it all the way onto the field before the surgeon popped an "oh, by the way, pt has CJD." Didn't go over well, as you can imagine ...

We lots of policy /p that one ... for suspected CJD cases we have disposable brain biopsy kits. But what's really scary is that if we have well over a hundred neuro cases a year, then the chances of a pt with CJD getting surgery for, say, an aneurysm or trauma---especially in an emergent situation, while still tiny, are growing ...

[Jo Dirt]

What are the symptoms of people who come in the hospital with CJD and why are they going in for brain surgery in the first place?

In countries that test for Mad Cow the average of infected cattle is 1:14. But the US routinely tests none. We know it has been in the sheep in this country since the 40's and that is a conservative estimate. It has more likely been in sheep forever, and people have been eating sheep for thousands of years, so there is something funny going on...someone doesn't want the real facts to come forth.

Interestingly, there has never been a case of a dog getting mad cow but cats get it and it is becoming common for a cat to contract this disease. There have been a lot of cases of mad cow disease in Kentucky, which seems to have come from people eating squirrel brains. I guess they fry the squirrel with the brain and all up there...yuck...

[Tweety, BSN, RN]

What are the symptoms of people who come in the hospital with CJD and why are they going in for brain surgery in the first place?

I'm no expert on this disease, but I believe the only way to definatively diagnose it is with a brain biopsy.

They can present with stroke like symptoms, speech problems, gait disturbances, just about any neuro symptom. Perhaps a lesion is then found on CT scan and it's biopsied later in the OR for diagnostics.

I'm talking from my one an only experience with it a couple of years ago, so anyone may feel free to correct me if I'm wrong. Thanks.

[talaxandra]

The index patient in Melbourne had a tumour - I believe he had two surgeries for debulking. I have no idea how they discovered he had CJD because, as Tweety said, you can only find it on brain biopsy. He died in May and the news was released a couple of weeks ago (the wait for the test is a less than a month). Maybe he had a really thorough autopsy...