OT: Surgical instruments spreading brain wasting disease
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"Teresa" ctfe...@homesweethome.com
Holy shit! I had no idea that any kind of pathogen could survive the sterilization process that is normally used on surgical instruments.
As it turns out, prions that cause Creutzfeldt-Jakob disease are not killed by steam sterilization, thus instruments used on a patient with this disease are capable of spreading the disease to every person who undergoes surgery with the same set of instruments.
Teresa - wondering how these prions can be killed?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Brain malady exposure feared Surgical instruments may have transmitted Creutzfeldt-Jakob disease to six patients By Jim Erickson and Tillie Fong, News Staff Writers Six Denver-area brain surgery patients may have been exposed to the rare and always fatal Creutzfeldt-Jakob disease at Denver's St. Joseph Hospital through possibly contaminated surgical instruments.
Two Denver-area residents also treated at the hospital died of the disease in January and February.
A 66-year-old Aurora woman was diagnosed with the disease on Dec. 11 and died in February, and a 70-year-old Lakewood man was diagnosed in January and died the same month, according to an official from Kaiser Permanente.
Doctors from Kaiser, a health maintenance organization, performed the surgery.
The type of Creutzfeldt-Jakob disease found in the United States is not linked to mad cow disease. In Europe, a variant form of Creutzfeldt-Jakob has been tied to the livestock disease and is believed responsible for 94 human deaths, said Dr. Cathy Van Blerkom, chairman of the department of pathology and infectious disease at St. Joseph.
Brain tissue was taken from the Aurora woman on Nov. 20 to determine what type of neurological disorder she had, said Dr. Bill Marsh, ***ociate medical director for Kaiser Permanente. Creutzfeldt-Jakob was not suspected at the time, and the tissue was sent to the Mayo Clinic in Minnesota for analysis.
An initial diagnosis of Creutzfeldt-Jakob disease, or CJD, was communicated to the hospital on Dec. 11. Instruments that may have been used in the brain biopsy were immediately quarantined, and the Colorado Department of Public Health and Environment was notified.
The diagnosis was confirmed in early January by a CJD expert at Case Western Reserve University in Cleveland.
Between Nov. 20 and Dec. 11, six people had brain surgery at St. Joseph using the same set of surgical instruments used on the Aurora woman. All six of those patients were over 62, said a Kaiser official at a Friday night news conference.
There is no test to determine whether a person has CJD, and there is no cure. Kaiser Permanente will track the six patients for many years to see if they develop the disease, Marsh said Friday night.
"We don't even know if these people have been exposed, and that's the hard part," he said. "We think the chances are very low, but I can't put a number on it.
Creutzfeldt-Jakob disease is very rare and causes a few hundred deaths in this country each year, Van Blerkom said. It normally strikes people between the ages of 50 and 70, and about 85 percent of the cases are of unknown cause and are referred to as "sporadic." Ten percent to 15 percent of the cases are transmitted within families. A small percentage of the cases are blamed on surgical procedures. But the federal Centers for Disease Control and Prevention in Atlanta has not received a report of surgically transmitted CJD in the past 20 years.
Victims usually die within a few months of diagnosis, Van Blerkom said.
The deaths of two people from CJD at the same hospital and within a few weeks of each other is extremely rare, Marsh and Van Blerkom said Friday night. The two deaths are unrelated, they said.
The Lakewood man came to the hospital with suspected CJD after suffering symptoms of neurological disease for several months. A brain biopsy was done on Jan. 10, and the diagnosis came back on Jan. 26.
St. Joseph tracks which surgical instruments are used on each patient, and there is no possibility that -- beyond the six people who were notified two weeks ago -- any other patients may have been exposed, Marsh said.
The instruments used in the Aurora woman's biopsy were chemically sterilized with sodium hydroxide and heat-sterilized in an autoclave afterward, which is standard procedure. Even so, there is a chance the protein that transmits CJD, called a prion, survived the sterilization and infected one or more of the six surgery patients, Marsh said.
Colorado health officials began tracking CJD in 1997. Three cases were reported here in 1998, two in 1999, four in 2000 and two so far in 2001, said John Pape, an epidemiologist with the state health department. All of the victims died.
State health officals are investigating two other possible cases of CJD.
Both people died in Colorado last year, and health officials are awaiting results on the diagnosis, Pape said.
March 24, 2001 ~~~~~~~~~~~~~~~~~~~~~~~~~~~ Instrument sterilization will fail Earliest spongiform brain disease seen in goats, sheep during 1700s By Dick Foster, News Southern Bureau Creutzfeldt-Jakob disease in humans, chronic wasting disease in deer and elk, and mad cow disease in cattle, belong to a family of diseases called transmissible spongiform encephalopathies, or TSEs.
The term spongiform describes the perforated spongelike condition of the brain found in its victims during autopsy.
Scientists saw the earliest version of spongiform disease in sheep and goats (called scrapie) in the 1700s, and besides deer, elk, cattle and humans, they now see it in minks, domestic cats and monkeys.
Creutzfeldt-Jakob disease, or CJD, remains rare. It infects two to five people annually in Colorado and one person per million worldwide.
A few cases of CJD are inherited. Some others have been caused by transplanting tissue from a diseased person. Still others were caused by a cornea transplant and human growth hormone injections.
The cause of CJD remains unknown for most human cases, which seem to erupt spontaneously in middle-age adults, killing them within eight to 10 months.
The destructive agent in all spongiform diseases, including CJD in humans, is not a virus or bacterium, but a kind of mutant protein particle called a prion that spreads through healthy brain and nerve tissue forming cavities and lesions.
The prion stubbornly resists traditional methods of killing infectious agents, including extreme heat used in sterilizing surgical instruments.
Scientists have transplanted the disease from one animal to another and from one species to another by implanting prions from diseased brains into the brains of healthy animals.
At Tulane University last year, surgical instruments used on a patient with a neurologic disorder were then used on eight other patients before the first patient was diagnosed with CJD and later died.
Now, say Tulane officials, all eight patients "may have been exposed to CJD" and "might have some risk of contracting it." The CJD risk is "not eliminated by normal sterilization protocols." Scientific evidence strongly links one new human strain called "new variant" CJD to mad Cow disease.
The human victims in Britain who died of new variant CJD years after eating the meat of diseased cows -- most likely brain, central nervous system and lymphatic tissue ground into hamburger and sausages -- were found to have similar patterns of damaged brain tissue as the cattle.
Those patterns were significantly different from those in traditional human CJD.
March 24, 2001
geo ...@apan.org (George Byrd)
In <alt.true-crime>, Sat, 24 Mar 2001 13:54:46 GMT, on "OT: Surgical instruments spreading brain wasting disease" "Teresa" <ctfe...@homesweethome.com> wrote: Prions are protein fragments. Isn't there some question of whether they're "alive" in the ordinary sense of the word?
Do they "reproduce" in the sense of hijacking some DNA or RNA synthesis process in a cell to make more of them, like viruses do? Or do they act more-or-less as a catalyst and cause some protein cleavage or metabolic process to chop up existing proteins into duplicates of them? Or neither? Or both?
I'm asking, not debating. I've never seen a definitive explanation of exactly what prions actually do.
GB <-- not falling asleep near any suspicous looking peapods just in case
--
Opinions above are NOT those of APAN, Inc. & are NOT legal advice.
"However, this would be severe topic drift except for the fact that floorwax has more nutritional value then McD's burgers." << Lon Stowell, in AFU, 1/22/98 >>
Samuel Sands ssa...@bellsouth.net
Suspicious looking peapods? You mean there's another type?
Sam (suspicious of all legumes) Sands
indigo ...@aol.comfounditallanyway (Anne Warfield)
This stuff is scary! I remember reading in _The Coming Plague_ that there now exist microbes that can live in bleach. ::shudder::
--
Anne Warfield http://www.goodsol.com/cats/
Samuel Sands ssa...@bellsouth.net
Well, they're welcome to it. I'm staying right were I am.
Sam (at least 'til the lease is up, then I'll consider bleach) Sands
"Teresa" ctfe...@homesweethome.com
From what I understand, prions are abnormally shaped protiens which cause normal protiens to take on their strange shape. These prions then allow the brain tissue to become spongy which allows the brain to take on too much fluid. It sounds way too simple a process to me, but that may be why it is so hard to stop it.
I found this little demo that you might want to watch: http://www.msnbc.com/modules/Newsweek/mad_cow/default.html Teresa
Samuel Sands ssa...@bellsouth.net
Wow? Great link, Teresa. That little animation really was informative. And scary. :^( Sam (hiding under the bed) Sands
"Teresa" ctfe...@homesweethome.com
So as not to muddy the waters, I'll quote here from this URL: http://www.sciam.com/askexpert/medicine/medicine14.html <quote> Susan Lindquist is a researcher at the Howard Hughes Medical Institute, located in the department of molecular genetics and cell biology at the University of Chicago. She responds: "'Prion' is a term first used to describe the mysterious infectious agent responsible for several neurodegenerative diseases found in mammals, including Creutzfeldt-Jakob disease (CJD) in humans. The word itself derives from 'proteinaceous infectious particle'; it refers to the initially heretical hypothesis that the infectious agent causing those diseases consists only of protein, with no nucleic acid genome. (All previously known pathogens, such as bacteria and viruses, contain nucleic acids, which enable them to reproduce.) The prion hypothesis explained why the mysterious infectious agent is resistant to ultraviolet radiation, which breaks down nucleic acids, but is susceptible to substances that disrupt proteins.
"A major breakthrough occurred when researchers discovered that the infectious agent consists primarily of a protein found in the membranes of normal cells, but in this case the protein has an altered shape, or conformation. Some scientists hypothesized that the distorted protein could bind to other proteins of the same type and induce them to change their conformation as well, producing a chain reaction that propagates the disease and generates new infectious material. Since then, the gene for this protein has been successfully cloned, and studies using transgenic mice have bolstered the prion hypothesis. The evidence in support of the hypothesis is now very strong, though not incontrovertible.
<unquote> Here are a couple more good sites to check out: http://www.nmia.com/~mdibble/prion.html http://www.cyber-dyne.com/~tom/misfolding_review.html Teresa
"Teresa" ctfe...@homesweethome.com
Better read the list of ingredients on your herbal supplements.
I sure wouldn't want to be ingesting cow brains right about now.
Teresa ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Supplements Raise Mad Cow Concerns By LAURAN NEERGAARD .c The ***ociated Press WASHINGTON (AP) - Dr. Scott Norton was browsing through herbal supplements when he spotted bottles containing not just plants but some unexpected animal parts: brains, testicles, tracheas and glands from cows and other animals.
The Maryland physician sounded an alarm: How can Americans be sure those supplements, some imported from Europe, are made of tissue free from mad cow disease?
Norton's complaint has government scientists scrambling to investigate a possible hole in the nation's safety net against mad cow disease and its cousin that destroys human brains.
Mad cow disease, or bovine spongiform encephalopathy, has never been found in this country. Nor has the human ``new variant Creutzfeldt-Jakob disease'' that people in Britain, France and Ireland caught apparently from eating BSE-infected beef. The government has taken steps to guard against BSE spreading here, such as banning the importation of European beef imports and the use of even domestic cow remains in U.S. cattle feed.
But critics are pointing to some loopholes far removed from beef: Just what dietary supplements or bulk ingredients containing cow brain or nerve tissue might be slipping from Europe through U.S. ports?
Recently, the Food and Drug Administration quietly cracked down on some vaccine manufacturers after discovering they improperly imported certain European animal-derived ingredients. Supplements are far less closely regulated, and the FDA inspects less than 1 percent of all imports under its jurisdiction.
``It would not be difficult for a manufacturer of a dietary supplement to obtain a cow brain in Britain, crush it up, dry it up, and then if they wished get it into this country,'' contends Dr. Peter Lurie, a physician and consumer advocate who is one of the FDA's independent scientific advisers on BSE.
As for FDA catching such imports, ``if they find anything, it's good luck.'' Adds Dr. Paul Brown, the FDA advisers' chairman and a BSE expert at the National Institutes of Health: ``The worry is not that we're getting all kinds of cow brain from mad cows into this country. The worry is that we could, without knowing it,'' because the FDA lacks resources or authority to strongly police supplements.
Nor are imports the only loophole worry. Animals other than cows get similar brain diseases, including ``chronic wasting disease'' that afflicts deer and elk in certain Western states and scrapie in sheep.
Yet Norton discovered supplement labels that don't reveal which animal the tissue came from, or the country of origin. Some don't even clearly label animal tissue, merely listing ``orchis,'' for example, as an ingredient few laymen would recognize means testicles.
But of most concern are spinal cord and brain tissue, including glands found in the brain. Brown reads from one supplement label that promised half a gram of imported raw cow brain.
FDA officials contend the issue isn't a huge concern. They note the majority of supplements are made from plants, not animals.
They also insist bovine-containing supplements mostly are made from safe U.S.
cattle, citing an FDA prohibition on certain cow-derived imported ingredients
- although they couldn't say how well inspectors enforced that import policy.
Still, the agency recently wrote supplement makers that it ``strongly recommends'' they take ``whatever steps are necessary'' to ensure products don't contain ingredients of concern.
``Our radar is on alert. We're actively reviewing'' the issue, said FDA supplement chief Christine Lewis, promising to make public her office's ultimate findings. So far, she said, ``we have minimal evidence there's a problem.'' The industry's Council for Responsible Nutrition also calls the worry exaggerated, saying gland-containing supplements account for less than 1 percent of sales. Officials are trying to determine how much is imported and plan to meet soon with FDA.
Meanwhile, what's a concerned consumer to think? The FDA's Robert Moore suggests calling supplement makers to ask their source of animal tissue.
``Just as if they're buying a car they need to be active participants in buying these things.'' Lurie is more blunt: ``I'm not taking any brain extracts, not a chance.'' EDITOR'S NOTE - Lauran Neergaard covers health and medical issues for The ***ociated Press in Washington.
On the Net: http://www.fda.gov/oc/opacom/hottopics/bse.html and http://www.fda.gov/cber/bse/bse.htm
geo ...@apan.org (George Byrd)
In <alt.true-crime>, Sat, 24 Mar 2001 23:31:24 GMT, on "Re: OT: Surgical instruments spreading brain wasting disease" "Teresa" <ctfe...@homesweethome.com> wrote: [snip quotes] The Newsweek animation illustrated well the mechanisms described in <http://www.nmia.com/~mdibble/prion.html>.
These things remind me of the Borg in StarTrek -- they don't reproduce, but convert other things into themselves.
Thanks a bunch for the information and URLs.
GB <-- hoping somebody invents a subspace disruptor to knock 'em out
"Teresa" ctfe...@homesweethome.com
Thanks, Sam. Glad you enjoyed it.
I've always prefered stories with pictures myself.
Teresa
"Teresa" ctfe...@homesweethome.com
Well, I found the answer to my question. In case anyone else here is interested, here it is: <quote> Table C Effective Prion Deactivators Autoclaving @ 134C/275F for One Hour Cleaning Instruments and Equipment with 2.5-5% NaHypochlorite for 24 Hours.
Incineration 1MNaOH, 24 Hours (ANA Recommendation) 3-6 Guanidumiun Isothiocynate (3M 24 Hours; 4M 1 Hour; 6M 15 Minutes) Boiling 3% NaDODECYL SULFATE (SDS) 10 Minutes (Robert-Koch Institute, 1996) Because the TSEs present such unique and unconventional challenges for containment, decontamination, and sterilization, careful planning is required in preparation for invasive procedures to be performed on these patients. The College of American Pathologists recommends that all brain biopsies for dementia should be handled as possible CJD cases. (Crain, 1998) That recommendation should be the first criteria stated in a policy and procedure for case containment of suspected CJD cases.
Table D is a consolidation of recommendations found in current literature for case containment in suspected CJD cases.
Table D Recommendations for Case Containment of Suspected Creutchfeldt-Jakob Patients .
Surgery Room Preparation Remove all unnecessary equipment Use as many disposable items as possible Use disposable linen Close and seal all room cabinets Schedule the case as the last case of the day Intra-Operative Do Not use Gas Sterilizable Only Instrumentation Irrigate any Percutaneous Exposure to Fluid and Tissue with 0.5% Bleach Use Outside Circulator to Obtain Needed Supplies Use of Power Instrumentation is NOT Recommended Use Waterproof Shoe Covers and Remove Before Leaving Room Post-Operative Clean All Instruments in the OR Suite using usual Cleaning Products Sterilize Instruments in the Substerile Room Autoclave as follows: Gravity Style Autoclave: 132*, 60 minutes Prevacuum Style Autoclave: 134*C 18 minutes Following Initial Sterilization, instruments can be returned to the Central Processing Unit for the usual decontamination process: Decontamination in the washer/sterilizer/decontaminator ***embly and wrapping Terminal Sterilization Fluids: All fluids in the room should be treated with bleach and disposed of according to local health codes.
If fluids are disposed of in a hopper, care must be taken to avoid aerosols during the flush cycle and the hopper must be thoroughly cleaned with bleach following the flush cycle.
Some recommend that liquids be incinerated, including wash water.
All room surfaces and equipment must be wiped down with bleach or Sodium hydroxide after the procedure. This may require specially trained staff since these are hazardous materials.
Although the main focus of this article is for nursing care and concerns for the patient suffering from CJD this author believes that the policy and procedures for this disease needs to be comprehensive. Table E is summation of CJD recommendations from the College of American Pathologists (Crain, 1998). (Click here to download a copy of Table E separate from this article) <unquote> Teresa - hoping I don't need brain surgery anytime soon
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