CJD infection linked to dura mater grafts
CJD infection linked to dura mater grafts
Japan cases bring total to 61 patients
Allograft patients in the United States who have rapidly progressive dementing illnesses consistent with Creutzfeldt-Jakob disease (CJD) should be reported through their respective local or state health departments to the Centers the Centers for Disease Control division of viral and rickettsial diseases, the CDC advises.1
Several cases of CJD recently described in Japan indicate that recipients of contaminated allografts may remain at risk for CJD at least 16 years after the procedure, the CDC reports. Analysis of a 1996 mail questionnaire survey of neurologic, psychiatric, and neuropathologic institutions throughout Japan identified 829 patients with CJD diagnosed by physicians during January 1979-May 1996. Those included 43 who had received a cadaveric dura mater graft during a neurosurgical (42) or orthopedic (1) procedure during 1979-1991. At least 41 of the patients received Lyodura brand dura mater grafts from the same processor, B. Braun Melsungen AG, the CDC reports. The company changed its collection processing procedures in May 1987 after the first CJD case linked to a graft was reported.2,3 The Japanese grafts had been processed before that time. Revised processing procedures included conversion from batch to individual processing of dura mater and treatment of each graft with 1.0 normal sodium hydroxide (NaOH).
The findings bring to 61 the number of Lyodura-associated CJD cases that have been reported worldwide, indicating an international outbreak of CJD associated with a single brand of dura mater grafts is larger than previously recognized and that recipients of contaminated grafts may remain at risk for CJD for years following receipt of grafts, the CDC states.
"Even stringent donor screening and processing of each dura separately to avoid possible cross-contamination may not completely eliminate the potential for an infectious graft," the CDC concludes. "In addition, the treatment of dura with NaOH may not inactivate all of the infectious agent that may be present. Therefore, surgeons should be aware of the possibly inherent risk for CJD transmission by dura mater grafts and may want to consider the alternative use of autologous fascia lata, fascia temporalis, or synthetic substitutes."
References
1. Centers for Disease Control and Prevention. Creutzfeldt-Jakob disease associated with cadaveric dura mater grafts Japan, January 1979-May 1996. MMWR 1997; 46:1066-1069.
2. Centers for Disease Control and Prevention. Rapidly progressive dementia in a patient who received a cadaveric dura mater graft. MMWR 1987; 36:49-50, 55.
3. Centers for Disease Control and Prevention. Update: Creutzfeldt-Jakob disease in a patient receiving a cadaveric dura mater graft. MMWR 1987; 36:324-5.
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