About 1 in 6 patients with Creutzfeldt-Jakob disease (CJD) undergo surgery, raising the risk of iatrogenic transmission of this rare but universally fatal prion disease.
In a retrospective analysis, researchers found that 26 of 121 (21%) patients with probable or definite CJD at four US academic medical centers underwent a total of 55 procedures.
These included high-risk procedures for two patients with neuropathologically proven CJD. One underwent ophthalmic artery aneurysm clipping for unruptured aneurysm, and the other underwent diagnostic brain biopsy.
"The findings were definitely surprising to me and my team ― particularly the high frequency with which patients with an irreversible and particularly transmissible neurologic disease underwent invasive medical procedures either just before or shortly after the emergence of symptoms later attributed to CJD," study investigator Gregory Day, MD, with Mayo Clinic College of Medicine, Jacksonville, Florida, told Medscape Medical News.
The study was published online March 9 in JAMA Network Open.
Poor Infection Control
The investigators note that the majority of CJD cases are sporadic or are inherited, but research shows that prion transmission can occur via contaminated tissues or reusable medical equipment.
While the risk of iatrogenic transmission is highest following procedures involving the central nervous system, where prion burden is highest, experimental models suggest CJD transmission can occur after contact with other tissues, including nasal mucosa, lung, lymph nodes, and spleen, the researchers note.
