Link found between surgery and Creutzfeldt-Jakob disease
12 July 2010
A causal relationship between the onset of Creutzfeldt-Jakob
disease (CJD) and general surgery has been found by analysing decades of
Danish and Swedish electronic patient records .
CJD manifests itself in hereditary acquired; and sporadic forms,
or for unknown reasons, which accounts for the majority of cases.
"Based on monitoring records of spongiform encephalopathy in two
Nordic countries, we studied the possibility of transmission of the
sporadic form of CJD through general surgery", explained Jesús de
Pedro, main author of the study and head of prion monitoring in
patients at the National Epidemiology Centre of the Carlos III
Health Institute in Spain.
The finding, published recently in the Journal of Neurology,
Neurosurgery & Psychiatry, reveals that, with a few exceptions, the
risk of having contracted the sporadic form of CJD manifests itself
at least 20 years after having undergone an operation.
"While we are not ruling out the idea that intraoperational
transfusions may play a secondary part, the data suggest that the
disease enters and spreads much more quickly within the central or
peripheral nervous system", confirms De Pedro.
According to the authors, the fact that computer records of
surgeries have been in place since the early seventies in hospitals
in Sweden and Denmark enables operations on residents of those
countries to be linked to cases of CJD, which "extends an
extraordinary quality to the information and more credibility to the
findings given the almost total absence of memory bias".
The finding points to an external cause that could be prevented
and may signify a shift in our understanding of the nature of
neurodegenerative diseases, such as Alzheimer's or Parkinson's.
It also poses the question of whether other types of motor
neurone diseases can be transmitted through surgery and be latent
for decades, such as those where risk factors, particularly physical
professions and activities or certain sporting activities, for
example, which are more likely to lead to surgery, have already been
"Suggesting that a disease could have been acquired during health
care is a very delicate affirmation, as some relatives of patients
with sporadic CJD may be tempted to seek compensation from health
authorities for the alleged intraoperational transmission years
previously, which would be impossible to prove in individual cases",
Nonetheless, the most conclusive pattern that the study presents,
albeit based on few cases and one that must be replicated in future
studies, is that the onset of CJD occurs approximately 10 years
after an operation on the retina with reused equipment.
1. Jesús de Pedro-Cuesta, Ignacio Mahillo-Fernández, Alberto
Rábano, Miguel Calero, Mabel Cruz, Ake Siden, Henning Laursen,
Gerhard Falkenhorst, Kare Mølbak y el Grupo de Investigación
EUROSURGYCJD. Nosocomial transmission of sporadic Creutzfeldt-Jakob
disease: results from a risk-based assessment of surgical
interventions. J Neurol Neurosurg Psychiatry (2010).