Variant Creutzfeldt-Jakob disease: a cause for concern. Review of the evidence for risk of transmission through abdominal lymphoreticular tissue surgery.
BACKGROUND
Concern has long existed regarding the possible iatrogenic spread of variant Creutzfeldt-Jakob disease (v-CJD) through surgery. This had been fueled by recent reports of bovine spongiform encephalopathy in U.S. cattle and the first probable case of blood transmission of v-CJD in the UK.


METHODS
Systematic review of experimental and nonexperimental studies. Studies identified from searches of Medline, Embase, Cochrane Library, Science Citation Index medical databases, searching bibliographies of retrieved papers, and personal communication with international experts in the field.


RESULTS
Six articles satisfied our search criteria. Evidence stems from case reports, case series, and cross-sectional studies. There are no published cases of surgically transmitted v-CJD.


CONCLUSIONS
We found evidence of v-CJD prion agents in the spleen, appendix, rectum, and adrenal glands of affected patients and evidence of v-CJD prion in the appendix of patients in the preclinical stage of the disease. The risk of transmission of v-CJD prion during abdominal surgery is currently unquantifiable.
Olsen
S B
SB
Department of Surgical Technology and Oncology, Imperial College of Science, Technology and Medicine, St. Mary's Hospital, London W2 1NY, United Kingdom. s.olsen@imperial.ac.uk
Sheikh
A
A
Peck
D
D
Darzi
A
A
D000005:Abdomen / Q000601:surgery*; D007562:Creutzfeldt-Jakob Syndrome / Q000635:transmission*; D004724:Endoscopy / Q000009:adverse effects*; D004866:Equipment Contamination; D006801:Humans; D008221:Lymphoid Tissue / Q000601:surgery*; D012157:Mononuclear Phagocyte System / Q000601:surgery*; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*