Monday, August 18, 2014

Bilateral Hearing Loss Heralding Sporadic Creutzfeldt-Jakob Disease: A Case Report and Literature Review

September 2014 - Volume 35 - Issue 8 - p 1327-1329 doi: 10.1097/MAO.0000000000000485 Sensorineural Hearing Loss & Tinnitus
 
Bilateral Hearing Loss Heralding Sporadic Creutzfeldt-Jakob Disease: A Case Report and Literature Review
 
Salazar, Richard*; Cerghet, Mirela†; Ramachandran, Virginia‡
 
Supplemental Author Material Collapse Box Abstract Objective
 
To report a case of sporadic Creutzfeldt-Jakob disease (CJD) with bilateral hearing loss at onset and literature review of the scarce cases of CJD with similar audiologic manifestations at presentation.
 
Case Report
 
A 67-yr-old man presented to the hospital for evaluation of rapid progression of behavioral decline, unsteady gait, and bilateral hearing loss. Three months before admission, he abruptly developed bilateral hypoacusis without associated tinnitus or vertigo. Shortly after, his family noted an ataxic gait and behavioral changes, for example, paranoid delusions. Initial workup, including a complete autoimmune panel and heavy metals, infectious, toxicology, and paraneoplastic panel (e.g., anti-Hu, anti-VGKC), was conducted. Electroencephalography revealed diffuse generalized slowing without periodic complexes. The presence of distortion product otoacoustic emissions bilaterally was consistent with normal cochlear function, suggesting a retrocochlear origin for symptoms of hearing loss. In the meantime, the patient developed startle myoclonus. The brain magnetic resonance imaging demonstrated asymmetric cortical ribbon along with T2 FLAIR signal hyperintensities of bilateral basal ganglia. Later on, the protein 14-3-3 in the cerebrospinal fluid came back positive, which supported the diagnosis of CJD. Only three cases of CJD with deafness at onset have been published: one sporadic, associated with symptoms suggestive of polyneuropathy; and the other two familial, with the E200K mutation. One presented with symptoms of polyneuropathy and the other with typical features.
 
Conclusion
 
This case illustrates the phenotypic variability of presentation of CJD in a patient with hearing loss as the initial manifestation. In patients with subacute bilateral hypoacusis and signs of dementia, the differential diagnosis of CJD must be taken into consideration.
 
Copyright © 2014, Otology & Neurotology, Inc.
 
 
 
SepOct2012 | Audiology Today 53
 
The Case of Encephalopathy Presenting as Hearing Loss
 
By Emily Na irn, Virginia Ramacha ndran, and Brad A. Stach
 
Case History A 67-year-old male was seen in the emergency department, accompanied by his family. The patient was unable to communicate and could not give his own case history information. It was reported that both the patient and his wife developed flulike symptoms about two months earlier. His wife recovered, but the patient reportedly woke up one morning shortly after contracting the illness and stated that he was having “difficulty hearing.” At this time he also complained of a headache at the back of his head and base of his neck. Over the course of the next two months he began to experience confusion, gait problems, slurred speech, weight loss, emotional lability, and eventually, hallucinations. The patient’s family noticed a distinct progressive decline in hearing ability during this time, with the patient talking loudly. Due to the severity and progression of symptoms, the patient’s daughter, who lives in the United States, flew to his home in Central America, escorted her father back to the United States, and brought him immediately to the emergency department. The treating physician reported that the patient was “deaf” and was speaking loudly. At this time, the patient was admitted with a working diagnosis of “encephalitis” (inflammation of the brain).
 
SNIP...
 
And the Diagnosis Is… Creutzfeldt-Jakob disease
 
worsening hearing loss were instrumental in shaping the initial diagnostic picture for the treating physicians. Hearing loss is characteristic of Susac’s syndrome but rare in CJD, and this knowledge initially led the team to lean toward the former diagnosis, which has a very different prognosis and treatment strategy. In the end, audiologic evaluation results were only able to rule out extensive peripheral hearing loss, and we were 56 Audiology Today | SepOct2012 CSI: Audi ology unable to confirm or rule out the existence of retrocochlear or cortical hearing loss. As we are well aware, the existence of peripheral sensorineural hearing loss in the older population is pervasive, so the presence of such in this patient would not be diagnostically useful. However, the absence of peripheral hearing loss, while not ruling out Susac’s syndrome, can be helpful in the diagnostic equation, because it has been shown that the hearing loss characteristic of this disorder is peripheral and not central (Rennebohm et al, 2010). This case is illustrative of the challenges inherent in diagnosing rare disorders in the face of abnormal presenting symptoms. The due diligence that ultimately resulted in the determination of CJD demonstrates the value that can be found in a multidisciplinary approach to diagnosis.
 
SEE FULL TEXT ;
 
 
Familial Creutzfeldt–Jakob disease with E200K mutation presenting with neurosensorial hypoacusis
 
Creutzfeldt–Jakob disease (CJD) is characterised by rapidly progressive dementia, myoclonus, ataxia, visual disturbances and motor dysfunction. Neuropathological examination shows diffuse spongiosis, neuronal loss, gliosis and a variable degree of amyloid plaque deposition composed of protease-resistant prionic protein (PrPRES) in several locations, including the brain stem. The most frequent clinical presentations are dementia, ataxia or visual symptoms. Most of the cases are sporadic. Only 10–15% are familial, and the most frequent point mutation is E200K. The course of disease, investigation results and neuropathology are similar to those of the sporadic form of CJD. The typical clinical presentation of E200K is a rapidly progressive dementia with myoclonus and pyramidal, cerebellar or extrapyramidal signs.1 We report a familial case with an unusual onset, with deafness and polyneuropathy.
 
A 53-year-old man presented with subacute progressive bilateral hypoacusis, with tinnitus in the left ear. He was a frequent diver and the symptoms were attributed to barotrauma. During the following months, his hypoacusis worsened and he progressively developed bilateral stocking-type paresthaesia and gait instability. On examination, he was alert and cooperative, although communication was mildly affected because of the hypoacusis. He showed emotional lability; his speech was slow but fluent, and he was partially disoriented in time. Extrinsic ocular motility, cranial nerves and muscular strength were normal. Lower limbs showed mild hypertonia, right extensor plantar response, stocking-type hypoaesthaesia and hypopallaesthaesia, and moderate gait ataxia. An audiometric examination showed bilateral neurosensorial hypoacusis, and nerve conduction studies showed a mixed axonal polyneuropathy. Computed tomography and magnetic resonance imaging of the brain were normal and the electroencephalography (EEG) showed non-specific changes.
 
These symptoms led to an initial suspicion of a paraneoplastic disorder, and an examination for malignant disease was started. At this moment, we learnt that the patient’s mother had died of neuropathologically confirmed CJD; hence we conducted a CSF 14-3-3-protein detection test, which was positive. Serial EEGs showed repeated non-specific changes. Brain stem auditory evoked potentials (BAEPs) could not be performed, owing to lack of patient collaboration.
 
During the following 2 weeks, myoclonus appeared and rapidly generalised, mental status deteriorated and progressive ataxia confined the patient to bed. He died of respiratory infection 10 months after onset of symptoms.
 
Neuropathological examination showed neuronal loss, microspongiosis and astroglial and microglial proliferation predominantly in the isocortex, entorhinal cortex, and hippocampal CA1 region, striatum, amygdala and cerebellar cortex. Punctate, synaptic-like deposits of PrPRES in the cerebral and cerebellar cortices were found, as well as scattered large PrPRES deposits in the granular layer of the cerebellum. The mesencephalon did not show spongiosis, but gliosis in colliculum and periaqueductal grey matter were detected.
 
Marked neuronal loss and gliosis in the vestibular and cochlear nuclei were observed, associated with PrPRES deposition (fig 1). Western blot of PrPRES showed a three-band pattern, with an unglycated fragment migrating at 21 kDa, corresponding to PrPRES type 1. Genetic sequencing of PrP showed the presence of the E200K mutation in heterozygosis. No insertions or deletions were found in the 51–91 region. The patient was heterozygotic for the M/V polymorphism at codon 129.
 
Only two cases of CJD with deafness at onset have been published: one sporadic, associated with symptoms suggestive of polyneuropathy,2 and the other familial, with the E200K mutation and typical features.3 Other cases have been reported as presenting with auditory agnosia or with cortical deafness, and early involvement of the acoustic pathway was already detected through demonstration of progressive BAEP deterioration in patients with CJD who did not present deafness in the course of the disease.
 
The first case was that of a 71-year-old woman who presented with a sudden change in hearing and aural fullness, and a vague feeling of imbalance.2 Hearing loss and gait instability worsened rapidly Audiometry showed bilateral neurosensorial hearing loss, and BAEPs were initially normal. She later developed signs of polyneuropathy and mental deterioration, left homonynous hemianopsia and decreased vibratory and pinprick sensation. The second case was that of a 46-year-old Italian woman with the E200K mutation, who had rapidly worsening hearing loss.3 Three weeks later she developed an unstable gait, and her condition rapidly progressed to bilateral deafness, ataxia, myoclonus, pyramidal and extrapyramidal dysfunction, and mental deterioration. She died 6 months after the onset of the disease. Magnetic resonance imaging scans showed high signal areas, mostly in the caudate and putamen, EEGs showed periodic sharp-wave complexes, and protein 14-3-3 was present in the cerebrospinal fluid. Audiometric investigation showed bilateral sensorineural hearing loss, and BAEP abnormalities from the beginning seemed to confirm early brain stem involvement. The course of the illness, clinical features and EEG recordings were similar to those of the sporadic form of CJD.
 
Accumulation of PrP in the brain stem has been found to be an early pathological event in sporadic CJD, but these deposits are not necessarily associated with clinical symptoms or neuronal loss, and the brain stem seems to remain relatively resistant to the pathological process of sporadic CJD.4 Neuropathological changes in brain stem structures have been described in sporadic and familial CJD, associated with atypical onset, with gaze disorders and with fatal familial insomnia. Unfortunately, necropsy was not possible in the two patients with early deafness, and to our knowledge specific involvement of cochlear and vestibular nuclei has not been reported previously
 
Western blot of PrP showed a type 1 pattern in our case. This is the pattern usually observed in sporadic CJD M/M homozygotic at codon 129, and it has also been described in patients with the E200K mutation associated with the allele 129M in the mutated chromosome.5 It is not known whether the glycation pattern of abnormal PrP has an influence on phenotype. In our patient also, who was M/V homozygotic, the codon 129 status of the mutated allele was not investigated. This case illustrates the phenotypic variability of presentation of CJD, and describes the specific involvement of brain stem auditive nuclei in a patient with hypoacusis as the initial manifestation, thereby reflecting early brain stem involvement.
 
 
Prions 2005, pp 31-40 Dura mater related Creutzfeldt-Jakob disease in Japan: Relationship between sites of grafts and clinical features
 
T. Sato, M. Masuda, Y. Utsumi, Y. Enomoto, M. Yamada, H. Mizusawa, T. Kitamoto
 
 Summary
 
A nationwide survey documented 117 cases of Creutzfeldt-Jakob disease (CJD) transmitted from cadaveric dura mater grafts in Japan to September 2004. Of these, 110 patients were identified to have received the same type of lyophilized cadaveric dura mater graft during the period between 1978 and 1991. Incubation period from grafting to onset of symptoms varied from 16 months to 23 years, with most patients developing neurological symptoms after 2 to 15 years. We conducted q retrospective review of the full medical records of 107 of dura-related CJD (dCJD) patients. Patients were divided into two groups by site of neurosurgical or orthopedic procedure (supratentorial vs. infratentorial). Hemiparesis or hemianopsia developed as an initial manifestation in 31.9% of 47 patients with supratentorial grafts but did not develop among any of the infratentorial group (p<0 .0001="" 25.0="" brainstem="" but="" conversely="" diplopia="" div="" facial="" group="" hearing="" in="" infratentorial="" ipsilateral="" loss="" not="" noted="" nystagmus="" of="" or="" p="" paresis="" paresthesia="" seen="" supratentorium="" symptoms="" the="" were="">
 
 
Hearing loss as the initial presentation of Creutzfeldt-Jakob disease
 
July 31, 2004 by Priya Krishna, MD; Carol Bauer, MD, FACS
 
Abstract
 
Creutzfeldt-Jakob disease is a rare type of spongiform encephalopathy. Affected patients present with constitutional symptoms, which progress to severe mental deterioration and movement disorders. Dizziness is the most common early otologic symptom. Few reports in the literature describe patients with Creutzfeldt-Jakob disease who present with sudden-onset hearing loss as their primary symptom for seeking treatment. This paper discusses one such patient and reviews the clinical presentation, treatment options, and relevant literature.
 
 
J Neurol Neurosurg Psychiatry 1994;57:872-873 doi:10.1136/jnnp.57.7.872 Research Article
 
Research Article:
 
A case of Creutzfeldt-Jakob disease presenting with cortical deafness. E Tobias, C Mann, I Bone, R de Silva, J Ironside J Neurol Neurosurg Psychiatry 1994;57:7 872-873doi:10.1136/jnnp.57.7.872
 
SNIP...
 
In conclusion, this pathologically verified case of Creutzfeldt-Jakob disease presented with cortical deafness. This is, to our knowledge, the first description of such a presentation, and emphasises the variety of cortical disturbances with which this disease can present...
 
 
Sunday, December 15, 2013
 
FDA PART 589 -- SUBSTANCES PROHIBITED FROM USE IN ANIMAL FOOD OR FEED VIOLATIONS OFFICIAL ACTION INDICATED OIA UPDATE DECEMBER 2013 UPDATE
 
 
*** Singeltary reply ; Molecular, Biochemical and Genetic Characteristics of BSE in Canada Singeltary reply ;
 
 
10,000,000+ LBS. of PROHIBITED BANNED MAD COW FEED I.E. BLOOD LACED MBM IN COMMERCE USA 2007
 
Date: March 21, 2007 at 2:27 pm PST
 
RECALLS AND FIELD CORRECTIONS: VETERINARY MEDICINES -- CLASS II
 
PRODUCT
 
Bulk cattle feed made with recalled Darling's 85% Blood Meal, Flash Dried, Recall # V-024-2007
 
CODE
 
Cattle feed delivered between 01/12/2007 and 01/26/2007
 
RECALLING FIRM/MANUFACTURER
 
Pfeiffer, Arno, Inc, Greenbush, WI. by conversation on February 5, 2007.
 
Firm initiated recall is ongoing.
 
REASON
 
Blood meal used to make cattle feed was recalled because it was cross- contaminated with prohibited bovine meat and bone meal that had been manufactured on common equipment and labeling did not bear cautionary BSE statement.
 
VOLUME OF PRODUCT IN COMMERCE
 
42,090 lbs.
 
DISTRIBUTION
 
WI
 
___________________________________
 
PRODUCT
 
Custom dairy premix products: MNM ALL PURPOSE Pellet, HILLSIDE/CDL Prot- Buffer Meal, LEE, M.-CLOSE UP PX Pellet, HIGH DESERT/ GHC LACT Meal, TATARKA, M CUST PROT Meal, SUNRIDGE/CDL PROTEIN Blend, LOURENZO, K PVM DAIRY Meal, DOUBLE B DAIRY/GHC LAC Mineral, WEST PIONT/GHC CLOSEUP Mineral, WEST POINT/GHC LACT Meal, JENKS, J/COMPASS PROTEIN Meal, COPPINI - 8# SPECIAL DAIRY Mix, GULICK, L-LACT Meal (Bulk), TRIPLE J - PROTEIN/LACTATION, ROCK CREEK/GHC MILK Mineral, BETTENCOURT/GHC S.SIDE MK-MN, BETTENCOURT #1/GHC MILK MINR, V&C DAIRY/GHC LACT Meal, VEENSTRA, F/GHC LACT Meal, SMUTNY, A- BYPASS ML W/SMARTA, Recall # V-025-2007
 
CODE
 
The firm does not utilize a code - only shipping documentation with commodity and weights identified.
 
RECALLING FIRM/MANUFACTURER
 
Rangen, Inc, Buhl, ID, by letters on February 13 and 14, 2007. Firm initiated recall is complete.
 
REASON
 
Products manufactured from bulk feed containing blood meal that was cross contaminated with prohibited meat and bone meal and the labeling did not bear cautionary BSE statement.
 
VOLUME OF PRODUCT IN COMMERCE
 
9,997,976 lbs.
 
DISTRIBUTION
 
ID and NV
 
END OF ENFORCEMENT REPORT FOR MARCH 21, 2007
 
 
Friday, December 14, 2012
 
DEFRA U.K. What is the risk of Chronic Wasting Disease CWD being introduced into Great Britain? A Qualitative Risk Assessment October 2012
 
snip...
 
==================================
 
In the USA, under the Food and Drug Administration’s BSE Feed Regulation (21 CFR 589.2000) most material (exceptions include milk, tallow, and gelatin) from deer and elk is prohibited for use in feed for ruminant animals. With regards to feed for non-ruminant animals, under FDA law, CWD positive deer may not be used for any animal feed or feed ingredients. For elk and deer considered at high risk for CWD, the FDA recommends that these animals do not enter the animal feed system. ***However, this recommendation is guidance and not a requirement by law.
 
=================================
 
Animals considered at high risk for CWD include:
 
1) animals from areas declared to be endemic for CWD and/or to be CWD eradication zones and
 
2) deer and elk that at some time during the 60-month period prior to slaughter were in a captive herd that contained a CWD-positive animal.
 
Therefore, in the USA, materials from cervids other than CWD positive animals may be used in animal feed and feed ingredients for non-ruminants.
 
The amount of animal PAP that is of deer and/or elk origin imported from the USA to GB can not be determined, however, as it is not specified in TRACES. It may constitute a small percentage of the 8412 kilos of non-fish origin processed animal proteins that were imported from US into GB in 2011.
 
Overall, therefore, it is considered there is a __greater than negligible risk___ that (nonruminant) animal feed and pet food containing deer and/or elk protein is imported into GB.
 
There is uncertainty associated with this estimate given the lack of data on the amount of deer and/or elk protein possibly being imported in these products.
 
snip...
 
36% in 2007 (Almberg et al., 2011). In such areas, population declines of deer of up to 30 to 50% have been observed (Almberg et al., 2011). In areas of Colorado, the prevalence can be as high as 30% (EFSA, 2011).
 
The clinical signs of CWD in affected adults are weight loss and behavioural changes that can span weeks or months (Williams, 2005). In addition, signs might include excessive salivation, behavioural alterations including a fixed stare and changes in interaction with other animals in the herd, and an altered stance (Williams, 2005). These signs are indistinguishable from cervids experimentally infected with bovine spongiform encephalopathy (BSE).
 
Given this, if CWD was to be introduced into countries with BSE such as GB, for example, infected deer populations would need to be tested to differentiate if they were infected with CWD or BSE to minimise the risk of BSE entering the human food-chain via affected venison.
 
snip...
 
The rate of transmission of CWD has been reported to be as high as 30% and can approach 100% among captive animals in endemic areas (Safar et al., 2008).
 
snip...
 
In summary, in endemic areas, there is a medium probability that the soil and surrounding environment is contaminated with CWD prions and in a bioavailable form. In rural areas where CWD has not been reported and deer are present, there is a greater than negligible risk the soil is contaminated with CWD prion.
 
snip...
 
In summary, given the volume of tourists, hunters and servicemen moving between GB and North America, the probability of at least one person travelling to/from a CWD affected area and, in doing so, contaminating their clothing, footwear and/or equipment prior to arriving in GB is greater than negligible. For deer hunters, specifically, the risk is likely to be greater given the increased contact with deer and their environment. However, there is significant uncertainty associated with these estimates.
 
snip...
 
Therefore, it is considered that farmed and park deer may have a higher probability of exposure to CWD transferred to the environment than wild deer given the restricted habitat range and higher frequency of contact with tourists and returning GB residents.
 
snip...
 
 
The BSE surveillance and testing have also been proven to be flawed, and the GAO and OIG have both raised serious question as to just how flawed it has been (see GAO and OIG reports). North America has more documented TSE prion disease, in different documented species (excluding the Zoo BSE animals in the EU), then any other place on the Globe. This does not include the very likelihood that TSE prion disease in the domestic feline and canine have been exposed to high doses of the TSE prion disease vid pet food. To date, it’s still legal to include deer from cwd zone into pet food or deer food. Specified Risk Material i.e. SRM bans still being breach, as recently as just last month.
 
nvCJD or what they now call vCJD, another case documented in Texas last month, with very little information being released to the public on about this case? with still the same line of thought from federal officials, ‘it can’t happen here’, so another vCJD blamed on travel of a foreign animal disease from another country, while ignoring all the BSE TSE Prion risk factors we have here in the USA and Canada, and the time that this victim and others, do spend in the USA, and exposed to these risk factors, apparently do not count in any way with regard to risk factor. a flawed process of risk assessment.
 
sporadic CJD, along with new TSE prion disease in humans, of which the young are dying, of which long duration of illness from onset of symptoms to death have been documented, only to have a new name added to the pot of prion disease i.e. sporadic GSS, sporadic FFI, and or VPSPR. I only ponder how a familial type disease could be sporadic with no genetic link to any family member? when the USA is the only documented Country in the world to have documented two different cases of atypical H-type BSE, with one case being called atypical H-G BSE with the G meaning Genetic, with new science now showing that indeed atypical H-type BSE is very possible transmitted to cattle via oral transmission (Prion2014). sporadic CJD and VPSPR have been rising in Canada, USA, and the UK, with the same old excuse, better surveillance. You can only use that excuse for so many years, for so many decades, until one must conclude that CJD TSE prion cases are rising. a 48% incease in CJD in Canada is not just a blip or a reason of better surveillance, it is a mathematical rise in numbers. More and more we are seeing more humans exposed in various circumstance in the Hospital, Medical, Surgical arenas to the TSE Prion disease, and at the same time in North America, more and more humans are becoming exposed to the TSE prion disease via consumption of the TSE prion via deer and elk, cattle, sheep and goats, and for those that are exposed via or consumption, go on to further expose many others via the iatrogenic modes of transmission of the TSE prion disease i.e. friendly fire. I pondered this mode of transmission via the victims of sporadic FFI, sporadic GSS, could this be a iatrogenic event from someone sub-clinical with sFFI or sGSS ? what if?
 
Two decades have passed since Dr. Ironside first confirmed his first ten nvCJD victims in 1995. Ten years later, 2005, we had Dr. Gambetti and his first ten i.e. VPSPR in younger victims. now we know that indeed VPSPR is transmissible. yet all these TSE prion disease and victims in the USA and Canada are being pawned off as a spontaneous event, yet science has shown, the spontaneous theory has never been proven in any natural case of TSE prion disease, and scientist have warned, that they have now linked some sporadic CJD cases to atypical BSE, to atypical Scrapie, and to CWD, yet we don’t here about this in the public domain. We must make all human and animal TSE prion disease reportable in every age group, in ever state and internationally, we must have a serious re-evaluation and testing of the USA cattle herds, and we must ban interstate movement of all cervids. Any voluntary effort to do any of this will fail. Folks, we have let the industry run science far too long with regards to the TSE prion disease. While the industry and their lobbyist continues to funnel junk science to our decision policy makers, Rome burns. ...end
 
REFERENCES
 
Sunday, June 29, 2014
 
Transmissible Spongiform Encephalopathy TSE Prion Disease North America 2014
 
 
Tuesday, August 12, 2014
 
*** MAD COW USDA TSE PRION COVER UP or JUST IGNORANCE, for the record AUGUST 2014 ***
 
see history of record of either the biggest cover up of mad cow disease, or one of the biggest blunders of the mad cow debacle, just my opinion of the facts...tss
 
 
Monday, June 02, 2014
 
Confirmed Human BSE aka mad cow Variant CJD vCJD or nvCJD Case in Texas
 
 
Tuesday, April 01, 2014
 
*** Questions linger in U.S. CJD cases 2005, and still do in 2014 ***
 
 
Monday, August 18, 2014
 
*** Barriers to Creutzfeldt-Jakob Disease Autopsies, California and the USA
 
 
PLEASE REMEMBER ;
 
The Akron, Ohio-based CJD Foundation said the Center for Disease Control revised that number in October of 2004 to about one in 9,000 CJD cases per year in the population group age 55 and older.
 
HAVE YOU GOT YOUR CJD QUESTIONNAIRE ASKING REAL QUESTIONS PERTAINING TO ROUTE AND SOURCE OF THE TSE AGENT THAT KILLED YOUR LOVED ONE ???
 
if not, why not...
 
Friday, November 30, 2007
 
CJD QUESTIONNAIRE USA CWRU AND CJD FOUNDATION
 
 
 
2000 Terry S. Singeltary Sr.
 
just speaking of human TSE's; "different strains (of same disease), different routes of infection (of same disease), different infectivity levels (dose rate) of the (same disease) = different symptoms, different lengths of illness from 1st onset of illness to death, (of the same disease) + different cultures = different geographical locations = different strains (of same disease)...TSS"
 
see full text ;
 
 
p.s. for anyone wanting to read the old links, you will have to change the links with lyman in it, change lyman to madcow, leave everything else the same, and then copy and paste that link in the link window and it should work. the vegsource site was the first site I started documented the history of the usda inc. mad cow follies. it was before the blogs, before social media, and all that stuff. thank you to Jeff Nelson for allowing me to document this history, and keeping it on files for everyone to witness. this was the second message board. there was a first with Howard Lyman and Oprah Winfrey, but after the first trial, and before the second trial, they took the first website down, no history of that board is available, but when it came back after the second trial was victorious as well, then it just became a board for me to post science and history of the TSE prion aka mad cow type disease too. ...
 
SEE TRIAL;
 
 
example ;
 
'v' CJD could it be vaccineCJD???
 
 
change to ;
 
 
YOU can see the history of the USDAinc MAD COW FOLLIES HERE. remember, I was young and dumb, my manors were not to write home to mom about, but I was persistent in wanting to find the truth. ...
 
 
 
 
 
 
 
 
 
 
 
 
 
TSS

Creutzfeldt-jakob disease in Peru 2014 Report


versión impresa ISSN 1726-4634


Rev. perú. med. exp. salud publica vol.31 no.2 Lima abr. 2014


 


Reporte de Caso

Enfermedad de creutzfeldt-jakob en el Perú: reporte de once casos
Creutzfeldt-jakob disease in Peru: report of eleven cases
 
Luis Torres-Ramírez1,a, Jorge Ramírez-Quiñones1,b, Carlos Cosentino-Esquerre1,a, Miriam Vélez-Rojas 1,a, Martha Flores-Mendoza1,a, Diana Rivas-Franchini2,c, Rafael Suarez-Reyes1,a, Yesenia Núñez-Coronado1,a
1 Departamento de Enfermedades Neurodegenerativas, Instituto Nacional de Ciencias Neurológicas. Lima, Perú.
2 Departamento de Neuropatología, Instituto Nacional de Ciencias Neurológicas. Lima, Perú.
a Médico neurólogo; b médico residente de neurología; c médico patólogo.

RESUMEN
La enfermedad de Creutzfeldt-Jakob (ECJ) es una enfermedad neurológica fatal producida por la isoforma patológica de la proteína priónica humana. Se reporta las características clínicas de seis casos de la forma esporádica de ECJ con diagnóstico definitivo por histopatología, y cinco casos con diagnóstico probable, en pacientes atendidos en el Instituto Nacional de Ciencias Neurológicas del Perú. La edad de inicio en los casos definitivos fue de 55,8 años y, en los probables, de 59,6 años, con predominio del sexo masculino. El tiempo de enfermedad fue de 8,8 meses. Se encontró un EEG típico en 50% de los casos definitivos y 80% de los probables. La proteína 14-3-3 en líquido cefalorraquídeo fue positiva en un caso probable y los hallazgos típicos en resonancia magnética se observaron en dos casos probables. Todos los casos cursaron con una evolución clínica típica de la enfermedad, y se considera el primer reporte de ECJ en el Perú.
Palabras clave: Síndrome de Creutzfeldt-Jakob; Enfermedades por prión; Proteínas PrPSc; Priones; Perú (fuente: DeCS BIREME).

ABSTRACT
Creutzfeldt-Jakob disease (CJD) is a fatal neurological disease caused by pathological isoform of the human prion protein. Clinical features of six cases of the sporadic form of CJD with definitive diagnosis by histopathology, and five cases with probable diagnosis were reported in patients treated at the Peruvian National Institute of Neurological Sciences. The average age of onset in definite cases was 55.8 years and in probable cases was 59.6, mostly males. The average disease duration was 8.8 months. A typical EEG was found in 50% of definite cases and in 80% of probable. The 14-3-3 protein in cerebrospinal fluid was positive in a probable case, and typical MRI findings were observed in two probable cases. All cases studied had a typical clinical course of the disease, and it is considered as the first report of CJD in Peru.
Key words: Creutzfeldt-Jakob syndrome; Prion diseases; PrPSc proteins; Prions; Peru (source: MeSH NLM).

INTRODUCCIÓN
La enfermedad de Creutzfeldt-Jakob (ECJ) es la enfermedad por priones más común en humanos (1). Fue descrita por Hans Creutzfeldt en 1920 y Alfons Jakob, un año después, en cinco pacientes con características clínicas heterogéneas bajo el nombre de “seudoesclerosis espástica”. Walther Spielmeyer, en 1922, acuñó el término de ECJ (2). Es producida por la presencia en el parénquima cerebral de la isoforma patológica de la proteína priónica (PrPsc) la cual resulta del plegamiento anormal de la isoforma normal (PrPc) con mayor contenido de estructura de lámina beta y, por consiguiente, mayor resistencia a la digestión proteolítica y mayor agregación intracelular (3,4).
La ECJ se manifiesta característicamente por una demencia rápidamente progresiva y otros signos neurológicos (1). Existen cuatro formas etiológicas de la enfermedad en humanos: la forma esporádica (esECJ), familiar (fECJ), iatrogénica (iECJ) y la variante (vECJ), cada una con características particulares. La esECJ es la más común, representa alrededor del 85% de los casos de ECJ, con una incidencia anual de 1 caso/millón habitantes (5,6) y es producida por la generación endógena de PrPsc debido a plegamientos anormales aleatorios en la estructura de la PrPc, con mayor frecuencia en individuos con predisposición genética (4,7,8). El diagnóstico definitivo de esECJ se realiza mediante el estudio histopatológico; aunque mediante pruebas diagnósticas como el electroencefalograma, el análisis del líquido cefalorraquídeo y la resonancia magnética, se puede realizar un diagnóstico probable.
En el presente artículo se reportan las características clínicas de seis casos con diagnóstico definitivo por confirmación histopatológica y se describen los hallazgos en cinco casos probables de esECJ atendidos entre los años 1998 y 2013 en el Departamento de Enfermedades Neurodegenerativas del Instituto Nacional de Ciencias Neurológicas del Perú.
REPORTE DE CASOS
CASO 1
Varón de 64 años. Inicia con visión borrosa, mareos, inestabilidad para la marcha, alteración de la memoria e insomnio. Al examen se le encontró parcialmente orientado, con hemiparesia derecha y espasticidad, hiperreflexia y signo de Babinski presente, rigidez en hemicuerpo izquierdo, dismetría bilateral; apraxia y compromiso de memoria. En las semanas siguientes presentó mioclonías periorales y en miembros superiores, deterioro rápidamente progresivo de funciones superiores, signo del “miembro extraño” en miembro superior izquierdo (MSI), con postración ulterior. Falleció a los 9 meses de enfermedad. El estudio histopatológico mostró abundantes vacuolas en el neuropilo de la corteza cerebral, el cerebelo y los núcleos basales, asociado a gliosis extensa, compatibles con ECJ. No se realizó inmunomarcación de PrPsc.
CASO 2
Varón de 35 años. Tiempo de enfermedad de un año; caracterizado por ánimo depresivo, por lo que recibe fluoxetina. Meses después se añadió alteración de memoria (corto y largo plazo) y “fallas en la escritura” (escritura incorrecta de algunas palabras). Progresó con inestabilidad para la marcha, “olvidó la utilidad de las cosas” y presentó pérdida del cuidado personal. En la evaluación se le encontró bradipsíquico, desorientado, con conducta pueril, rigidez en hemicuerpo izquierdo, posturas distónicas, mioclonías generalizadas, presencia de reflejo de prehensión y palmomentoniano; fluencia verbal disminuida, repetición y nominación alteradas; apraxia ideatoria. En las semanas siguientes: cuadriparesia espástica hiperrefléxica con signo de Babinski bilateral llegando a estado de mutismo aquinético. Falleció a los 15 meses de enfermedad. Estudio histopatológico: marcada vacuolización neuronal asociada a gliosis reactiva en corteza y núcleos basales con distribución irregular.
CASO 3
Mujer de 64 años. Dos meses antes del ingreso presentó “temblor” de miembro superior derecho, inestabilidad para la marcha, alucinaciones visuales, dificultad para nominar objetos y labilidad emocional. Al examen, se encontró desorientada, con hemiparesia derecha espástica hiperrefléxica, mioclonías generalizadas a predominio de miembros superiores; en la evaluación de funciones superiores: afasia global. Cursó con evolución tórpida con crisis tónico-clónicas generalizadas y deterioro del nivel de conciencia. Falleció a los 6 meses de enfermedad. El estudio histopatológico evidenció gliosis reactiva con presencia de astrocitos gemistocíticos y moderada vacuolización neuronal en diferentes zonas del cerebro a predominio frontal.
CASO 4
Varón de 59 años. Tiempo de enfermedad de dos semanas; caracterizado por visión borrosa, inestabilidad para la marcha, “habla incoherente” e incontinencia urinaria. En la evaluación se encontró paciente parcialmente orientado, bradipsíquico, hipoactivo, con espasticidad generalizada; en la evaluación de funciones superiores: apraxia, agnosia, compromiso de memoria a corto plazo. Cursó con deterioro rápidamente progresivo de funciones superiores, presentó mioclonías generalizadas y evolucionó a estado de mutismo aquinético. Falleció a los 4 meses de enfermedad. Estudio histopatológico: en la corteza cerebral, el cerebelo y los núcleos basales, abundantes vacuolas de 5-10 micras a nivel del neuropilo, acompañada de abundante gliosis que reemplaza parénquima normal. Escasas neuronas de aspecto encogido y citoplasma eosinófilo intenso.
CASO 5
Varón de 69 años. Tiempo de enfermedad de cuatro semanas; caracterizado por insomnio, “no sabía el nombre de los objetos”, “olvidó la forma de comer y vestirse”, “habla incoherente”, episodios de autoagresión y desorientación. Al examen, se encontró paciente parcialmente orientado, hipoactivo, con temblor de reposo y postural en miembros superiores. Durante las semanas siguientes el cuadro progresó con hemiparesia derecha espástica hiperrefléxica, limitación en la supraversión de la mirada, afasia global y mioclonías periorales y en miembros superiores. Falleció a los 5 meses de enfermedad. Estudio histopatológico: corteza cerebral, cerebelo y núcleos basales con presencia focal de espongiosis de neuropilo, marcada gliosis, con astrocitos gemistocíticos y marcada ausencia neuronal.
CASO 6
Mujer de 54 años. Inició con “temblor” de reposo en miembro superior derecho, apatía, pérdida del cuidado personal, “lenguaje incoherente”, alucinaciones visuales y pérdida progresiva de la fluencia verbal. Al examen, se encontró desorientada, hipoactiva, con posturas distónicas episódicas, cuadriparesia hipertónica normorrefléxica, mioclonías generalizadas; a la evaluación de funciones superiores: afasia global. Semanas después entró en estado de mutismo aquinético. Falleció a los 13 meses de enfermedad. Estudio histopatológico: focos de espongiosis de neuropilo en corteza cerebral, cerebelo y núcleos basales, definida por vacuolas ovales y redondas de 5-10 micras acompañadas de pérdida neuronal severa y algunos astrocitos gemistocíticos.
DISCUSIÓN
La esECJ es de inicio tardío; la edad promedio de inicio en los casos reportados como definitivos fue de 55,8 años (35-64 años) y en los probables fue de 59,6 años (55-66 años), consistente con otros reportes que indican un pico de edad de inicio entre 55-75 años y una edad promedio de 61 años. De forma infrecuente se presenta en menores de 40 años (9), como en el caso 2. El 64% de los casos reportados fueron de sexo masculino aunque la esECJ afecta en igual proporción a ambos sexos (1).
La tercera parte de los pacientes con esECJ inicia la enfermedad con alteraciones cognitivas y/o conductuales; otro tercio inicia con signos de focalización neurológica (pérdida de la visión, ataxia cerebelosa, afasia o déficit motor), y un tercio restante con síntomas inespecíficos como: fatiga, disminución de apetito, alteraciones del sueño o del humor (1,4). Cuatro de los casos definitivos tuvieron signos neurológicos focales como forma de presentación (visión borrosa y temblor) y dos presentaron insomnio y alteración del humor. En los casos probables, dos iniciaron con signos neurológicos focales, dos con alteraciones del sueño y del humor y uno con compromiso cognitivo. Posteriormente, la mayoría de pacientes con esECJ desarrolla una demencia rápidamente progresiva, disfunción cerebelosa, alteraciones visuales como alucinaciones, agnosia visual y ceguera cortical; y mioclonías espontáneas o inducidas las que suelen estar presentes en alrededor del 90% de casos en fases finales de la enfermedad. El 91% de los casos cursó con mioclonías y el 73% con compromiso visual y/o cerebeloso.
Al igual que en todos nuestros casos, más del 70% individuos con esECJ presentan signos de disfunción piramidal y extrapiramidal (hiperreflexia, espasticidad, rigidez, temblor) y síntomas de depresión (10) durante el curso de la enfermedad. Dos casos presentaron crisis convulsivas, manifestación reportada de forma infrecuente (11). Seis casos (tres definitivos y tres probables) presentaron al final de la enfermedad un estado de mutismo aquinético, dato consistente con la literatura que reporta cifras entre el 30 y el 100% (10). El caso 1 cursó con el signo del “miembro extraño” en el MSI, el cual es un signo infrecuente, que afecta con mayor frecuencia los miembros del lado izquierdo y puede ser el síntoma inicial de la enfermedad (12). Esta heterogeneidad fenotípica en la forma de presentación y en el curso del esECJ ha sido relacionada a los diversos polimorfismos en el codón 129 del gen PRNP y a las características fisicoquímicas de la PrPsc (13).
El tiempo total de enfermedad (hasta la muerte) es más corto en los pacientes con esECJ comparado con la vECJ. Aproximadamente el 90% de casos de esECJ fallece antes del primer año de enfermedad (1). El promedio en nuestros casos definitivos fue de 8,6 meses y en los probables fue 9 meses, cifras ligeramente mayores a las encontradas en la literatura que las ubican en un rango de 5 a 8 meses en los casos de esECJ. Dicho hallazgo se debe a la presencia de fenotipos no clásicos entre nuestros casos, en los cuales según la literatura el promedio de duración de enfermedad es entre 6 a 17 meses según el polimorfismo encontrado (4).
El diagnóstico probable de esECJ según los criterios actuales propuestos por Zerr et al. requiere la presencia de un síndrome demencial rápidamente progresivo y dos signos clínicos (mioclonías, disturbios visuales y/o cerebelosos, signos piramidales/extrapiramidales y mutismo aquinético) asociados a hallazgos típicos en por lo menos una prueba complementaria y la ausencia de un diagnóstico alternativo. Las tres pruebas complementarias son: el electroencefalograma (EEG), el análisis del líquido cefalorraquídeo (LCR) y la resonancia magnética (RM) cerebral (4,11,14). Según el estudio de Zerr et al., la combinación de los resultados de estas pruebas alcanza una sensibilidad y especificidad de 98 y 71% respectivamente (14). Las características clínicas y los hallazgos en las pruebas complementarias de nuestros casos definitivos y probables están descritos en la Tabla 1 y 2 respectivamente.


En la forma esECJ, el EEG típicamente muestra complejos periódicos o pseudoperiódicos generalizados de ondas agudas bifásicas o trifásicas de 1-2 ciclos/segundo que se observan con mayor frecuencia en las fases avanzadas de la enfermedad (11) y según Gao et al. se encuentran en el 63,5% de los casos (llegando al 90% en casos con mioclonías) (10). Se realizó un EEG a todos nuestros casos encontrándose los complejos típicos en el 80% de los casos probables y en el 50% de los definitivos (Figura 1), probablemente debido a que en los casos definitivos se realizó el EEG de forma más temprana.

El estudio del LCR muestra una discreta elevación del nivel de proteínas sin incremento de la celularidad (hallazgo no siempre presente) y se pueden encontrar bandas oligoclonales IgG. El análisis de algunas proteínas, como la proteína 14-3-3, es útil y su elevación en LCR representa daño neuronal aunque no es específico de ECJ (15) y tiene una mayor sensibilidad en la esECJ que en las otras formas. Según Chohan et al. la proteína 14-3-3 tiene una sensibilidad de 86% y una especificidad de 74% en fases avanzadas de la enfermedad (16). Se realizó la detección de la proteína 14-3-3 en tres de nuestros casos y solo en uno fue positivo. No se realizó en los demás casos por la reciente disponibilidad en nuestro país y alto costo de la prueba. Existen otras proteínas, como la proteína tau, la enolasa neuronal específica y el marcador astrocítico s100b que han mostrado una sensibilidad cercana a la proteína 14-3-3 y su combinación con esta muestra mayor especificidad (16).
En la mayoría de casos de esECJ la tomografía cerebral es normal o muestra diversos grados de atrofia cerebral. En la RM, las anomalías en los protocolos de difusión y FLAIR forman parte de los criterios diagnósticos actuales de ECJ probable. En esECJ, es característica la hiperintensidad bilateral del núcleo caudado, putamen, tálamo y áreas de la corteza cerebral, hallazgos presentes entre el 81 y el 91% de casos (14,17). Se realizó la RM con los protocolos mencionados en siete de nuestros casos y se observaron los hallazgos típicos en dos de los casos probables.
El diagnóstico definitivo de la ECJ solo puede ser realizado mediante el estudio histopatológico. Macroscópicamente, se observa distintos grados de atrofia cerebral y cerebelosa. En la microscopia de los pacientes con esECJ, tinciones como la hematoxilina-eosina, muestran la triada característica de vacuolización intracitoplasmática (cambio espongiforme), marcada pérdida neuronal y gliosis en zonas de la corteza cerebral, cerebelo y núcleos basales (18). Previa autorización del familiar directo, se realizó el estudio histopatológico post mortem a seis de nuestros casos y se observaron dichos cambios en todos nuestros casos definitivos (Figura 2). No se encontraron placas amiloides rodeadas de cambios espongiformes, típicas de la vECJ.

Existen reportes de esECJ en varios países de Sudamérica y se ha implementado un sistema de vigilancia de ECJ en países como Chile, Argentina, Uruguay y Brasil, con el objetivo de detectar de forma oportuna los casos de ECJ (en especial los de vECJ) debido a su riesgo potencial de transmisión. Actualmente la ECJ no forma parte de las enfermedades de notificación individual del sistema nacional de vigilancia epidemiológica del Perú por lo que sugerimos su inclusión.
En conclusión, se presentan seis casos de la forma esporádica de ECJ con diagnóstico definitivo por confirmación histopatológica, y cinco casos con diagnóstico probable, de ascendencia amerindia en Perú. Debe considerarse esta enfermedad en individuos mayores de 50 años, con una demencia rápidamente progresiva asociada a mioclonías, síntomas visuales y cerebelosos, con signos de disfunción piramidal y extrapiramidal. A pesar que el diagnóstico final es histopatológico, existen pruebas complementarias disponibles actualmente que ayudan a identificar con precisión y rapidez esta enfermedad.
Contribuciones de autoría: LTR, JRQ y CCE, participaron en la concepción, diseño, redacción y en la aprobación de su versión final. LTR, JRQ y DRF participaron en la recolección, análisis e interpretación de datos. LTR, JRQ, CCE, MVR, MFM, DRF, RSR y YNC participaron en la revisión crítica del artículo.
Fuentes de financiamiento: autofinanciado.
Conflictos de interés: los autores declaran no tener conflictos de interés.
 
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Correspondencia: Luis Torres Ramírez
Dirección: Jr. Ancash 1271 Lima 1 Perú.
Teléfono: 4117700 – Anexo 232
Correo electrónico: torresramirezl@hotmail.com
 
Recibido: 29-11-13
Aprobado: 12-03-14





  • April 29, 2014
    • Poster Session II
      • CNS Infectious Disease: Miscellaneous

First Case of Familial Creutzfeldt - Jakob Disease Associated with E200K Mutation in Peru: A Case Report (P2.308)

  1. Jonathan Eskenazi1
  1. Neurology April 8, 2014 vol. 82 no. 10 Supplement P2.308



    Abstract

    OBJECTIVE:Report the first case with definitive genetic diagnosis of familial Creutzfeldt-Jakob disease in Peru. Consider CJD as an etiology in patients presenting with rapidly progressive dementia.
    BACKGROUND:CJD is an uncommon neurodegenerative disease with an incidence of 1 per million individuals per year. The familial variant accounts for 10 to 15% of all cases of the CJD, where a missense mutation involving the substitution of lysine for glutamine in codon 200 is the most common PRNP gene mutation.
    RESULTS:A 46 year old male from Lima, Peru, with initial complains of paresthesias and dysesthesias of lower limbs for the past two months. One and a half month before admission, he started complaining of a mild headache and dizziness. One month before admission, ataxia, dysarthria, and daytime sleepiness developed, as well as mood and behavioral changes. 2 weeks before admission, anterograde amnesia and disturbance of visual acuity developed. On admission he was oriented in person and place but not in time. He was dysarthric with fasciculations in the right nasolabial fold on inspection. There was mild right-sided weakness associated with a right plantar extensor response as well as clonus and brisk deep-tendon reflexes. Superficial and deep sensitivity were preserved. Patient also presented a broad-based gait with a positive Romberg sign a well as bilateral dysmetria and dysdiadochokinesia. Cranial nerves examination was normal except for left deviation of the uvula. Laboratory studies including tumor markers, 24 hour heavy metal excretion, autoimmnune antibodies and CSF analysis were normal. An electroencephalogram showed periodic synchronous triphasic sharp wave complexes (PSWC). DWI and FLAIR MRIs demonstrated high signal intensities in basal ganglia and cortex of the medial surface of the temporal and occipital lobes on both sides. PCR amplification followed by sequenced analysis of a DNA sample showed a mutation of the gene E200K involving codon 129.
    CONCLUSIONS:This is the first case with genetic confirmation of E200K mutation for familial CJD in Peru.
    Disclosure: Dr. Eskenazi has nothing to disclose.

    Tuesday, April 29 2014, 7:30 am-11:00 am


     


     

     

    BSE IN SOUTH AMERICA

     

    Information on imports of risk material or MBM is scarce...

     


     


     

    4. Information published by the OIE is derived from declarations made by the OIE Delegate of Member Countries.

     

    ***The OIE is not responsible for publication and maintenance of Member Countries disease status based on inaccurate information or non-reporting of changes in epidemiological status or other significant events subsequent to the time of declaration of the BSE risk status.***



    THE ASSEMBLY


    RESOLVES THAT



    1. The Director General publish the following list of Member Countries recognised as having a negligible BSE risk in accordance with Chapter 11.5. of the Terrestrial Code:


    Argentina


    Australia


    Austria


    Belgium


    Brazil


    Chile


    Colombia


    Denmark


    Finland


    Iceland


    India


    New Zealand


    Norway




    Panama




    Paraguay




    Peru




    Singapore




    Sweden




    Uruguay


    – 151 –


    80 GS/FR – PARIS, May 2012

     


     

     

    *** Transmissible Spongiform Encephalopathy TSE Prion Disease North America 2014 ***

     

    Transmissible Spongiform Encephalopathy TSE Prion Disease have now been discovered in a wide verity of species across North America. typical C-BSE, atypical L-type BASE BSE, atypical H-type BSE, atypical H-G BSE, of the bovine, typical and atypical Scrapie strains, in sheep and goats, with atypical Nor-98 Scrapie spreading coast to coast in about 5 years. Chronic Wasting Disease CWD in cervid is slowly spreading without any stopping it in Canada and the USA and now has mutated into many different strains. Transmissible Mink Encephalopathy TME outbreaks. These Transmissible Spongiform Encephalopathy TSE Prion Disease have been silently mutating and spreading in different species in North America for decades.

     

    The USDA, FDA, et al have assured us of a robust Triple BSE TSE prion Firewall, of which we now know without a doubt, that it was nothing but ink on paper. Since the 1997 mad cow feed ban in the USA, literally tons and tons of banned mad cow feed has been put out into commerce, never to return, as late as December of 2013, serious, serious breaches in the FDA mad cow feed ban have been documented. The 2004 enhanced BSE surveillance program was so flawed, that one of the top TSE prion Scientist for the CDC, Dr. Paul Brown stated ; Brown, who is preparing a scientific paper based on the latest two mad cow cases to estimate the maximum number of infected cows that occurred in the United States, said he has "absolutely no confidence in USDA tests before one year ago" because of the agency's reluctance to retest the Texas cow that initially tested positive.

     

    see ;

     


     

    The BSE surveillance and testing have also been proven to be flawed, and the GAO and OIG have both raised serious question as to just how flawed it has been (see GAO and OIG reports). North America has more documented TSE prion disease, in different documented species (excluding the Zoo BSE animals in the EU), then any other place on the Globe. This does not include the very likelihood that TSE prion disease in the domestic feline and canine have been exposed to high doses of the TSE prion disease vid pet food. To date, it’s still legal to include deer from cwd zone into pet food or deer food. Specified Risk Material i.e. SRM bans still being breach, as recently as just last month.

     

    nvCJD or what they now call vCJD, another case documented in Texas last month, with very little information being released to the public on about this case? with still the same line of thought from federal officials, ‘it can’t happen here’, so another vCJD blamed on travel of a foreign animal disease from another country, while ignoring all the BSE TSE Prion risk factors we have here in the USA and Canada, and the time that this victim and others, do spend in the USA, and exposed to these risk factors, apparently do not count in any way with regard to risk factor. a flawed process of risk assessment.

     

    sporadic CJD, along with new TSE prion disease in humans, of which the young are dying, of which long duration of illness from onset of symptoms to death have been documented, only to have a new name added to the pot of prion disease i.e. sporadic GSS, sporadic FFI, and or VPSPR. I only ponder how a familial type disease could be sporadic with no genetic link to any family member? when the USA is the only documented Country in the world to have documented two different cases of atypical H-type BSE, with one case being called atypical H-G BSE with the G meaning Genetic, with new science now showing that indeed atypical H-type BSE is very possible transmitted to cattle via oral transmission (Prion2014). sporadic CJD and VPSPR have been rising in Canada, USA, and the UK, with the same old excuse, better surveillance. You can only use that excuse for so many years, for so many decades, until one must conclude that CJD TSE prion cases are rising. a 48% incease in CJD in Canada is not just a blip or a reason of better surveillance, it is a mathematical rise in numbers. More and more we are seeing more humans exposed in various circumstance in the Hospital, Medical, Surgical arenas to the TSE Prion disease, and at the same time in North America, more and more humans are becoming exposed to the TSE prion disease via consumption of the TSE prion via deer and elk, cattle, sheep and goats, and for those that are exposed via or consumption, go on to further expose many others via the iatrogenic modes of transmission of the TSE prion disease i.e. friendly fire. I pondered this mode of transmission via the victims of sporadic FFI, sporadic GSS, could this be a iatrogenic event from someone sub-clinical with sFFI or sGSS ? what if?

     

    Two decades have passed since Dr. Ironside first confirmed his first ten nvCJD victims in 1995. Ten years later, 2005, we had Dr. Gambetti and his first ten i.e. VPSPR in younger victims. now we know that indeed VPSPR is transmissible. yet all these TSE prion disease and victims in the USA and Canada are being pawned off as a spontaneous event, yet science has shown, the spontaneous theory has never been proven in any natural case of TSE prion disease, and scientist have warned, that they have now linked some sporadic CJD cases to atypical BSE, to atypical Scrapie, and to CWD, yet we don’t here about this in the public domain. We must make all human and animal TSE prion disease reportable in every age group, in ever state and internationally, we must have a serious re-evaluation and testing of the USA cattle herds, and we must ban interstate movement of all cervids. Any voluntary effort to do any of this will fail. Folks, we have let the industry run science far too long with regards to the TSE prion disease. While the industry and their lobbyist continues to funnel junk science to our decision policy makers, Rome burns. ...end

     

    REFERENCES

     

    Sunday, June 29, 2014

     

    Transmissible Spongiform Encephalopathy TSE Prion Disease North America 2014

     


     

    Tuesday, August 12, 2014

     

    *** MAD COW USDA TSE PRION COVER UP or JUST IGNORANCE, for the record AUGUST 2014 ***

     

    see history of record of either the biggest cover up of mad cow disease, or one of the biggest blunders of the mad cow debacle, just my opinion of the facts...tss

     



    Monday, June 02, 2014

    Confirmed Human BSE aka mad cow Variant CJD vCJD or nvCJD Case in Texas
    http://vcjd.blogspot.com/2014/06/confirmed-variant-cjd-case-in-texas.html

    Tuesday, April 01, 2014

     

    *** Questions linger in U.S. CJD cases 2005, and still do in 2014 ***

     


     

     

    Monday, August 18, 2014

     

    *** Barriers to Creutzfeldt-Jakob Disease Autopsies, California and the USA

     


     

     

    PLEASE REMEMBER ;

     

    The Akron, Ohio-based CJD Foundation said the Center for Disease Control revised that number in October of 2004 to about one in 9,000 CJD cases per year in the population group age 55 and older.

     

    HAVE YOU GOT YOUR CJD QUESTIONNAIRE ASKING REAL QUESTIONS PERTAINING TO ROUTE AND SOURCE OF THE TSE AGENT THAT KILLED YOUR LOVED ONE ???

     

    if not, why not...

     

    Friday, November 30, 2007

     

    CJD QUESTIONNAIRE USA CWRU AND CJD FOUNDATION

     


     


     

     

    TSS