Turkish Archives of Otorhinolaryngology (Jun 2003)
The Transmission Risk of Prion-like Proteins in Adenotonsillar Surgery: ‘Iatrogenic’ Variant Creutzfeldt-Jakob Disease (vCJD)
Abstract
Bovine spongioform encephalopathy (BSE) and variant Creutzfeldt-Jacob disease (vCJD) are degenerative disorders, which have occurred in several countries since 1980s. Prionlike proteins are blamed as responsible infectious agents for BSE and also for vCJD, in humans. As iatrogenic transmission by surgical instruments was shown, adenotonsillar surgery has been a concern because of the presence of prion-like proteins in lymphoepithelial tissue such as tonsils. To date, no cases of iatrogenic vCJD has been demonstrated during adenotonsillar surgery. However, theoretically, it contains a possible risk to choose re-usable instruments rather than using disposable ones for adenotonsillectomy. Therefore, the sterilization facilities should be upgraded in the operation rooms of the hospitals. -In the recent years, use of disposable instruments in adenotonsillectomy has been controversial in the UK, due to increase in vCJD cases. Despite use of disposable sets had started in January 2001, these instruments were withdrawn by the UK Government-Health Authority, because of postoperative complications (including one death) as of December 2001, until more suitable single-use instruments are provided for the ENT surgeons.- We should be aware of the potential transmission of prion-like proteins from the presymptomatic patients, particularly in adenotonsillar surgery, although no case of BSE or vCJD in Turkey have been shown (like the other lowest-risk countries in Europe). Overall, defining the right indications for adenotonsillectomy and modifying the sterilization methods; would be the best prevention in order to eliminate the possible risk of transmission of the disease, via iatrogenic route. This review reflects the issue in the light of NHS-ENT clinic experience of the author in London UK, 2001-2002.
