CJD: Contagious Dementia
One of my co-workers has inhaled a specimen infected with Creutzfeldt-Jakob Disease, CJD. There was a case that no one knew was CJD. She cut it, which creates thin paraffin ribbons. The ribbon broke. It fluttered at her face and she breathed. The next day a pathologist called our lab and told us the case was positive for CJD.
My poor co-worker remembered the case because it was brain and she inhaled part of the specimen. That doesn’t happen often but it does happen especially in the lab where I currently work. The ventilation system in the lab is wild and causes all sorts of air currents. The paraffin ribbons we cut float on the currents. They spin and break and stick to our clothes and settle all over our cutting areas. To make matters worse, people walk around us and sometimes run. That breaks the ribbons even more; after all residents need to look busy and running looks so busy. So a ribbon floated into my co-worker’s mouth and it was the CJD case.
Creutzfeldt-Jakob Disease is one of the few contagions we worry about in histology. The human tissues with which we work are fixed in formalin and that kills most bacteria, viruses, and fungus. Prions, which are believed to cause CJD, are not killed by formalin. A Prion is a small piece of protein that can’t really die. It needs to be chewed apart with bleach or formic acid in order to stop it from being infections.
Usually any case of CJD we handle is treated with formic acid before we get it in the lab. Then the infection rate drops dramatically but untreated tissue?
No one can tell us what my co-worker’s chances are. The disease can take years to progress or come on quickly. She is worried. He children are grown. At least there is that.
I know of one other incident where this happened. It was two decades ago. That tech was lucky. A doctor suspected CJD and treated the specimen with formic acid before it was sent to the lab. She inhaled a ribbon as well but the formic acid treatment reduced her chances of getting the disease dramatically and last I knew she was fine. This case the other day wasn’t treated. All of us were exposed but those of us with broken skin or who ingested it are truly at risk. I, thank goodness, had no broken skin; no cuts, no abrasions, no dry skin, not even a hang nail. The same cannot be said for another tech who handled the tissue. She is the mother a one year old.
Will anyone keep track of these exposures? Will they know if these women get the disease? What if they quit the job? Will the hospital track them? Will it help them if they get sick or will the hospital deny culpability? I have so many questions. Does anyone know how many histotechs are exposed to CJD each year? How many have actually inhaled a specimen like that? I shudder to think. The disease is nasty.
The National Institute of Health states:
CJD is characterized by rapidly progressive dementia. Initially, individuals experience problems with muscular coordination; personality changes, including impaired memory, judgment, and thinking; and impaired vision. People with the disease also may experience insomnia, depression, or unusual sensations. As the illness progresses, mental impairment becomes severe. Individuals often develop involuntary muscle jerks and they may go blind. They eventually lose the ability to move and speak and enter a coma.
What I find ironic is the beginning stages of CJD sound a lot like me and my co-workers. Histotechs keep odd hours, working on specimens late into the night. Lack of sleep causes a lot of those symptoms as does stress. The job is routine and difficult at the same time. We work with surgical specimens. If we screw up, it could mean a life is lost, maybe even our own when CJD is in the lab.
I could say a lot more about our work and how it puts us in danger but this case, this CJD case that was then inhaled, leaves me so numb with concern for my co-worker I want to stop with this thought. She deserves recognition. She now suffers daily. Every time she can’t remember something she will wonder if it is normal or CJD. Every time she has a symptom from the list above she feels it doubly.
We cannot know if she got the disease. There is no test. There is no cure if she does get it. There is dementia and inevitable early death. That is what she waits for. I hope someone she helped appreciates the worry she endures on their behalf. It was her desire to help that put her in that seat with that specimen. I hope anyone who has ever had a biopsy can appreciate the contribution she made to their health.