Diagnosis of Creutzfeldt-Jakob disease

BMJ 1999;318:538 ( 20 February )

Letters

Diagnosis of Creutzfeldt-Jakob disease

Routine tonsil biopsy for diagnosis of new variant Creutzfeldt-Jakob disease is not justified

Subtypes of S100 proteins must be identified

Routine tonsil biopsy for diagnosis of new variant Creutzfeldt-Jakob disease is not justified

The first 150 words of the full text of this article appear below.

EDITOR $---$ Collinge et al recommend that tonsil biopsy be considered in all those in whom new variant Creutzfeldt-Jakob diseaseis suspected.¹ Though the detection of protease resistant prionprotein in tonsillar tissue from a young person with a rapidlyprogressive dementia may have a high specificity for this diagnosis,there are no published data on sensitivity, specificity, or safety;the procedure carries the risk of haemorrhage and infection aswell as the risks associated with anaesthesia. Some patients clinicallysuspected of having new variant Creutzfeldt-Jakob disease, andtherefore potential candidates for tonsil biopsy, have subsequentlyrecovered.² Further information is obviously required, andwe concur with the recommendation of a recent WHO consultationthat this should come from postmortem studies.³

Brain biopsy has been carried out in 9 of the 27 cases of new variant Creutzfeldt-Jakob disease in the United Kingdom. Thisprocedure has risks but, in contrast to tonsillar biopsy, enables. . . [Full text of this article]

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