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Diagnosis of Creutzfeldt-Jakob disease

BMJ 1999; 318 doi: (Published 20 February 1999) Cite this as: BMJ 1999;318:538

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

  1. M Zeidler, Specialist registrar,
  2. R Knight, Consultant neurologist,
  3. G Stewart, Specialist registrar,
  4. J W Ironside, Consultant neuropathologist,
  5. R G Will, Director,
  6. A J E Green, Clinical scientist,
  7. M Pocchiari, Director of research
  1. CJD Surveillance Unit, Western General Hospital, Edinburgh EH4 2XU
  2. Department of Neuroimmunology, National Hospital for Neurology and Neurosurgery, London WC1N 3BG
  3. Laboratory of Virology, Instituto Superiore di Sanità, Rome, Italy
  4. Department of Pediatrics, University of Zurich,CH-8032 Zurich, Switzerland

    EDITOR—Collinge et al recommend that tonsil biopsy be considered in all those in whom newvariant Creutzfeldt-Jakob disease is suspected.1 Though the detection of protease resistant prion protein in tonsillar tissue from a young person with a rapidly progressive 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 as well as the risks associated with anaesthesia. Some patients clinically suspected of havingnew variant Creutzfeldt-Jakob disease, and therefore potential candidates for tonsil biopsy, have subsequently recovered.2 Further information is obviously required, and we concur with the recommendation of a recent WHO consultation that …

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