Article

Mortality from Creutzfeldt-Jakob disease and related disorders in Europe, Australia, and Canada

Area of Applied Epidemiology, Instituto de Salud Carlos III, Madrid, Madrid, Spain
Neurology (Impact Factor: 8.3). 06/2005; 64(9):1586-91. DOI: 10.1212/01.WNL.0000160117.56690.B2
Source: PubMed

ABSTRACT An international study of the epidemiologic characteristics of Creutzfeldt-Jakob disease (CJD) was established in 1993 and included national registries in France, Germany, Italy, the Netherlands, Slovakia, and the United Kingdom. In 1997, the study was extended to Australia, Austria, Canada, Spain, and Switzerland.
Data were pooled from all participating countries for the years 1993 to 2002 and included deaths from definite or probable CJD of all etiologic subtypes.
Four thousand four hundred forty-one cases were available for analysis and included 3,720 cases of sporadic CJD, 455 genetic cases, 138 iatrogenic cases, and 128 variant cases. The overall annual mortality rate between 1999 and 2002 was 1.67 per million for all cases and 1.39 per million for sporadic CJD. Mortality rates were similar in all countries. There was heterogeneity in the distribution of cases by etiologic subtype with an excess of genetic cases in Italy and Slovakia, of iatrogenic cases in France and the UK, and of variant CJD in the UK.
This study has established overall epidemiologic characteristics for Creutzfeldt-Jakob disease (CJD) of all types in a multinational population-based study. Intercountry comparisons did not suggest any relative change in the characteristics of sporadic CJD in the United Kingdom, and the evidence in this study does not suggest the occurrence of a novel form of human bovine spongiform encephalopathy infection other than variant CJD. However, this remains a possibility, and countries currently unaffected by variant CJD may yet have cases.

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    • "Despite their rarity, the economic and public-health impacts of human prion diseases [2] maintain a need for detailed surveillance and prompt diagnosis, usually with support from expert reference units [3]. Sporadic Creutzfeldt-Jakob disease (sCJD) accounts for 80-90% of annual human prion disease mortality (~1-2 per million) [4]. With its subtype heterogeneity [5] and diverse presenting symptoms [6] that may accompany other conditions [7], differentiation of sCJD from other subacute encephalopathies can challenge the clinician, especially on a first encounter [8]. "
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    ABSTRACT: To better characterize the value of cerebrospinal fluid (CSF) proteins as diagnostic markers in a clinical population of subacute encephalopathy patients with relatively low prevalence of sporadic Creutzfeldt-Jakob disease (sCJD), we studied the diagnostic accuracies of several such markers (14-3-3, tau and S100B) in 1000 prospectively and sequentially recruited Canadian patients with clinically suspected sCJD. The study included 127 patients with autopsy-confirmed sCJD (prevalence = 12.7%) and 873 with probable non-CJD diagnoses. Standard statistical measures of diagnostic accuracy were employed, including sensitivity (Se), specificity (Sp), predictive values (PVs), likelihood ratios (LRs), and Receiver Operating Characteristic (ROC) analysis. At optimal cutoff thresholds (empirically selected for 14-3-3, assayed by immunoblot; 976 pg/mL for tau and 2.5 ng/mL for S100B, both assayed by ELISA), Se and Sp respectively were 0.88 (95% CI, 0.81-0.93) and 0.72 (0.69-0.75) for 14-3-3; 0.91 (0.84-0.95) and 0.88 (0.85-0.90) for tau; and 0.87 (0.80-0.92) and 0.87 (0.84-0.89) for S100B. The observed differences in Sp between 14-3-3 and either of the other 2 markers were statistically significant. Positive LRs were 3.1 (2.8-3.6) for 14-3-3; 7.4 (6.9-7.8) for tau; and 6.6 (6.1-7.1) for S100B. Negative LRs were 0.16 (0.10-0.26) for 14-3-3; 0.10 (0.06-0.20) for tau; and 0.15 (0.09-0.20) for S100B. Estimates of areas under ROC curves were 0.947 (0.931-0.961) for tau and 0.908 (0.888-0.926) for S100B. Use of interval LRs (iLRs) significantly enhanced accuracy for patient subsets [e.g., 41/120 (34.2%) of tested sCJD patients displayed tau levels > 10,000 pg/mL, with an iLR of 56.4 (22.8-140.0)], as did combining tau and S100B [e.g., for tau > 976 pg/mL and S100B > 2.5 ng/mL, positive LR = 18.0 (12.9-25.0) and negative LR = 0.02 (0.01-0.09)]. CSF 14-3-3, tau and S100B proteins are useful diagnostic markers of sCJD even in a low-prevalence clinical population. CSF tau showed better overall diagnostic accuracy than 14-3-3 or S100B. Reporting of quantitative assay results and combining tau with S100B could enhance case definitions used in diagnosis and surveillance of sCJD.
    BMC Neurology 10/2011; 11(1):133. DOI:10.1186/1471-2377-11-133 · 2.49 Impact Factor
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    • "Sporadic Creutzfeldt-Jakob disease (sCJD) is a fatal neurodegenerative disorder which constitutes the most common form of human Transmissible Spongiform Encephalopathy (TSE) occurring at a rate of 1-1.5 cases per million of the population per annum[1]. Clinical features may vary but classic sCJD cases present a rapidly progressive dementia accompanied by focal neurological signs that progress to akinetic mutism and death within 4-6 months[2,3]. "
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    ABSTRACT: Sporadic Creutzfeldt-Jakob disease (sCJD) is a rare neurodegenerative disorder in humans included in the group of Transmissible Spongiform Encephalopathies or prion diseases. The vast majority of sCJD cases are molecularly classified according to the abnormal prion protein (PrPSc) conformations along with polymorphism of codon 129 of the PRNP gene. Recently, a novel human disease, termed "protease-sensitive prionopathy", has been described. This disease shows a distinct clinical and neuropathological phenotype and it is associated to an abnormal prion protein more sensitive to protease digestion. We report the case of a 75-year-old-man who developed a clinical course and presented pathologic lesions compatible with sporadic Creutzfeldt-Jakob disease, and biochemical findings reminiscent of "protease-sensitive prionopathy". Neuropathological examinations revealed spongiform change mainly affecting the cerebral cortex, putamen/globus pallidus and thalamus, accompanied by mild astrocytosis and microgliosis, with slight involvement of the cerebellum. Confluent vacuoles were absent. Diffuse synaptic PrP deposits in these regions were largely removed following proteinase treatment. PrP deposition, as revealed with 3F4 and 1E4 antibodies, was markedly sensitive to pre-treatment with proteinase K. Molecular analysis of PrPSc showed an abnormal prion protein more sensitive to proteinase K digestion, with a five-band pattern of 28, 24, 21, 19, and 16 kDa, and three aglycosylated isoforms of 19, 16 and 6 kDa. This PrPSc was estimated to be 80% susceptible to digestion while the pathogenic prion protein associated with classical forms of sporadic Creutzfeldt-Jakob disease were only 2% (type VV2) and 23% (type MM1) susceptible. No mutations in the PRNP gene were found and genotype for codon 129 was heterozygous methionine/valine. A novel form of human disease with abnormal prion protein sensitive to protease and MV at codon 129 was described. Although clinical signs were compatible with sporadic Creutzfeldt-Jakob disease, the molecular subtype with the abnormal prion protein isoforms showing enhanced protease sensitivity was reminiscent of the "protease-sensitive prionopathy". It remains to be established whether the differences found between the latter and this case are due to the polymorphism at codon 129. Different degrees of proteinase K susceptibility were easily determined with the chemical polymer detection system which could help to detect proteinase-susceptible pathologic prion protein in diseases other than the classical ones.
    BMC Neurology 10/2010; 10(1):99. DOI:10.1186/1471-2377-10-99 · 2.49 Impact Factor
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    • "Prion diseases, or Transmissible Spongiform Encephalopathies (TSEs), are invariably fatal neurodegenerative diseases associated with the conversion of the normal host cellular prion protein (PrP c ) into the abnormal protease-resistant isoform (PrP Sc ) [1]. They occur in a wide range of host species including humans, the most common of which is sporadic CJD (sCJD), occurring at a rate of approximately 1 case per million a year worldwide and accounts for greater than 80% of CJD cases [2]. Amino acid changes, which include point or insertional mutations in the normal (cellular) prion protein (PrP C ) encoded by the PRNP gene, are linked to genetic prion diseases such as Gerstmann- Strausler-Sheinker (GSS) disease, fatal familial insomnia (FFI), and genetically associated Creutzfeldt-Jakob disease (CJD). "
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    ABSTRACT: The advent of genomics and proteomics has been a catalyst for the discovery of biomarkers able to discriminate biological processes such as the pathogenesis of complex diseases. Prompt detection of prion diseases is particularly desirable given their transmissibility, which is responsible for a number of human health risks stemming from exogenous sources of prion protein. Diagnosis relies on the ability to detect the biomarker PrP(Sc), a pathological isoform of the host protein PrP(C), which is an essential component of the infectious prion. Immunochemical detection of PrP(Sc) is specific and sensitive enough for antemortem testing of brain tissue, however, this is not the case in accessible biological fluids or for the detection of recently identified novel prions with unique biochemical properties. A complementary approach to the detection of PrP(Sc) itself is to identify alternative, "surrogate" gene or protein biomarkers indicative of disease. Biomarkers are also useful to track the progress of disease, especially important in the assessment of therapies, or to identify individuals "at risk". In this review we provide perspective on current progress and pitfalls in the use of "omics" technologies to screen body fluids and tissues for biomarker discovery in prion diseases.
    BioMed Research International 03/2010; 2010(1110-7243):613504. DOI:10.1155/2010/613504 · 2.71 Impact Factor
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