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Letter
Barriers to Creutzfeldt-Jakob
Disease Autopsies, California
Kurt B. Nolte*
*University of New Mexico, Albuquerque, New Mexico, USA
Suggested
citation for this article
To the Editor: The recent article by Louie et al. underscores
a more general disparity between the need for autopsies in potential infectious
disease deaths and our present national capacity (1).
In addition to confirming Creutzfeldt-Jakob disease (CJD) and allowing
the differentiation of classic and variant CJD, autopsies identify previously
undetected infections, discover causative organisms in unexplained infectious
disease deaths, and provide insights into the pathogenesis of new or unusual
infections (2,3). This information is essential for public
health and medical interventions.
As outlined by Louie et al., hospital autopsy rates have dropped to single
digits, and concerns by pathologists about occupational risks and biosafety
have likely contributed to this decline. Currently, the last stronghold
of autopsy expertise is forensic pathology (4). However,
the medicolegal death investigative system does not have jurisdiction
over all potential infectious disease deaths nor is it adequately supported
to assume the cases that are missed by our present hospital autopsy system.
Additionally, many medicolegal and hospital autopsy facilities with outdated
or poorly-designed air flow systems are ill suited to handle autopsies
when infectious disease is suspected (5). Air-handling
systems can be expensive to fix.
Reference centers such as the National Prion Disease Pathology Surveillance
Center, while providing diagnostic expertise, fail to surmount the biosafety
obstacles (real and perceived) that prevent pathologists from enthusiastically
performing autopsies on those who died of potential infectious diseases,
including prion diseases. One potential solution is the creation of regional
centers of excellence for infectious disease autopsies that could operate
in conjunction with a mobile containment autopsy facility (5,6).
Such centers could provide diagnostic expertise as well as biosafety capacity.
References
- Louie JK, Gavali SS, Belay ED, Trevejo R, Hammond
LH, Schonberger LB, et al. Barriers
to Creutzfeldt-Jakob disease autopsies, California. Emerg Infect
Dis. 2004;10:1677–80.
- Nolte KB, Simpson GL, Parrish RG. Emerging
infectious agents and the forensic pathologist: the New Mexico model.
Arch Pathol Lab Med. 1996;120:125–8.
- Schwartz DA, Bryan RT, Hughes JM. Pathology
and emerging infections—quo vadimus? Am J Pathol. 1995;147:1525–33.
- Hirsch CS. Forensic
pathology and the autopsy. Arch Pathol Lab Med. 1984;108:484–9.
- Nolte KB, Taylor DG, Richmond JY. Biosafety
considerations for autopsy. Am J Forensic Med Pathol. 2002;23:107–22.
- Centers for Disease Control and Prevention. Medical
examiners, coroners, and biologic terrorism: a guidebook for surveillance
and case management. MMWR Recomm Rep. 2004;53 (No. RR-8):1–27.
Suggested citation
for this article:
Nolte KB. Barriers
to Creutzfeldt-Jakob disease autopsies, California [letter]. Emerg Infect
Dis [serial on the Internet]. 2005 May [date cited]. Available
from http://www.cdc.gov/ncidod/EID/vol11no05/04-1133.htm
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