Laura Foucault-Fruchard1, Jean Baptiste Delaye2, Virginie Morange3, Emilie Beaufils4, Coline Duwicquet5, Isabelle Quadrio6, Anna Chloé Balageas4, Diane Dufour-Rainfray7. 1. CHU Tours, Service pharmacie, F-37044 Tours, France; UMR 1253, iBrain, Université de Tours, Inserm, Tours, France. Electronic address: laura.foucault@univ-tours.fr. 2. CHU Tours, Service de de médecine nucléaire in vitro, F-37044 Tours, France. 3. CHU Tours, Equipe Opérationnelle d'Hygiène, F-37044 Tours, France. 4. CHU Tours, Centre Mémoire Ressources et Recherche (CMRR), F-37044 Tours, France; UMR 1253, iBrain, Université de Tours, Inserm, Tours, France. 5. CHU Tours, Service de neurologie, F-37044 Tours, France. 6. Unité des pathologies neurodégénératives, Service de biochimie et biologie moléculaire Grand Est, Hospices civils de Lyon, Lyon, France; Equipe BIORAN Centre de Recherche en Neurosciences de Lyon, CNRS UMR 5292 INSERM U1028, Université de Lyon, France. 7. CHU Tours, Service de de médecine nucléaire in vitro, F-37044 Tours, France; UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; Groupe de Biologie Spécialisée de la Société Française de Médecine Nucléaire, France.
Abstract
INTRODUCTION: Knowing the risk of potential sporadic Creutzfeldt-Jakob disease (sCJD) instrument-contamination is essential in hospitals. We examined the relevance of the p-Tau/Tau ratio to exclude a probable case of sCJD in clinical practice, and we established an alert system to quickly inform health professionals in case of positivity. METHODS: This retrospective study was conducted on 143 cerebrospinal fluid samples from patients suspected for sCJD. The distinction between probable cases of sCJD and other patients was based on clinical, paraclinical and biological (14-3-3, Tau, p-Tau, Aβ 1-42) data. From this experience, the health professionals developed an alert system to be implemented upon a suspected case of sCJD. RESULTS: A significant decrease in p-Tau/Tau ratio between sCJD and the other diseases was observed (p < 0 .001). The combined Tau test presented a sensitivity higher than 14-3-3 (100% versus 92.3%, p =0 .006) and an equivalent specificity (90% versus 96.1%). The time required for obtaining results was higher for 14-3-3 due to the centralization of investigations in some laboratories (3 weeks versus 2 h). In the presence of these elements, the triggering of the alert system was based on the p-Tau/Tau ratio. This system involves sending an automatic mail to the hospital department involved in the patient's care and the hospital hygiene team, which oversees the application of the procedures. CONCLUSION: The p-Tau/Tau concentrations present the desired criteria for use in current medical practice to fight against iatrogenic transmission. The alert system confirms a probable case of sCJD instantly to health professionals. Hygiene and sterilization measures can be applied immediately.
INTRODUCTION: Knowing the risk of potential sporadic Creutzfeldt-Jakob disease (sCJD) instrument-contamination is essential in hospitals. We examined the relevance of the p-Tau/Tau ratio to exclude a probable case of sCJD in clinical practice, and we established an alert system to quickly inform health professionals in case of positivity. METHODS: This retrospective study was conducted on 143 cerebrospinal fluid samples from patients suspected for sCJD. The distinction between probable cases of sCJD and other patients was based on clinical, paraclinical and biological (14-3-3, Tau, p-Tau, Aβ 1-42) data. From this experience, the health professionals developed an alert system to be implemented upon a suspected case of sCJD. RESULTS: A significant decrease in p-Tau/Tau ratio between sCJD and the other diseases was observed (p < 0 .001). The combined Tau test presented a sensitivity higher than 14-3-3 (100% versus 92.3%, p =0 .006) and an equivalent specificity (90% versus 96.1%). The time required for obtaining results was higher for 14-3-3 due to the centralization of investigations in some laboratories (3 weeks versus 2 h). In the presence of these elements, the triggering of the alert system was based on the p-Tau/Tau ratio. This system involves sending an automatic mail to the hospital department involved in the patient's care and the hospital hygiene team, which oversees the application of the procedures. CONCLUSION: The p-Tau/Tau concentrations present the desired criteria for use in current medical practice to fight against iatrogenic transmission. The alert system confirms a probable case of sCJD instantly to health professionals. Hygiene and sterilization measures can be applied immediately.