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From: TSS (216-119-144-50.ipset24.wt.net)
Subject: CALIFORNIA CASE RAISES MAD COW SUSPICIONS
Date: November 12, 2004 at 2:20 pm PST

-------- Original Message --------
Subject: California case raises mad cow suspicions
Date: Fri, 12 Nov 2004 16:22:02 -0600
From: "Terry S. Singeltary Sr."
Reply-To: Bovine Spongiform Encephalopathy
To: BSE-L@UNI-KARLSRUHE.DE


##################### Bovine Spongiform Encephalopathy #####################

California case raises mad cow suspicions

By Steve Mitchell
UPI Medical Correspondent
Published November 12, 2004

WASHINGTON -- A California man has died from what tentatively was
diagnosed as a rare brain disorder, but his brother said the patient's
neurologist is concerned the man was infected with the human version of
mad cow disease, United Press International has learned.

The neurologist would not speak with UPI about the case, but if the
patient -- Patrick Hicks, 49 -- suffered from the human form of mad cow
disease, also known as variant Creutzfeldt Jakob disease, it would be
the first domestic-born case of the brain-wasting illness in the United
States.

One U.S. case of vCJD previously was detected in a Florida woman,
but she is thought to have contracted the illness while in England.

Hicks died early Thursday at Reche Canyon Health Care Center in
Colton, Calif. Initial test results conducted prior to his death
indicated he had a disease known as sporadic Creutzfeldt Jakob disease,
his brother Mike Hicks told UPI.

The sporadic form of CJD has no known cause and typically strikes
people in their 60s or older, so Patrick Hicks's relatively young age
raises concerns he was suffering from vCJD, which humans can contract
from eating beef products contaminated with the mad cow pathogen.

"I'm concerned he got it from beef," Mike Hicks said.

The only confirmed case of mad cow disease among U.S. cattle was
detected last December in Washington.

Distinguishing the type of CJD a person has requires an autopsy, but
Mike said Dr. Ron Bailey, Patrick's neurologist at Riverside Community
Hospital, told the family he thought Patrick's symptoms were consistent
with vCJD. Mike Hicks said these included initial psychiatric symptoms,
duration of illness over one year and normal electroencephalograms until
the late stages of the disease.

Patrick's mother, Theresa Hicks, said she also recalled Dr. Bailey
conveying this to the family.

Bailey's assistant told UPI federal laws pertaining to patient
confidentially precluded the neurologist from discussing the case
without consent from Patrick's wife, Ronele Hicks.

Ronele Hicks did not return calls from UPI.

Mike Hicks said some family members did not want to discuss
Patrick's case publicly.

If Patrick Hicks contracted vCJD, he probably would have acquired it
domestically because he had never traveled to England or Europe, which
have experienced major outbreaks of mad cow disease and where nearly all
151 cases of vCJD detected worldwide so far have occurred. In addition,
Patrick had not undergone any surgical procedures or received any
medical products that might have infected him, his brother said.

The U.S. Centers for Disease Control and Prevention in Atlanta
investigates cases of CJD in people under age 55 for possible vCJD
because almost all cases of the mad-cow-linked disease have occurred in
people under that age.

CDC officials would not say whether the agency had investigated
Patrick's case, but Mike Hicks said when family members were visiting
Patrick on Oct. 12 -- at Loma Linda University Medical Center in Loma
Linda, Calif. -- the family was asked to leave when several doctors
described only as "from Infectious Diseases in Atlanta" showed up to
view his brother.

Mike Hicks said Loma Linda also has refused to release Patrick's
medical records.

"I'm curious as to why six doctors from Atlanta would come in and
analyze him and there's no way to find out what conclusion they came up
with," he said.

Theresa Hicks confirmed this account. "At the time we were visiting,
a team of six doctors came in and they told us we'd have to leave," she
said, adding that she does not remember hearing anybody mention the
doctors were from Atlanta.

Asked if the CDC had investigated Patrick's case or if there was
concern he may have had vCJD, agency spokeswoman Christine Pearson told
UPI: "We cannot provide specifics on individual cases. I would suggest
you talk with the medical center or the state, as they would be the lead
in any investigation."

Phil Lowenthal, surveillance officer for the California Department
of Health's Emerging Infections Program in Richmond, told UPI he
notified the CDC of Patrick's case several days ago, but the agency
already had heard about it. Lowenthal said he did not know if the CDC
had been informed by family members or by the medical personnel who had
taken care of Patrick.

He said the CDC's help had not been requested by the state and he
did not know whether agency officials had visited Patrick while he was
at Loma Linda.

"If it is true they came and visited, it was something they did on
their own accord," Lowenthal said.

The CDC investigated 21 cases of possible vCJD in Californians under
the age of 55 between 1994 and 2002, according to agency documents UPI
has obtained via the Freedom of Information Act.

Mike Hicks said the family has never been contacted by the CDC about
his brother's case, but plans are in place to send samples of Patrick's
brain to the National Prion Disease Pathology Surveillance Center in
Cleveland, which is funded by the CDC to monitor for vCJD.

The fact that Patrick was younger than 55 "makes it of interest" for
possible vCJD, Lowenthal said. He noted, however, that CJD has been seen
in younger people and "we won't know what type of CJD it is until I see
further test results." Test results could be back in a few weeks or
less, he added.

Joy Jameson, spokeswoman for Loma Linda, said the hospital could not
discuss specific patients. Asked whether CDC personnel had visited the
facility in October, Jameson said, "We have no record of that."

Regarding allegations the facility did not share Patrick's medical
records with his wife, Jameson said she was not familiar with the
details of the case in question, but in general a spouse would be able
to obtain medical records.

The Hicks family "should definitely contact patient relations (at
Loma Linda) and if they feel like they should have access to those
records they should definitely pursue it," she said.

Although CJD and vCJD often have unique symptoms, they sometimes can
overlap and the only way to determine which type a person has contracted
is to conduct an examination of the patient's brain for characteristic
lesions.

Some animal studies have indicated, however, that mad cow also can
cause the form of CJD considered sporadic and a new British study adds
to that evidence.

The study, by John Collinge and colleagues at University College
London -- published in the Nov. 12 issue of the journal Science -- found
mice injected with the pathogen that causes vCJD could develop CJD, vCJD
or even a novel form of CJD not yet observed in humans, depending on the
genes the mice carried.

The findings suggest even examing brain lesions might not be able to
distinguish whether a person got infected by mad cow disease, a view
espoused for years by Laura Manuelidis, an expert on these diseases and
section chief of surgery in the neuropathology department at Yale
University.

"You cannot say definitively, even if it's ruled sporadic CJD, that
it didn't come from mad cow or chronic wasting disease," Manuelidis told
UPI.

Chronic wasting disease or CWD is a disorder similar to mad cow that
occurs in deer and elk. No human CJD or vCJD cases have been linked to
consumption of deer meat infected with CWD, but the pathogen has been
shown it is capable of infecting human cells in lab dishes. Mike Hicks
said Patrick ate venison approximately five to 10 years ago.

If there are CJD cases linked to mad cow or CWD that are going
undetected, the concern is the pathogen could mutate to a form that more
easily infects humans, Manuelidis said.

In addition, "once something like this gets in the human population,
there is the potential to infect many human beings" through blood
transfusions, surgical procedures and tissue transplants, she said.

http://www.wpherald.com/storyview.php?StoryID=20041112-050836-5758r

TSS

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