RedScrubs
The Resource for Medical Professionals

Immunosuppressive drugs are drugs that inhibit or prevent activity of the immune system. They are used to prevent transplant rejection, to treat autoimmune disorders (i.e. rheumatoid arthritis) and to treat other conditions such as asthma.

Federal health authorities have asked the manufacturers of four widely used immunosuppressive drugs to bolster black box warnings on the risk of developing opportunistic fungal infections with the use of these drugs. The four drugs in question are Humira, Cimzia, Enbrel and Remicade.

There has been a lot of talk about prions on redscrubs.com since the inception of the website. The articles have been about downer cows, mad cow disease, vCreutzfeldt-Jakob disease and those illnesses caused by prions generally termed transmissible spongiform encephalopathies (TSEs). This recent study published in the July 1 issue of Environmental Science and Technology highlights how prions survive in the environment.

Prions are difficult to inactivate surviving even autoclaving in a hospital setting unless the autoclaving is set for at least 18 minutes. They are resistant to extreme heat, chemical disinfectants and irradiation. Until now, scientists have never really looked to see if they survived wastewater treatment because the tests were not sensitive enough. Now the concern is that they are surviving as they come out of the sewers and septic tanks from slaughterhouses, meatpacking facilities and private game dressing businesses.

Scientists used lab experiments with simulated wastewater treatment to show that prions can be recovered from wastewater sludge after 20 days remaining in the “biosolids”, a by-product of sewage treatment sometimes used to fertilize fields.

Although the scientists clarified that prions have never been reported in wastewater treatment, they also noted that no one is testing for them.

Sutter Roseville Medical Center in the Sacramento area is emerging as a national leader to eliminate iatrogenic infections. A revamping of the hospital’s procedure for inserting central line catheters has completely abated bloodstream infections over the past two years. Some 3000 patients had central lines inserted over the period, none of them developed infections related to line insertions.

Is a new form of “mad cow disease” or Creutzfeldt-Jakob Disease (CJK) about ready to sweep the UK? A 39 year old woman recently died of a variant of CJK and scientists are worried that this new death might be attributed to a variant in the prion disease that causes CJK; they have dubbed this new disease vCKJ. Although scientists are saying there is nothing to panic about yet, it is a red flag indicating that neurologists should be on their toes.