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Introduction: retroviruses, DNA viruses, and prions
Iain C. Anthony, Neuropathology, University of Edinburgh, Western General Hospital, Edinburgh, Scotland, UK,
Peter Simmonds, Laboratory for Clinical and Medical Virology, Department of Medical Microbiology, University of Edinburgh, Summerhall, Edinburgh, UK,
Jeanne E. Bell, Neuropathology, University of Edinburgh, Western General Hospital, Edinburgh, Scotland, UK
On June 4, 1981, The Morbidity and Mortality Weekly Report from the Centers for Disease Control (CDC) in the United States published a report of five previously healthy young men with biopsy-confirmed pneumocystis carinii pneumonia (PCP) at three different hospitals in Los Angeles . It is extremely rare for healthy young individuals to develop PCP without an underlying immunodeficiency. The single factor linking these five individuals was that they were all active homosexuals. One month later, a further report documented 26 cases of Kaposi's sarcoma, which until then had been an extremely rare tumor in the United States . Again, all of the patients were young, previously healthy homosexual men. These were the first recorded reports of Acquired Immune Deficiency Syndrome (AIDS) and were quickly followed by reports of cases from other countries around the world. By September 1982, CDC had 593 reports of AIDS cases, 41% of whom were already dead. Seventy-five percent were known to be homosexual or bisexual males, and over half had PCP . In 1983, workers at the Pasteur Institute identified a virus from the lymph node of an asymptomatic individual who presented with lymphadenopathy . The virus replicated in culture releasing high titers of virions that contained magnesium-dependent reverse transcriptase activity and exhibited features of retroviruses on electron microscopy.
Laboratories concerned with the diagnosis of dementia, and research into dementing conditions, will come into contact sooner or later with brain tissue from patients in whom the dementia is due to the presence of an infective agent. Concern about the possible presence of such microorganisms is one important reason for ensuring that good laboratory practice and carefully devised safety precautions are implemented wherever dementia diagnosis and research is undertaken. This chapter is concerned with discussion of the likely hazards and risks involved in this kind of work and the strategies for safe practice which should be in place.
The concept of hazard focuses on the level of danger associated with the particular agent under consideration, while risk depends not only on the nature of the hazard but also on the likelihood of exposure (ACDP, 1995a). Consideration of the hazards and their likely risk in relation to dementing illnesses forms the basis of the containment protocols which have been developed to limit the danger posed by these hazards. The general principles of containment need to be considered in relation both to the process which is under way, for example the examination of a biopsy or the conduct of an autopsy, and the setting in which that process takes place, for example the laboratory or the post-mortem room. Laboratories which specialize in examining dementia cases may well be part of a formally constituted brain bank that stores tissues for research purposes and also dispatches tissue samples to the wider research community (Cruz-Sánchez & Tolosa, 1995). Particular safety precautions may well apply to individual brain banks that focus on infective dementias (Bell & Ironside, 1997).
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