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PROGRESSIVE INFLAMMATORY NEUROPATHY, PORK PLANT WORKERS - US

flounder

Well-known member
PROGRESSIVE INFLAMMATORY NEUROPATHY, PORK PLANT WORKERS - USA (06)
******************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 16 Apr 2008
Source: Associated Press [edited]
<http://ap.google.com/article/ALeqM5hqaebpM28dOdHO2Fop0x-o06mxqQD9037NQG2>


The number of mysterious neurological illnesses among workers who
processed pig brains at pork plants in 3 states has grown to as many
as 24, and other possible cases are being evaluated, researchers said
Wednesday [16 Apr 2008].

Dr Daniel Lachance, a Mayo Clinic neurologist, said there are now 18
confirmed cases among people who have worked at the Quality Pork
Processors plant in Austin, Minnesota. That's up from 13 cases
reported as of February 2008. Lachance also said there are now about
5 cases among workers at a pork plant in Indiana, compared with 2
confirmed earlier, and one recently identified case at a plant in
Nebraska. Officials have not publicly named the Indiana and Nebraska
plants.

Lachance spoke in a teleconference from Chicago, where he and other
researchers presented details about the ongoing investigation at a
neurology conference hosted by the St Paul-based American Academy of
Neurology.

The common thread among the affected workers is that they all worked
in a part of the plants that used compressed air to blow pig brains
out of skulls, Lachance said. All the plants have discontinued the
practice. The working hypothesis, he told reporters, is still that
some of the brain tissue was turned into a fine mist during the
process, and that the workers became exposed to it and somehow
developed an autoimmune response that caused nerve damage.

"The precise mechanism by which that is occurring, we do not yet
understand," Lachance said.

Common symptoms include pain, weakness, fatigue, and numbness. A
unique pattern of antibodies has been found in all the patients,
Lachance said.

A Spanish-language interpreter at an Austin clinic and plant nurses
realized in 2007 they were seeing a pattern of similar illnesses
among the workers. The Mayo Clinic reported 12 cases to the state
Health Department in November 2007. In January 2008, the Centers for
Disease Control and Prevention (CDC) gave the condition a name,
progressive inflammatory neuropathy, or PIN.

The 18 patients identified by the Mayo Clinic developed their
symptoms from the end of November 2006 through the 1st week of April
2008. But the illness might have appeared earlier. Lachance said that
he evaluated a 22-year-old woman in Austin in 2004 with some similar
symptoms, but that she refused to have a spinal tap, has since
returned home to Mexico and is not being studied. He said another
patient he first saw in November 2005 is still being evaluated.

Researchers don't think the general public is at risk. "It doesn't
appear that the slaughtered pigs have been ill," said Dr James
Sejvar, a neurologist and epidemiologist at the CDC. "It doesn't
appear that this is in any way a foodborne illness. And it doesn't
appear as if this particular illness can be transmitted person to
person."

Lachance said none of the patients have recovered completely, though
all have improved or stabilized to a degree. He also said some have
had relapses. Some of the patients have required only pain
medication, while the most seriously ill have undergone drug
treatments to suppress their immune systems.

The 3 plants are the only ones investigators have found in the USA
that used compressed air to harvest pig brains, which are considered
a delicacy in some Asian countries.

Sejvar said the CDC has been working with the WHO (World Health
Organization) to see whether the procedure has been used in any
plants abroad. So far, they haven't heard of any. Even if the illness
turns out to be an isolated problem, Lachance said he hopes
researchers will be able to apply what they've learned to other
autoimmune illnesses. Scientists still don't know what triggers many
of them, he said.

[Byline: Steve Karnowski]

--
Communicated by:
ProMED-mail
<[email protected]>

[The numbers continue to grow slowly. No specific information
regarding the immune reactions found in this cohort is given. It
continues to be the case that an immunologic illness precipitated to
exposure of porcine brain antigens is the likely cause of this
illness. - Mod.LL]


snip...end

http://www.promedmail.org/pls/otn/f?p=2400:1001:3215684746885055::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,72238


> Officials have not publicly named the Indiana and Nebraska
> plants.



----- Original Message -----

From: [email protected]
To: Terry S. Singeltary Sr.
Sent: Wednesday, March 12, 2008 4:53 PM
Subject: Re: question please.....Neurological illness strikes Nebraska pork
plant worker



We have confirmed to media who called here that we have one case of
progressive inflammatory neuropathy in a former worker in a Nebraska pork
processing plant. We haven't sent out a news release. There is nothing on
our Web site about it.

If you have other questions, write back.

Marla Augustine
Communications and Legislative Services
Nebraska Department of Health and Human Services
301 Centennial Mall South
P.O. Box 95026
Lincoln, NE 68509-5026
[email protected]
Work: (402) 471-4047
Cell: (402) 416-9388
Fax: (402) 471-3996



TSS
 

flounder

Well-known member
Mayo researchers said they have discovered an antibody in the workers proving that their immune systems reacted to a specific trigger. Whether pork protein is that trigger is being investigated by Columbia University in New York, which expects that results won't be known for a few months, the Minneapolis Star Tribune reported.

Dr. Daniel Lachance, a Mayo Clinic researcher studying the disease, theorized that due to the biological similarities between pig tissue and human tissue, the workers' immune systems launched antibodies to attack the foreign pig tissue but also their own nerve tissue, which caused symptoms including inflammation, tingling, weakness and pain.


http://www.meatingplace.com/MembersOnly/webNews/details.aspx?item=20289


TSS
 

flounder

Well-known member
Medical News from
AAN: American Academy of Neurology Meeting

AAN: Pork Worker Nerve Illness Has Autoimmune Cause
By John Gever, Staff Writer, MedPage Today
Published: April 16, 2008
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine,
University of California, San


CHICAGO, April 16 -- An autoimmune reaction stemming from exposure to
aerosolized pig brains appears to have caused mysterious neurological
symptoms in two dozen Midwestern pork plant workers, researchers said here.

The finding could lead to better understanding of other, more common
immunoneurological diseases, they suggested.

The outbreak was first disclosed by public health officials in Minnesota
last December. More than a dozen workers at a pork processing facility in
Austin, Minn., complained of leg pains, sensory disturbances, weakness, and
fatigue. Action Points
----------------------------------------------------------------------------
----

Explain to interested patients that breathing aerosolized pig brains
appeared to cause neurological problems in some pork plant workers.


Point out that the condition appears to be a reaction to brain tissue
particles and is not food-borne or otherwise transmissible from pork
products or live pigs.


Point out that the results were presented orally at a conference and should
be considered preliminary until they are published in a peer-reviewed
journal.
A smaller number of workers at two other plants in Indiana and Nebraska were
subsequently found to have similar symptoms.


The condition is now believed to result from neural inflammation prompted by
immune reaction to something in porcine brain tissue, reported Daniel
Lachance, M.D., of the Mayo Clinic in Rochester, Minn., who led the clinical
investigation into the outbreak.


Dr. Lachance gave what he described as the first detailed report to a
professional audience here at the American Academy of Neurology annual
meeting.


He said the researchers were now calling the syndrome progressive
inflammatory neuropathy. It is a form of immune polyradiculoneuropathy.


Dr. Lachance has been leading an investigation focusing on the Minnesota
workers -- now numbering 18 -- in collaboration with officials at the CDC
and the state health department.


The investigation found that all the workers had been assigned to a section
of the plant where brains were forced out of the pig skulls with compressed
air.


Dr. Lachance said the procedure "emulsifies" the brain tissue, causing
significant amounts of spatter and airborne mist in the room.


"The working hypothesis is that the workers are exposed to brain tissue in
the air," Dr. Lachance said.


When public health authorities first reached this conclusion, in early
December, plant officials halted the brain-extraction procedure.


No new cases have developed since then. However, additional cases have been
identified as workers have come forward to report long-standing symptoms.
The most recent of these was confirmed on April 3, Dr. Lachance said.


He said the outbreak and subsequent investigation have implications beyond
occupational safety in pork processing centers.


"The principles may be able to be applied to autoimmunity and autoimmune
neurological illnesses. There are several syndromes that are hypothesized to
be a result of autoimmunity, yet in most cases we really don't know the
trigger," he said.


Identification of such a trigger could be a breakthrough in the basic
biology of neurological autoimmunity, and this case could lead to that
identification, he suggested.


"We may have the opportunity to understand how an antigen can be presented
and how the body's immune system can react to produce disease."


Dr. Lachance said laboratory studies had found that all the workers carried
a never-before-seen immunoglobulin G autoantibody. The researchers do not
yet know how it arises.


But they did rule out infectious pathogens such as viruses or prion proteins
as a cause. It does not appear to be food-borne or related to any illness in
the pigs.


Affected workers underwent MRI scans, electrodiagnostic studies,
cerebrospinal fluid exams, and serological tests.


Nerve conduction abnormalities such as long R1 and/or R2 and low sensory
nerve action potential were found in most, but not all, of the patients.


Motor nerves have been less affected than sensory function, Dr. Lachance
said.


No patient has completely recovered at this point, he said. "All have
improved or stabilized to some degree [and] there have been a few relapses
so far."


MRI abnormalities were mostly centered in the spinal root, but also appeared
in the spinal cord, head, and plexus in a few patients.


Some 500 employees have worked in the area where the brain extraction took
place, suggesting that some people are more susceptible to having an immune
reaction.


CDC researcher James Sejvar, M.D., who also participated in the
investigation, said the workers had worn gloves and coats, but had
essentially no respiratory protection.


Dr. Sejvar said the plants sell the pig brains in Asia, where they are a
gastronomic delicacy.


After the outbreak in Minnesota came to light, officials canvassed some 25
other pork processing plants in the U.S. They found only two that used the
same compressed-air procedure for extracting brains.


At one of these, in Indiana, five neuropathy cases have been identified. One
worker with the condition was confirmed at the other plant, in Nebraska.


Dr. Lachance said the procedure had been used in Minnesota since at least
1999. He said he may have seen a case himself in 2004, when a female plant
worker presented with neuropathy symptoms.


He proposed a lumbar puncture for a cerebrospinal fluid exam, which the
patient declined. She subsequently moved to Mexico.


Most of the affected plant workers were Hispanic, as is the overall
workforce at the Minnesota plant.


Dr. Lachance said the outbreak was first noticed by a Spanish language
interpreter at a clinic who had translated for several plant workers with
similar neurological complaints. She told a physician at the clinic, who, in
turn, asked for help from the Mayo neurologists.


No funding information for the research was provided. The researchers
reported no potential conflicts of interest.


http://www.medpagetoday.com/MeetingCoverage/AANMeeting/tb/9147


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