Secondary prophylaxis after accidental exposure

Certain occupational groups are at risk of exposure to human prions, for instance neurosurgeons and other operating theatre staff, pathologists and morticians, histology technicians, and increasing number of laboratory workers. Because of the prolonged incubation periods to prions following administration to sites other than the central nervous system, which is associated with clinically silent prion replication in the lymphoreticular tissue, (101) treatments inhibiting prion replication in lymphoid organs may represent a viable strategy for rational secondary prophylaxis after accidental exposure. A preliminary suggested regimen is a short course of immunosuppression with oral corticosteroids in individuals with significant accidental exposure to human prions. (!°.2) Urgent surgical excision of the inoculum might also be considered in exceptional circumstances. There is hope that progress in the understanding of the peripheral pathogenesis will identify the precise cell types and molecules involved in colonization of the organism by prions. The ultimate goal will be to target the rate-limiting steps in prion spread with much more focused pharmacological approaches, which may eventually prove useful in preventing disease even after iatrogenic and alimentary exposure. (103)

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