Oral Care for a Patient with Sporadic Creutzfeldt-Jakob Disease: A Case Report

Abstract

Introduction:　Creutzfeldt-Jakob disease (CJD) is a prion disease in which the function of brain neurons is impaired by the accumulation of abnormal prion proteins in the brain, causing spongiform degeneration. We herein report a patient with sporadic CJD for whom we provided oral care until death.

Case:　A man in his 50s developed movement disorder and cognitive impairment in the summer of 2009 that gradually impaired his ability to work. He was admitted to the Department of Neurology at our hospital for a detailed examination in January 2010. A definitive diagnosis of sporadic CJD was reached based on the results of a prion protein gene analysis. Ten days after admission, the patient’s ataxia rapidly worsened, it became difficult for him to communicate, and he became bedridden. Oral ingestion was difficult, and enteral nutrition was initiated.

Course:　Our department received a request for oral care in February 2010. Patient symptoms included trismus, bleeding of the lips, oral malodor, oral dryness, a large amount of sputum, and adhesion of phlegm. Although it was difficult to provide oral care due to the trismus, we provided conventional care using tools such as a mouth gag, tongue cleaner, sponge brush, end-tufted brush, and moisturizer. Oral care resulted in healing of the bleeding of the lips and improvement of oral malodor and dryness. In addition, the number of days with fever decreased, albeit temporarily. During provision of oral care, disposable caps, face guards, gloves, and protective gear were worn, and these items were disposed of after completion of care.

Discussion:　Patients with CJD experience a period of ataxia and aphagia before succumbing to the disease, and onset of trismus and pneumonia is considered unavoidable in these patients. Oral care is therefore essential, and its provision may improve the oral condition and contribute, to some extent, to the prevention of pneumonia. Because prion proteins remain infectious even with regular disinfection and sterilization methods, it is necessary to avoid sustaining injuries as well as droplet infection during oral care for CJD patients. It is also desirable to use disposable items when possible, and to dispose of them after use.