In the autumn of 2014, the New York State Department of Health learned of five patients with a diagnosis of Q fever who had traveled to Germany as part of a larger group in May 2014. On May 30, they each received intramuscular injections of fetal sheep cells, becoming ill approximately one week later. In addition, a Canadian resident who had received an injection from the same physician on May 28 was found to have Q fever in July. All six patients had serological tests consistent with acute Q fever. Their Coxiella burnetii phase I IgG antibody titers ranged from1:512 to 1:2048, while their phase II IgG titers ranged from 1:4096 to 1:65,536. Phase I IgM titers were elevated in four patients, while phase II IgM titers were elevated in all six patients, ranging from 1:64 to 1:32,768. All patients were treated with doxycycline.
When notified, German authorities reported that, at the time, they were investigating an outbreak of Q fever in humans due to inhalation exposure to the very sheep flock that was the source of the fetal sheep cells administered to these six patients.
COMMENTARY
The diagnosis and management of Q fever is discussed in an excellent CDC monograph1 that I highly recommend.
The two patients who consented to be interviewed indicated that they were among a group that had traveled to Germany for injections twice each year for the past 5 years. Live cell therapy, developed in Switzerland more than 75 years ago, is purported to have innumerable health benefits, including improvement in energy and erectile function, as well as reversal of multiple diseases and slowing of aging.2 A wide array of cell types of varying animal origin have been used. One startling example of a live cell therapist is John R. Brinkley, commonly referred to as “the goat gland doctor,” who reportedly implanted as many as 16,000 men with tissue from the testicles of young goats.2
A variety of adverse consequences have been reported, many of which, such as polyradiculitis, leukoencephalitis, Guillain-Barré syndrome, vasculitis, encephalopathy, and skin reactions, may be immunologic in nature, but clostridial infections have also occurred. Many countries, including some where the treatment is offered, have no relevant regulations of the practice of live cell therapy. As a form of xenotransplantation, it is allowed in Germany as a “drug” manufactured by physicians only for the use in their own patients. In the United States, its use in a clinical trial setting would require the filing of an Investigational New Drug Application. The FDA recommends that recipients enrolled in research studies remain under lifelong surveillance with periodic clinical and laboratory monitoring and that both they and their intimate contacts refrain from blood and tissue donation. No such monitoring or restrictions are placed on “xenotourists” in the United States. As a consequence, xenotourism poses a potential threat that goes beyond the personal.
REFERENCES
- Anderson A, Bijlmer H, Fournier PE, et al. Diagnosis and management of Q fever — United States, 2013: Recommendations from CDC and the Q Fever Working Group. MMWR Recomm Rep 2013;62(RR-03):1-30.
- Barrett S. Cellular therapy. http://www.quackwatch.org/01QuackeryRelatedTopics/Cancer/cellular.html.
ABSTRACT & COMMENTARY: Beware injection with sheep fetal cells.
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