Norovirus outbreak associated with a natural lake used for recreation - Oregon, 2014.

In July 2014, Multnomah County public health officials investigated a norovirus outbreak among persons visiting Blue Lake Regional Park in Oregon. During the weekend of the reported illnesses (Friday, July 11-Sunday, July 13) approximately 15,400 persons visited the park. The investigation identified 65 probable and five laboratory-confirmed cases of norovirus infection (70 total cases). No hospitalizations or deaths were reported. Analyses from a retrospective cohort study revealed that swimming at Blue Lake during July 12-13 was significantly associated with illness during July 13-14 (adjusted relative risk = 2.3; 95% confidence interval [CI] = 1.1-64.9). Persons who swam were more than twice as likely to become ill compared with those who did not swim in the lake. To control the outbreak, Blue Lake was closed for 10 days to prevent further illness. This investigation underscores the need for guidance for determining when to reopen untreated recreational water venues (e.g., lakes) associated with outbreaks, and communication tools to inform the public about the risks associated with swimming in untreated recreational water venues and measures that can prevent illness.

An unusual presentation of Mycobacterium avium spp. paratuberculosis infection in a captive tundra reindeer (Rangifer tarandus tarandus).

This report describes an unusual presentation of paratuberculosis in a captive, 4-year-old female tundra reindeer (Rangifer tarandus tarandus). The gross and histological presentation was consistent with clinical paratuberculosis as previously reported for other ruminants, with poor body condition, subcutaneous oedema, granulomatous ileitis (multibacillary), mesenteric lymphadenitis and hepatitis. However, this animal also presented with unusual lung lesions, with necrosis and mineralization similar to that reported for Mycobacterium bovis in other wild and domestic ruminants. The presence of DNA of Mycobacterium avium subsp. paratuberculosis was confirmed by polymerase chain reaction (PCR) in intestine and lung tissue (IS900, Hsp65) and PCR tests for the detection of Mycobacterium tuberculosis complex and other members of the M. avium complex were negative.

Mycobacterium avium subsp. hominissuis Infection in a captive-bred kiang (Equus kiang).

Equids are considered highly resistant to mycobacterial infections and clinical cases have been described in domestic horses only. Mycobacterium bovis is the most common species reported, although a single report exists of disease due to definitively diagnosed infection with Mycobacterium avium subsp. hominissuis in two domestic horses. This is the first report of a mycobacterial infection in a kiang (Equus kiang), or indeed any wild equid. The animal had chronic loss of condition and serum biochemical changes suggestive of liver disease and chronic infection. Further investigation showed a chronic granulomatous enteritis, lymphadenitis and hepatitis with focal granulomatous pneumonia due to systemic infection with M. avium subsp. hominissuis. The distribution and severity of the lesions suggested that the route of infection was alimentary.

Characterisation of [(125)I]-apamin binding sites in rat brain membranes with HE293 cells transfected with SK channel subtypes.

The pharmacology of [(125)I]-apamin binding sites was examined in rat cortical and hippocampal tissue and compared with membranes prepared from human embryonic kidney (HEK293) cells transfected with SK channel subtypes hSK1, rSK2 and rSK3. The K(D) of [(125)I]-apamin in rat cortex and hippocampus was similar to the apamin-sensitive subtypes, rSK2 and rSK3 (K(D) (pM): 6.4, 7.08, 6.56 and 8.94, respectively). In addition, [(125)I]-apamin had a K(D)=270.4pM for the putatively 'apamin-insensitive' hSK1. Apamin had about a three-fold higher affinity than [(125)I]-apamin in brain tissue and in the cells expressing the different SK channel subtypes. Pancuronium, bicuculline and d-tubocurarine displayed micromolar affinity for all five-membrane preparations, whereas dequalinium and gallamine appear to show some subtype selectivity. Tetraethylammonium (TEA) and 4-aminopyridine (4-AP) had millimolar affinity and linopirdine had no effect. In conclusion, the pharmacology of [(125)I]-apamin binding in the cortex and hippocampus was similar to that in the apamin-sensitive clones, rSK2 and rSK3. In addition, we demonstrated low affinity [(125)I]-apamin binding for hSK1 and identified compounds that show subtype selectivity. These data cast further doubt on the identification of SK1 as encoding for the K(+) channel responsible for the apamin-insensitive sAHP.

Serum withdrawal causes apoptosis in SHSY 5Y cells.

A proportion of differentiated SH-SY5Y cells undergo cell death in response to withdrawal of serum. This death manifests the hallmark features of apoptosis including changes in nuclear morphology, processing and activation of caspase 3 and cleavage of the caspase 3 substrates acetyl-Asp-Glu-Val-Asp-aminomethylcoumarin and poly(ADP-ribose) polymerase. These findings represent the first demonstration of serum withdrawal induced apoptosis in SH-SY5Y cells. The reduction in viability induced by serum deprivation and assessed using an inhibitor of mitochondrial respiration can be partially inhibited by FK506, but FK506 does not prevent caspase 3 processing or cleavage of caspase 3 substrates. FK506 is also able to promote the viability of a small proportion of embryonic mouse sensory neurons following nerve growth factor-withdrawal induced apoptosis. FK506 did not promote viability in either cell type in the absence of serum- or nerve growth factor-withdrawal. These observations are consistent with a survival-promoting effect of FK506 in cultured neurons.

Caspase 6 activity initiates caspase 3 activation in cerebellar granule cell apoptosis.

Using a well documented ex vivo system consisting of rodent cerebellar granule cells (CGCs) the activation of caspases 3 and 6 during apoptosis induced by withdrawal of trophic support was analyzed. At the time of deprivation, the addition of the irreversible, broad-spectrum caspase inhibitor zVADfmk or the cell permeable, caspase 6 inhibitor CP-VEID-cho can transiently suppress the appearance of apoptosis, including the early appearance of DNA fragmentation. Using immunoblotting and fluorogenic peptide assays we observe deprivation-induced activation of caspases 3 and 6, but not caspase 9. Furthermore, active caspase 6 is capable of processing and activating procaspase 3 in cellular extracts prepared from non-apoptotic CGCs, whereas caspase 3 failed to activate caspase 6. In consonant with this, the cell permeable caspase 6 inhibitor prevented deprivation-induced caspase 3 activation whereas a cell permeable caspase 3 inhibitor, CP-DEVD-cho, had no effect on caspase 6 activation. This would indicate that caspase 6 is a significant inducer of the early caspase 3 activity in apoptotic CGCs.

Colonization of transplant unit water supplies with Legionella and protozoa: precautions required to reduce the risk of legionellosis.

Organ transplant recipients and other immunosuppressed patients are known to be at increased risk of nosocomial Legionnaires' disease. Although the ecology of Legionella in hospital water storage and distribution systems (including a protozoonotic relationship with free-living protozoa) has been well documented, little is known regarding the quality of water supplied to high-risk units. Hot- and cold-water samples (two first draw and one run to waste for 5 min) were taken from 69 (85%) of the 81 United Kingdom organ transplant units (31 renal, 24 bone marrow, nine cardiopulmonary and five liver transplant units) and cultured for Legionella and protozoa. Legionella spp. were isolated from the water supplies of 38 (55%) units and Legionella pneumophila from 31 (45%). The blue-white fluorescent group of Legionella (Legionella gormanii, Legionella bozemanii and others) was isolated from 18 (26%) units. Free-living protozoa were isolated from 47 units (68%) and genera of the protozoa known to permit the intracellular growth of Legionella (PGIGL), from 40 units (58%). Possible associations between Legionella and the variables Protozoa; PGIGL; water pH; and circulating water temperature (recorded after running to waste for 5 min) were examined by logistic regression analysis. In cold-water supplies, a significant association was found between the isolation of Legionella and PGIGL (P = 0.032; OR = 1.81; 95% CI 1.1-3.1). In hot-water supplies, an inverse association was found between the isolation of Legionella and circulating water temperature (P = 0.034; OR = 1.0719 per degree C; 95% CI 1.0052-1.1432). (We failed to isolate Legionella when the circulating hot water was > 58 degrees C. No other associations were significant. We recommend the active surveillance of water quality in high-risk patient areas, and that transplant units, either with a history of nosocomial Legionnaires' disease, or where active surveillance indicates a persistently high Legionella colony count, take remedial action. The quality of cold water may be improved by provision of a dedicated supply taken directly from the incoming mains; and of hot water by the use of a dedicated calorifier, able to maintain a minimum circulating hot water return temperature of 60 degrees C.

Fatal nosocomial Legionnaires' disease: relevance of contamination of hospital water supply by temperature-dependent buoyancy-driven flow from spur pipes.

The investigation, epidemiology, and effectiveness of control procedures during an outbreak of Legionnaires' disease involving three immunosuppressed patients are described. The source of infection appeared to be a network of fire hydrant spurs connected directly to the incoming hospital mains water supply. Removal of these hydrants considerably reduced, but failed to eliminate, contamination of water storage facilities. As an emergency control procedure the incoming mains water was chlorinated continuously. Additional modifications to improve temperature regulation and reduce stagnation also failed to eliminate the legionellae. A perspex test-rig was constructed to model the pre-existing hospital water supply and storage system. This showed that through the hydraulic mechanism known as 'temperature buoyancy', contaminated water could be efficiently and quickly exchanged between a stagnant spur pipe and its mains supply. Contamination of hospital storage tanks from such sources has not previously been considered a risk factor for Legionnaires' disease. We recommend that hospital water storage tanks are supplied by a dedicated mains pipe without spurs.