Novel Orthopoxvirus Infection in an Alaska Resident.

BACKGROUND.: Human infection by orthopoxviruses is being reported with increasing frequency, attributed in part to the cessation of smallpox vaccination and concomitant waning of population-level immunity. In July 2015, a female resident of interior Alaska presented to an urgent care clinic with a dermal lesion consistent with poxvirus infection. Laboratory testing of a virus isolated from the lesion confirmed infection by an Orthopoxvirus. METHODS.: The virus isolate was characterized by using electron microscopy and nucleic acid sequencing. An epidemiologic investigation that included patient interviews, contact tracing, and serum testing, as well as environmental and small-mammal sampling, was conducted to identify the infection source and possible additional cases. RESULTS.: Neither signs of active infection nor evidence of recent prior infection were observed in any of the 4 patient contacts identified. The patient's infection source was not definitively identified. Potential routes of exposure included imported fomites from Azerbaijan via the patient's cohabiting partner or wild small mammals in or around the patient's residence. Phylogenetic analyses demonstrated that the virus represents a distinct and previously undescribed genetic lineage of Orthopoxvirus, which is most closely related to the Old World orthopoxviruses. CONCLUSIONS.: Investigation findings point to infection of the patient after exposure in or near Fairbanks. This conclusion raises questions about the geographic origins (Old World vs North American) of the genus Orthopoxvirus. Clinicians should remain vigilant for signs of poxvirus infection and alert public health officials when cases are suspected.

Increase in Adverse Reactions Associated with Use of Synthetic Cannabinoids - Anchorage, Alaska, 2015-2016.

In July 2015, personnel in the Alaska Division of Public Health's Section of Epidemiology became aware of an increase in the number of patients being treated in Anchorage hospital emergency departments for adverse reactions associated with use of synthetic cannabinoids (SCs). SCs are a chemically diverse class of designer drugs that bind to the same cannabinoid receptors as tetrahydrocannabinol, the main psychoactive component of cannabis. A public health investigation was initiated to describe clinical outcomes, characterize the outbreak, and identify SC chemicals circulating in Anchorage. During July 15, 2015-March 15, 2016, a total of 1,351 ambulance transports to Anchorage emergency departments for adverse SC reactions were identified. A review of charts obtained from two Anchorage hospitals determined that among 167 emergency department visits for adverse SC reactions during July 15-September 30, 2015, 11 (6.6%) involved a patient who required endotracheal intubation, 17 (10.2%) involved a patient who was admitted to the intensive care unit, and 66 (39.5%) involved a patient classified as being homeless. Testing of 25 product and paraphernalia samples collected from patients at one hospital identified 11 different SC chemicals. Educational outreach campaigns focused on the considerable health risks of using SCs need to complement judicial and law enforcement actions to reduce SC use.

Free energy and entropy of activation for phospholipid flip-flop in planar supported lipid bilayers.

Basic transition state theory is used to describe the activation thermodynamics for phospholipid flip-flop in planar-supported lipid bilayers (PSLBs) prepared by the Langmuir-Blodgett/Langmuir-Schaeffer method. The kinetics of 1,2-distearoyl-sn-glycero-3-phosphocholine (DSPC) flip-flop were determined as a function of temperature and lateral surface pressure using sum-frequency vibrational spectroscopy (SFVS). From the temperature and lateral pressure dependent DSPC flip-flop kinetics, a complete description of the activation thermodynamics for flip-flop in the gel state, including free energy of activation (DeltaG(++)), area of activation (Deltaa(++)), and entropy of activation (DeltaS(++)), was obtained. The free energy barrier for flip-flop of DSPC was determined to be DeltaG(++) = 105 +/- 2 kJ/mol at 40 degrees C at a deposition surface pressure of 30 mN/m. The free energy barrier was found to consist of large opposing entropic and enthalpic contributions. The influence of alkyl chain length on the activation thermodynamics of flip-flop was also investigated. Decreasing the alkyl chain length led to a decrease in DeltaG(++) due primarily to an increase in DeltaS(++). The values obtained here are compared to previous studies investigating flip-flop by vesicle based methods.

Outbreak of Enterococcus gallinarum infections after total knee arthroplasty.

In September 2006, we investigated a cluster of 9 patients who developed Enterococcus gallinarum infection after total knee arthroplasty. Isolates recovered from these patients were from the same outbreak strain. Although all 9 patients were monitored by the same healthcare personnel, were given spinal anesthesia, and had the same specific type of wound irrigation procedure performed during their hospitalization, the source or sources of these infections were not identified.