Epidemiological and molecular assessment of a measles outbreak in a highly vaccinated population of northeast Italy.

SUMMARYTwo distinct measles outbreaks, unrelated from the epidemiological point of view but caused by genetically related strains, occurred in the Friuli Venezia Giulia region of northeastern Italy. Forty-two cases were reported during the period April–May 2008. In the first outbreak the index case was a teacher who introduced the virus into the Pordenone area, involving eight adolescents and young adults. The other concomitant outbreak occurred in the city of Trieste with 33 cases. The containment of the epidemics can be explained by the high MMR vaccine coverage in an area where the first dose was delivered to 93·4% and the second dose to 88·3% of the target children. Phylogenetic analysis of 14 measles virus strains showed that they belonged to a unique D4 genotype indistinguishable from the MVs/Enfield.GBR/14.07 strain, probably introduced from areas (i.e. Piedmont and Germany) where this genotype was present or had recently caused a large epidemic

Herpes simplex virus (HSV) pneumonia in the non-ventilated immunocompromised host: Burden and predictors

Objectives: To evaluate burden and predictors of HSV pneumonia among immunocompromised patients not undergoing invasive mechanical ventilation according to a tailored diagnostic algorithm. Methods: This prospective, observational study included immunocompromised adults with pneumonia non-responding to empirical antibiotic therapy. Bronchoalveolar lavage (BAL) specimens were cultured for bacteria, mycobacteria and fungi. Real-time PCR for Herpesviruses and other microorganisms were performed on BAL and other specimens. Cytological examination of BAL samples was carried out for identification of intranuclear inclusion bodies and immunohistochemical staining for HSV. Results: We enrolled 45 patients (mean age 64.6 years) from January 2015 to June 2016. Nineteen (42.2%) cases tested positive for HSV-1 PCR on BAL. According to our definitions, 11 (24.4%) patients had HSV- 1 pneumonia with viral loads ranging between 10 3 copies/mL and 10 7 copies/mL. HSV-1 positive throat swab (OR 85.2, 95% CI 5.83\u20131245.1, P < 0.001) and solid organ transplant (SOT) (OR 53.3, 95% CI 1.37\u20132072.8, P < 0.03) as underlying condition were found to be independently associated with HSV pneumonia by multivariable analysis. Conclusions: HSV pneumonia turned out to be relatively common and should be investigated especially in individuals with HSV positive throat swab and SOT. Interventional studies are needed to assess the real clinical impact of HSV pneumonia in immunocompromised patients

Extended-spectrum β-lactamase-producing Escherichia coli from extraintestinal infections in humans and from food-producing animals in Italy: a 'One Health' study

In recent years, Escherichia coli producing extended spectrum beta-lactamases (ESBL) have become a serious public health problem and food-producing animals (FPA) have been suggested as a potential reservoir/source. In this study, we aimed to compare ESBL-producing E. coli isolates from different sources. ESBL-producing E. coli isolates were collected from humans (n=480) and FPA (n=445) in Italy (2016-2017). Isolates were screened for the presence of ESBL and carbapenemase genes and classified according to phylogenetic group and MLST genotyping. mcr-1 to -5 genes were searched for in colistin resistant isolates. CTX-M was the most frequent ESBL-type in both human and animal isolates. CTX-M-15 prevailed in humans (75%) and cattle (51.1%) but not in poultry (36.6%). CTX-M-1 was common (58%) in pigs. SHV-type and CMY-2-like were found in FPA, especially in poultry (17.0% and 29.9%, respectively). 29 isolates were mcr-1 carriers (3 from humans and 26 from FPA). No carbapenemase genes were detected. Human isolates mostly belonged to phylogroup B2 (76.5%). Animal isolates were distributed among groups A (35.7%), B1 (26.1%) and C (12.4%). Few animal isolates (almost all from poultry) were classified into group B2 (4.3%). Most human isolates (83.4%) belonged to the pandemic ST131 clone and frequently carried CTX-M-15 (75.9%). ST131 was rarely detected in FPA (n=3 isolates from poultry). Nineteen STs were shared in both sources with ST10, ST410 and ST69 being more frequently detected. According to our results the potential exchange of ESBL genes from animals to humans is feasible, underlying the need for a strict monitoring based on an "One Health" approach

Lung ultrasound may support internal medicine physicians in predicting the diagnosis, bacterial etiology and favorable outcome of community-acquired pneumonia

To assess the usefulness of lung ultrasound (LUS) for identifying community-acquired pneumonia (CAP) among adult patients with suspected lower respiratory tract infection (LRTI) and for discriminating between CAP with different cultural statuses, etiologies, and outcomes. LUS was performed at internal medicine ward admission. The performance of chest X-ray (CXR) and LUS in diagnosing CAP in 410 patients with suspected LRTI was determined. All possible positive results for pneumonia on LUS were condensed into pattern 1 (consolidation + / - alveolar-interstitial syndrome) and pattern 2 (alveolar-interstitial syndrome). The performance of LUS in predicting culture-positive status, bacterial etiology, and adverse outcomes of CAP was assessed in 315 patients. The area under the receiver operating characteristic curve for diagnosing CAP by LUS was significantly higher than for diagnosis CAP by CXR (0.93 and 0.71, respectively; p &lt; 0.001). Pattern 1 predicted CAP with bacterial and mixed bacterial and viral etiologies with positive predictive values of 99% (95% CI, 94-100%) and 97% (95% CI, 81-99%), respectively. Pattern 2 ruled out mortality with a negative predictive value of 95% (95% CI, 86-98%), respectively. In this study, LUS was useful in predicting a diagnosis of CAP, the bacterial etiology of CAP, and favorable outcome in patients with CAP

Has VZV epidemiology changed in Italy? Results of a seroprevalence study

The aim of the study was to evaluate if and how varicella prevalence has changed in Italy. In particular a seroprevalence study was performed, comparing it to similar surveys conducted in pre-immunization era. During 2013–2014, sera obtained from blood samples taken for diagnostic purposes or routine investigations were collected in collaboration with at least one laboratory/center for each region, following the approval of the Ethics Committee. Data were stratified by sex and age. All samples were processed in a national reference laboratory by an immunoassay with high sensitivity and specificity. Statutory notifications, national hospital discharge database and mortality data related to VZV infection were analyzed as well. A total of 3707 sera were collected and tested. In the studied period both incidence and hospitalization rates decreased and about 5 deaths per year have been registered. The seroprevalence decreased in the first year of life in subjects passively protected by theirmother, followed by an increase in the following age classes. The overall antibody prevalence was 84%. The comparison with surveys conducted with the samemethodology in 1996–1997 and 2003–2004 showed significant differences in age groups 1–19 y. The study confirms that in Italy VZV infection typically occurs in children. The impact of varicella on Italian population is changing. The comparison between studies performed in different periods shows a significant increase of seropositivity in age class 1 – 4 years, expression of vaccine interventions already adopted in some regions

Tick-borne encephalitis in north-east Italy: a 14-year retrospective study, January 2000 to December 2013

Italy is considered at low incidence of tick-borne encephalitis (TBE), and the occurrence of human cases of TBE appears to be geographically restricted to the north east of the country. However, most information to date derives from case series, with no systematic data collection. To estimate incidence rates (IR) and spatial distribution of TBE cases, we conducted a retrospective study in north-eastern Italy. Data were collected through the infectious disease units and public health districts of three regions (Friuli Venezia Giulia, Trentino Alto Adige and Veneto) between 2000 and 2013. Overall, 367 cases were identified (IR: 0.38/100,000). The cases' median age was 56 years and 257 (70%) were male. Central nervous system involvement was reported in 307 cases (84%). Annual fluctuations in case numbers occurred, with peaks in 2006 and in 2013, when 44 and 42 cases were respectively observed. A strong seasonality effect was noted, with the highest number of cases in July. In terms of geographical location, three main endemic foci with high TBE IR (> 10/100,000) were identified in three provinces, namely Belluno (Veneto region), Udine (Friuli Venezia Giulia) and Trento (Trentino Alto-Adige). When investigating the whole study area in terms of altitude, the IR between 400 and 600\u2009m was greater (2.41/100,000) than at other altitudes (p< 0.01). In conclusion, the incidence of TBE in Italy is relatively low, even considering only the three known affected regions. However, three endemic foci at high risk were identified. In these areas, where the risk of TBEV infection is likely high, more active offer of TBE vaccination could be considere

Group B streptococcus prevalence in pregnant women from North‐Eastern Italy: advantages of a screening strategy based on direct plating plus broth enrichment

To assess the sensitivity of a combined selective broth enrichment technique plus selective plating for the detection of group B streptococcus (GBS) colonisation in a large cohort of pregnant women from North-Eastern Italy 5020 pregnant women were screened between the 35th and the 37th week of gestation during 2002\u20132005. 901 Women (17.9%) were positive for GBS. On 728 positive samples, corresponding to patients enrolled between 2003 and 2005, the results of selective direct plating and selective broth enrichment were compared. A total of 561 (77.1% of positive samples, corresponding to 13.9% of patients) were positive on direct selective agar; an additional 167 isolates (22.9% of samples, 4.1% of patients) were recovered from the LIM broth subculture. The prevalence of GBS carriage in this study is a reliable estimate considering the sensitivity of the methods used, the rate of attendance of pregnant women to clinical and laboratory settings and the compliance to the protocol

Antiviral properties of blue laser in an in vitro model of HSV-1 infection

6noHerpes simplex virus type-1 (HSV-1) is known to cause lifelong infections in humans. First infection is characterized by gingiva-stomatitis and pharyngitis, while virus reactivation causes recurrent herpes labialis with ulcerations on intraoral mucosa, mouth or external facial skin [1]. Laser therapy (LT), set at red and infrared wavelengths, has been reported as able to reduce HSV-1 recurrence and duration of herpetic sores [2]. Despite the blue wavelength already showed its efficacy in killing different strains of bacteria, it has never been tested on viruses [3].partially_openembargoed_20190716Zupin, Luisa*; Caracciolo, Ilaria; Tricarico, Paola Maura; Ottaviani, Giulia; D'Agaro, Pierlanfranco; Crovella, SergioZupin, Luisa; Caracciolo, Ilaria; Tricarico, Paola Maura; Ottaviani, Giulia; D'Agaro, Pierlanfranco; Crovella, Sergi

Zika virus induces inflammasome activation in the glial cell line U87-MG

4noIn the last years, neurological complications related to Zika virus (ZIKV) infection have emerged as an important threat to public health worldwide. ZIKV infection has been associated to neurological disorders such as congenital microcephaly in newborns and Guillain-Barré syndrome, myelopathy and encephalitis in adults. ZIKV is characterized by neurotropism and neurovirulence. Several studies have identified microglial nodules, gliosis, neuronal and glial cells degeneration and necrosis in the brain of ZIKV infected infants, suggesting that ZIKV could play a role in these neurological disorders through neuroinflammation and microglial activation. Little information is available about neuroinflammation and ZIKV-related neurological disorders. Therefore, we investigated if ZIKV is able to infect a glial cell line (U87-MG) and how the glial cell line responds to this infection in terms of inflammation (IL-1β, NLRP-3 and CASP-1), oxidative stress (SOD2 and HemeOX) and cell death. We observed a significant increase of ZIKV load in both cells and supernatants after 72 h, compared to 48 h of infection. We found that ZIKV infection induces an increase of IL-1β, NLRP-3 and CASP-1 genes expression. Significant increase of IL-1β and unchanged pro-IL-1β protein levels have also been detected. Moreover, we observed SOD2 and HemeOX increased gene expression mainly after 72 h post ZIKV infection. Subsequently, we found a decrease of U87-MG cell viability, after both 48 h and 72 h of ZIKV infection. Our results show that U87-MG cells are susceptible to ZIKV infection. ZIKV is able to successfully replicate in infected cells causing oxidative stress, NLRP3 inflammasome activation and subsequent release of mature IL-1β; this process culminates in cell death. Thus, considering the central role of neuroinflammation in neurological disorders, it is important to comprehend every aspect of this mechanism in order to better understand the pathogenesis of ZIKV infection and to identify possible strategies to fight the virus by rescuing cell death.partially_openembargoed_20180201Tricarico, Paola Maura; Caracciolo, Ilaria; Crovella, Sergio; D'Agaro, PierlanfrancoTricarico, PAOLA MAURA; Caracciolo, Ilaria; Crovella, Sergio; D'Agaro, Pierlanfranc