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Neurocysticercosis is rarely reported in short-term travelers, although the disease remains a major public health problem in tropical regions. We present a case of neurocysticercosis that was probably acquired by ingestion of Taenia solium eggs contained in the stomach of a pig butchered by the traveler. Complete clinical resolution was obtained by medical treatment, underlying the importance of early suspicion and diagnosis of the disease.

Macrolide resistance in disseminated Mycobacterium avium infection is of major concern in AIDS patients as these drugs represent the main component of combination therapy. Clarithromycin and azithromycin should not be used alone for the treatment and prophylaxis of the disease because of the risk of selecting resistant strains. We report the case of a clarithromycin resistant disseminated M. avium infection in an AIDS patient, acquired after long term monotherapy with clarithromycin for the treatment of cryptosporidiosis.

To the Editors: Tuberculosis (TB) and HIV co-infection is a public health priority in sub-Saharan Africa, where TB is the leading cause of death among HIV infected patients and the first manifestation of the HIV infection. 1–3. An unprecedented global effort allowed increasing access to antiretroviral treatment in Africa, where >2 million persons received highly active antiretroviral therapy (HAART) at the end of 2007 1. There is evidence that HAART reduces the risk of TB, in both industrialised 4 and resource-limited countries in sub-Saharan Africa and south-east Asia 5–9. However, there is no information on the HAART impact on the incidence of the different TB forms (sputum smear positive pulmonary (SSP-PTB), sputum smear negative (SSN-PTB) and extrapulmonary (EPTB)). We have measured TB incidence in a retrospective cohort of HIV infected persons who started HAART in four HIV/AIDS treatment centres in Ouagadougou, Burkina Faso. All consecutive HIV-seropositive patients aged …

Both hyper-reactive malarial splenomegaly (HMS) and HIV infection are highly prevalent in sub-Saharan Africa, but the inter-relationships between the two conditions are not clearly defined. Diagnosis of HMS is particularly difficult in HIV-infected patients, and detection of circulating malaria parasites by polymerase chain reaction (PCR) may represent a useful diagnostic tool.

The cases are described of two infants who developed clinical and laboratory signs of congenital syphilis in Northern Italy, a region where the disease had not been documented for several years. The report urges greater vigilance and screening for syphilis among pregnant women and newborns, and contributes to the evidence that the incidence of syphilis is rising among women in Italy.

Toxoplasmosis is a well recognized manifestation of AIDS, but the disseminated disease is a rare condition and it has not been associated to HIV seroconversion to our knowledge. We describe a fatal episode of disseminated T. gondii acute infection with massive organ involvement during primary HIV infection. The serological data demonstrate primary T. gondii infection. The avidity index for HIV antibodies supports recent HIV-1 infection.

On September 1, 2000, a 37-year-old Italian manwas admitted to our Infectious Diseases Institute with a7-day history of irregularly relapsing fever,shaking chills,and a single ulcerative lesion on a toe of the right foot.The patient had returned from Vietnam 1 week before,after a 1-month stay in a holiday resort.On August 19,he had been bitten by an urban rat on the first toe of theright foot while he was wearing open shoes. At theemergency department of a Saigon hospital,the woundwas thoroughly cleaned, and tetanus immunoglobulinswere administered. No antibiotic prophylaxis was pre-scribed.On admission to our institute,the patient appearedseverely ill, complained of malaise, headache, photo-phobia,and pain at the right foot.Physical examinationwas significant for a systolic blood pressure of 80 mm Hg,a pulse of 110 per minute,respiration of 30 per minute,and a temperature of 39.8°C.A small painful ulcerativelesion was present at the right toe, with perilesionaledema and erythema, and large regional lympha-denopathy.There was neither rash nor complaints of jointpain.Laboratory investigation showed neutrophil leuko-cytosis (leukocyte count:32,000/ L,neutrophils 89%),erythrocyte sedimentation rate (ESR) at 120 per hour,and C-reactive protein of 57.3 mg/L.Blood and urinecultures,repeated blood smears for malaria,and rickettsia,brucella,leptospira,salmonella,and syphilis serological testswere all negative.Spirillum-like organisms were identi-fied in dark-field examination of the ulcer exudate. Adiagnosis of spirillary RBF was made. Owing to thehigh clinical suspicion, treatment with IV ampicillin-sulbactam had already been started a few hours afteradmission.Fever and other signs and symptoms of sys-temic inflammatory response syndrome resolved promptlyallowing for an early switch to oral therapy (day 3) andhospital discharge on day 4.A 2-week antibiotic coursewith oral amoxicillin-clavulanic acid was prescribed athome,with complete resolution at 1 month follow-up.Sodoku is a rare disease,object of a few sporadic casereports

Respiratory symptoms and signs are reported in 4% to 18% of the cases with uncomplicated Plasmodium falciparum malaria and are also a major feature in severe malaria. Plasmodium vivax malaria seldom results in pulmonary damage, and pulmonary complications are exceedingly rare. We report a case of Acute Respiratory Distress Syndrome (ARDS) complicating infection with P vivax malaria from Venezuela. A 50‐year‐old, otherwise healthy Italian woman presented at the Institute of Infectious and Tropical Diseases, University of Brescia, on 17 December, 2004, with a 4‐day history of fever and chills. She had been working as a volunteer in Venezuela (rural area near Caracas) for 1 month without taking any antimalarial chemoprophylaxis. She had returned to Italy 11 days before admission. On admission, she had fever (39.9°C), moderate hypotension (100/60 mm Hg), relative bradycardia (pulse rate was 64 beats/min), and oxygen saturation of 99%. Physical examination was normal. Initial laboratory investigations showed severe trombocytopenia platelet (PTL) count = 25 × 109/mL and moderate leucopoenia (white blood cell [WBC] count = 3.1 × 109/mL), with a normal differential count and no significant anemia (Hb …

Background Sexually transmitted infections are widespread globally, especially among people aged 15–25. Chlamydia trachomatis is the most common sexually-acquired bacterial disease. This infection is not notified in Italy; prevalence data on population-based surveys are not available. Methods We conducted a prevalence survey among students aged 18 or older attending high schools in the Province of Brescia, Northern Italy. A total of 3134 adolescents were offered to enter the study; overall, 1886/3134 (60.2%) participated. Each consenting student answered to a socio-behavioural questionnaire and C. trachomatis and N. gonorrhoeae were searched on first void urine samples using VERSANT ® CT/GC DNA 1.0 Assay (kPCR). We present preliminary data concerning 1311 enrolled individuals attending 16 schools. Results Overall, 63.8% (836/1311) were females and the median age was 18.4 years. Most students (91.7%) were born in Italy. 77.1% of the enrolled students declared to be sexually active (F > M, p F, p = 0.017) admitted always using it. Females were found to become sexually active earlier, had more partners in the previous six months and less frequently used condoms. No case of N. gonorrhoeae infection was identified, while 8 males and 13 females were positive for C. trachomatis, with a prevalence rate among sexually active students of 2.4% (IC 95%:1.0–4.8) and 1.9% (IC 95%:1.0–3.3) respectively. The factors significantly associated with an increased risk of Chlamydial infection were the inconsistent condom use (p = 0.029) and a higher number of sexual partners during the previous six months (p = 0.013). Conclusion A lower than expected prevalence of C. trachomatis infection was observed among sexually active adolescents in Northern Italy. Study conducted with scientific and logistic support from Copan S.p.A. and Siemens Healthcare Diagnostic S.p.A.

Plasmodium vivax infections caused by strains with low sensitivity to primaquine are widespread in the Western Pacific and Southeast Asia, and have been recently reported from Central America as well. We report a case of primaquine failure in a P. vivax infection acquired in Guatemala. A 28-year-old Italian woman developed two months after returning from Guatemala a vivax malaria attack that was treated with a standard chloroquine course (1,500 mg over three days) combined with primaquine (15 mg/day for 14 days). Two months later, she had a relapse that was again treated with chloroquine and primaquine at the same doses. After two more months, a second relapse occurred : this time primaquine (30 mg/day for 14 days was administered ; the patient remained well during a follow-up period of six months and all parasitologic examination results were negative. Doses of primaquine as high as 6 mg/kg total dose may be indicated in the treatment of vivax malaria cases from Central America.

Mefloquine is recommended for malaria chemoprophylaxis in short-term travelers to subSaharan Africa by many national and international organizations.’,’ Although mefloquine is presently highly effective against Pfalriparum in this area, resistance to the drug may develop, as occurred in Thailand in recent years.’ Continued monitoring and detailed documentation of malaria in people who use mefloquine for prophylaxis is therefore essential. We describe a case of malaria caused by P&kiparcrm in one Italian soldier returning &om Mozambique. He was taking mefloquine chenioprophylaxis. A 20-year-old man was admitted to hospital on July 16,1993, with a 3-day history of fever, diarrhea, and epigastric pain. He had served in the Italian army in rural areas ofMozambique from March 3 to July 13,1993. He reported no complaints during the stay. To prevent malaria he had taken chloroquine 300 mg weekly, and proguanil 200 mg daily until June 17. Then, as preventive guidelines in the army changed, he started taking mefloquine 250 mg weekly. He reported that he had not missed any doses of mefloquine, the last one being taken on July 15. O n the day of admission to hospital, July 16, a peripheral blood smear showed trophozoites of Pfalcipanm, with an asexual parasite count of 7950 per cmm. The serum mefloquine level in blood obtained on the same day was 920 ng per mL (determined by high performance liquid chromatography, at the Department of Clinical Chemistry, Falu Central Hospital, Sweden). The parasite strain was isolated, and in vitro sensitivity to antimalarial drugs was assessed with the 3H-hypoxanthine semimi~rotest.~

There has been concern that impregnated bed nets are an insufficiently powerful method to control malaria in areas with very high perennial transmission, as in the humid lowland parts of tropical Africa. We carried out a ‘cross-over’ trial among children under 5 years of age in 2 villages in rural Zanzibar. In 1989, one village was supplied with newly permethrin-impregnated bed nets whereas the other served as unprotected control. In 1992, when those nets had lost their insecticidal activity and were badly torn, the village which had previously been the control was given newly impregnated bed nets. Each time, reinfection with Plasmodium falciparum was measured after initially clearing the parasites by administering a therapeutic dose of sulfadoxine/pyrimethamine. The introduction of bed nets led to a 74–78% reduction in the weekly rate of reinfection with malaria parasites, in all age groups. The nets apparently also affected perceived clinical symptoms, haemoglobin levels, and the mosquito sporozoite rate.

We report a case of cutaneous bartonellosis in a 24-year-old Italian woman. Soon after returning from a seven-month stay in a central area of Peru at an altitude of 3,130 meters, she developed high fever, headache, and muscle and joint pain that resolved after antibiotic therapy. Two months later, she presented with disseminated, painless, firm, purple, subcutaneous nodules on the neck, shoulders, legs, left eyelid, and hard palate, some of which developed into vegetating lesions. The diagnosis of bartonellosis was made on the basis of the clinical picture, the patient's medical history, the incubation period, the confirmatory histopathologic findings, and the response to treatment with chloramphenicol (500 mg four times a day for 14 days).

Severe anaemia in pregnancy is a major obstetric problem in malaria-endemic areas. This study reports a cross-sectional investigation of malaria infection and haematological values at delivery in 440 women from urban Zanzibar. Severe anaemia [with haemoglobin (Hb)or = 7 g/dl] was identified in 36 women (9.3%) and mild anaemia (7Hb10 g/dl) in 269 (69.7%) while 81 women (21.0%) had normal Hb values. Malaria infection was diagnosed in 187/385 women (48.6%) on the basis of either peripheral blood examination or placental histology. Univariate analysis indicated that the proportion of women with anaemia was similar in those with (85%) and without (80%) malaria infection. However, when primigravidae were considered alone, malaria infection was significantly more frequent among anaemic women (65.2%) than in those with normal Hb values (40.0%). In the logistic regression analysis, including age, parity, education level, malaria and free serum iron as independent variables and anaemia (Hbor = 10 g/dl) as response variable, the odds ratio (OR) for malaria infection was 1.2 (P0.1). However, a similar analysis indicated that malaria was significantly associated with anaemia in the primigravidae, with an OR of 3.2 (95% confidence interval: 1.1-9.6; P0.05). In conclusion, this cross-sectional investigation indicated that malaria plays a significant role in the determination of anaemia in primigravidae, but not in multiparae, in the urban study area.

Background Drug-resistant tuberculosis (DR-TB) is considered a real threat to the achievement of TB control. Testing of mycobacterial culture and testing of drug susceptibility (DST) capacity are limited in resource-poor countries, therefore inadequate treatment may occur, favouring resistance development. We evaluated the molecular assay GenoType® MTBDRplus (Hain Lifescience, Germany) in order to detect DR-TB directly in clinical specimens as a means of providing a more accurate management of chronic TB patients in Burkina Faso, a country with a high TB-HIV co-infection prevalence. Methods Samples were collected in Burkina Faso where culture and DST are not currently available, and where chronic cases are therefore classified and treated based on clinical evaluation and sputum-smear microscopy results. One hundred and eight chronic TB patients (sputum smear-positive, after completing a re-treatment regimen for pulmonary TB under directly observed therapy) were enrolled in the study from December 2006 to October 2008. Two early morning sputum samples were collected from each patient, immediately frozen, and shipped to Italy in dry ice. Samples were decontaminated, processed for smear microscopy and DNA extraction. Culture was attempted on MGIT960 (Becton Dickinson, Cockeysville, USA) and decontaminated specimens were analyzed for the presence of mutations conferring resistance to rifampin and isoniazid by the molecular assay GenoType® MTBDRplus. Results We obtained a valid molecular test result in 60/61 smear-positive and 47/47 smear-negative patients. Among 108 chronic TB cases we identified patients who (i) harboured rifampin- and isoniazid-susceptible strains (n 24), (ii) were negative for MTB complex DNA (n 24), and (iii) had non-tuberculous mycobacteria infections (n 13). The most represented mutation conferring rifampin-resistance was the D516V substitution in the hotspot region of the rpoB gene (43.8% of cases). Other mutations recognized were the H526D (15.6%), the H526Y (15.6%), and the S531L (9.4%). All isoniazid-resistant cases (n 36) identified by the molecular assay were carrying a S315T substitution in the katG gene. In 41.7% of cases, a mutation affecting the promoter region of the inhA gene was also detected. Conclusion The GenoType® MTBDRplus assay performed directly on sputum specimens improves the management of chronic TB cases allowing more appropriate anti-TB regimens.

We carried out an electron-microscopy study on in vitro cultures of Plasmodium falciparum, whose general ultrastructural features are consistent with previous reports. In addition, whorled membrane-vesicles systems involving parasite and host-cells, never described to our knowledge up to now. As far as the parasite is concerned, these membraneous systems appear to be related to its growth and its connection with the external medium, with the possible involvement of Maurer's clefts. As for the erythrocyte, surface vesicles prove to be related to plasmodial infection in long-term in vitro culture. Richness in membranous structures of the complex host-parasite varies according to the metabolic demand of the plasmodium (i.e. on the life-cycle stage) and is influenced by external factors, possibly being a marker of drug action.

Plasmodium vivax is the second most common species among malaria patients diagnosed in Europe, but epidemiological and clinical data on imported P. vivax malaria are limited. The TropNetEurop surveillance network has monitored the importation of vivax malaria into Europe since 1999. To present epidemiological and clinical data on imported P. vivax malaria collected at European level. Data of primary cases of P. vivax malaria reported between January 1999 and September 2003 were analysed, focusing on disease frequency, patient characteristics, place of infection, course of disease, treatment and differences between network-member countries. Within the surveillance period 4,801 cases of imported malaria were reported. 618 (12.9%) were attributed to P. vivax. European travellers and immigrants were the largest patient groups, but their proportion varied among the reporting countries. The main regions of infection in descending order were the Indian subcontinent, Indonesia, South America and Western and Eastern Africa, as a group accounting for more than 60% of the cases. Regular use of malaria chemoprophylaxis was reported by 118 patients. With 86 (inter-quartile range 41–158) versus 31 days (inter-quartile range 4–133) the median symptom onset was significantly delayed in patients with chemoprophylaxis (p < 0.0001). Common complaints were fever, headache, fatigue, and musculo-skeletal symptoms. All patients survived and severe clinical complications were rare. Hospitalization was provided for 60% and primaquine treatment administered to 83.8% of the patients, but frequencies varied strongly among reporting countries. TropNetEurop data can contribute to the harmonization of European treatment policies.

Removal of exhaled air from total body emanations or artificially standardising carbon dioxide (CO2) outputs has previously been shown to eliminate differential attractiveness of humans to certain blackfly (Simuliidae) and mosquito (Culicidae) species. Whether or not breath contributes to between-person differences in relative attractiveness to the highly anthropophilic malaria vector Anopheles gambiae sensu stricto remains unknown and was the focus of the present study. The contribution to and possible interaction of breath (BR) and body odours (BO) in the attraction of An. gambiae s.s. to humans was investigated by conducting dual choice tests using a recently developed olfactometer. Either one or two human subjects were used as bait. The single person experiments compared the attractiveness of a person's BR versus that person's BO or a control (empty tent with no odour). His BO and total emanations (TE = BR+BO) were also compared with a control. The two-person experiments compared the relative attractiveness of their TE, BO or BR, and the TE of each person against the BO of the other. Experiments with one human subject (P1) as bait found that his BO and TE collected more mosquitoes than the control (P = 0.005 and P < 0.001, respectively), as did his BO and the control versus his BR (P < 0.001 and P = 0.034, respectively). The TE of P1 attracted more mosquitoes than that of another person designated P8 (P < 0.021), whereas the BR of P8 attracted more mosquitoes than the BR of P1 (P = 0.001). The attractiveness of the BO of P1 versus the BO of P8 did not differ (P = 0.346). The BO from either individual was consistently more attractive than the TE from the other (P < 0.001). We demonstrated for the first time that human breath, although known to contain semiochemicals that elicit behavioural and/or electrophysiological responses (CO2, ammonia, fatty acids) in An. gambiae also contains one or more constituents with allomonal (~repellent) properties, which inhibit attraction and may serve as an important contributor to between-person differences in the relative attractiveness of humans to this important malaria vector.

Background: Anopheles gambiae is the main vector of Plasmodium falciparum in Africa. The mosquito midgut constitutes a barrier that the parasite must cross if it is to develop and be transmitted. Despite the central role of the mosquito midgut in the host/parasite interaction, little is known about its protein composition. Characterisation of An. gambiae midgut proteins may identify the proteins that render An. gambiae receptive to the malaria parasite. Methods: We carried out two-dimensional gel electrophoresis of An. gambiae midgut proteins and compared protein profiles for midguts from males, sugar-fed females and females fed on human blood. Results: Very few differences were detected between male and female mosquitoes for the approximately 375 silver-stained proteins. Male midguts contained ten proteins not detected in sugar-fed or blood-fed females, which are therefore probably involved in male-specific functions; conversely, female midguts contained twenty-three proteins absent from male midguts. Eight of these proteins were specific to sugar-fed females, and another ten, to blood-fed females. Conclusion: Mass spectrometry analysis of the proteins found only in blood-fed female midguts, together with data from the recent sequencing of the An. gambiae genome, should make it possible to determine the role of these proteins in blood digestion or parasite receptivity.

Malaria parasites that carry the DHFR-mutation I164L are not only highly resistant to sulfadoxine-pyrimethamine but also to the new antimalarial drug chlorproguanil-dapsone. The spread of this mutation in Africa would result in a public health disaster since there is a lack of effective alternatives that are both affordable and safe. Up to now, this mutation has only been described in Asian and Latin-American countries. The objective of this study was to assess the prevalence of this mutation in African isolates of Plasmodium falciparum that have been imported into Europe through travellers. TropNetEurop is a network for the surveillance of travel-associated diseases and seems to cover approximately 12% of all malaria cases imported into Europe. Within this network we screened 277 imported African isolates of P. falciparum with the help of PCR- and enzyme-digestion-methods for the antifolate-resistant mutation I164L. The I164L mutation was not detected in any of the isolates tested. Continuous molecular surveillance of mutations in P. falciparum, as it is practised within TropNetEurop, is an essential tool for the understanding and early detection of the spread of antimalarial drug resistance in Africa.

A prospective, multicentre study was carried out in Italy to assess the sensitivity and specificity of a rapid dipstick test (ICT Malaria P.f./P.v.) in the diagnosis of imported malaria caused by Plasmodium falciparum and other Plasmodium spp. The test is based on the detection of histidine-rich protein-2 (HRP-2) from P. falciparum and 'panmalarial' antigen in peripheral blood. The 241 subjects were international travellers or immigrants from areas where malaria is endemic. When compared with the microscopical examination of bloodsmears (used as the 'gold standard'), the dipsticks were found to be 94.4% sensitive and 94.5% specific for pure infections with P. falciparum. The performance of the tests when used on patients infected with species other than P. falciparum or more than one Plasmodium spp. showed a high degree of variability. Although the dipsticks represent a very simple, rapid, and valuable diagnostic aid, they should not be considered a complete substitute for direct microscopical diagnosis using stained bloodsmears.

The purpose of this study was to evaluate nitric oxide (NO) activity in patients with uncomplicated malaria. Lipopolysaccharide and gamma interferon (IFN-gamma) are potent inducers of NO by inducing production of NO synthase. NO activity was determined by measuring serum levels of nitrite/nitrate (metabolic end products of NO), and IFN-gamma in patients with uncomplicated malaria, mostly caused by Plasmodium falciparum. Neither serum levels of nitrite/nitrate nor of IFN-gamma were significantly increased in patients with uncomplicated malaria, especially in patients with P. falciparum infection, and in those with high parasitaemia. These results show that NO cannot play a role in uncomplicated malaria, and it is still debatable if NO production in this infection has beneficial or detrimental effects.

Hepatitis A virus (HAV) circulation in a given area is closely related to socioeconomic standards. Following the improvement of living conditions, HAV seroprevalence rates in the population have decreased steadily during the last decades in many Western European countries, including Italy, thereby leading to a shift of risk of disease towards older age groups. Since the severity of the disease closely parallels age, a higher incidence of symptomatic cases in adults is now reported in Europe and the United States, being travel-related to a large extent. Intrafamilial person-to-person spread is also an important source of infection and transmission from children to parents may occur due to the lack of immunity in the general population. In the last two decades, Italy has been the destination of an increasing number of migrants from developing countries, where HAV is highly endemic. Furthermore, international adoption programmes cause pediatric populations from HAV endemic countries to increase in low endemic areas, possibly leading to secondary cases in close contacts.7 The aim of this paper is to report the epidemic HAV outbreak which occurred among the voluntary nursing staff of a pediatric Rwandan refugee community hosted in a village of the Brescia Province, in northern Italy.

Tuberculosis (TB) is a leading cause of death among women of childbearing age, and may be responsible for severe complications during pregnancy. Between August 2014 and March 2015, we conducted a pilot project to promote active TB case finding in antenatal care (ANC) clinics in the Central Region of Burkina Faso. Our results show very limited TB diagnostic practices and possible severe underdiagnosis of TB at ANC clinics, despite adequate screening practices. Integration of training and supervision of TB diagnosis and treatment into ANC services is required.

The Indian Ocean provides a unique opportunity to curb the HIV epidemic in its nascent phase through strengthening STI control programmes. Making effective and appropriate health services available should be regarded as the first priority for STI control in the region and, whenever possible, core groups should be identified and targeted to interrupt transmission within such networks.

We report a fatal case of malaria in an HIV-coinfected nonimmune traveler. The primary cause of death is discussed. The importance of prevention of malaria in nonimmune travelers is stressed. Prevention of malaria in nonimmune travelers should be regarded as a priority area for clinical practice and operational research.

It is important to recognise the impact of COVID-19 on TB care to mitigate its consequences. TB services have an urgent need to identify novel strategies to ensure the continuum of TB care at the time of the coronavirus pandemic. https://bit.ly/2OIKnwL

Tackling tuberculosis requires early diagnosis, treatment and innovative transdisciplinary action through pan-European projects http://ow.ly/1sfJ30jy3VB