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Leishmaniasis and rickettsial diseases are endemic and common in Mediterranean countries and so, as in humans, these diseases could be an important cause of HLH in dogs and may respond to similar medications. In conclusion, we think that the diagnosis of HLH should be considered in dogs with pancytopenia and, in selected cases, immunosuppressive treatment might be warranted.

Zoonoses, often better defined with the term anthropozoonoses, are diseases that can be transmitted to humans either by direct contact with animals or through arthropod vector intervention. Microbial interaction between humans and animals constitutes an important public health challenge, particularly in the Mediterranean basin. The main reasons this challenge is still relevant today include the phenomenon of migration, of both humans and animals, and climate change, which tend to alter the geographical distribution of zoonosis or the zoonotic agent, as well as the distribution range of potential vectors. The Mediterranean area seems to be affected by plentiful and widely distributed zoonoses, the main diseases being rickettsiosis, leishmaniasis, brucellosis, hydatid disease and viral zoonoses. The aim of this study is to revisit the prevalence and main clinical features of anthropozoonoses observed at the Department of Sciences for Health Promotion and Mother & Child Care, University of Palermo, Sicily, Southern Italy.

Body lice transport B. recurrentis from man to man and humans are the only host. The presence of lice in Italy and an increasing number of cases in migrants can contribute to the onset of autochthonous cases. In this paper, we report a new case of Louse-borne Relapsing Fever (LBRF) diagnosed among migrants in Sicily exactly one year after the first case was recorded. We reviewed all cases reported in Europe from February 2016 until now. Our study identified two new cases of LBRF in migrants arrived in Europe: one who came from Somalia and one from Mali. Here we report data on a new case in Sicily. The number of migrants and refugees to transit in Sicily has increased, and this has led to the introduction of infectious diseases. Therefore, in our opinion it is essential to upgrade control of the sanitation conditions of migrants.

Recent data confirmed the hypothesis suggested by historical studies that the ratio of peripheral blood monocytes to lymphocytes (M/L) is associated with the risk of tuberculosis (TB) disease. We retrospectively analyzed the electronic health records of tuberculosis and HIV-positive patients who had followed day-care programs at the AIDS Center of the University of Palermo, Italy. 261 patients were recruited and divided into 6 groups as follows: healthy control group (HCG: 47 pts), latent HIV negative infected TB group (LIG, 43 pts), active HIV negative tuberculosis (TAG: 61 pts), treated tuberculosis HIV negative (TTG: 44 pts), HIV drug-naive patients tested TST and QFT-IT-negative with negative chest x-Ray (HIVnG: 44 pts), and HIV-tuberculosis coinfection (HIVTB-G: 22 pts). For each group, absolute lymphocyte (L), monocyte (M) and M/L ratio by peripheral blood was calculated. The mean value of monocytes in the TAG group was significant, the highest (0.70±0.37 1x103/μl) in comparison to HGC (0.70>0.44, p-value 0.40, p-value 0.45, p-value0.27, p-value0.29, p-value0.32) and HIVTB-G groups (0.49>0.27, p-value

In order to evaluate the efficacy and tolerability of a high intravenous dose of rifampin plus oral minocycline (administered daily for 3 weeks) for the treatment of acute brucellosis, we retrospectively reviewed the outcome of 239 consecutive patients (135 adults and 104 children) diagnosed and treated over a 17-year period in Italy. The combination used resulted in 100% response and a relapse rate lower than 2%. Fifty-two (30 adults and 22 children) (29.8%) complained of mild adverse effects including an increase in aspartate aminotransferase (>250 IU) observed in 12 cases and considered related to rifampin and in 11 cases a reversible hyperpigmentation of the tongue attributed to minocycline. A randomized prospective comparative study should be performed to confirm our encouraging results.

Visceral leishmaniasis (VL) is endemic in Sicily. Although it is a notifiable disease, there is evidence that the actual number of cases is higher than that reported. In 1987, a regional reference center for active surveillance of VL was established and it recorded a total of 284 cases through 1995, a mean of 31.5 cases/year and about four-fold more than previously reported. Of the 284 cases, 150 (53%) were children (≤ 14 years of age), and of the 134 adults, 39 (29%) were coinfected with human immunodeficiency virus (HIV). The commonest viscerotropic zymodeme of Leishmania infantum, MON 1, was identified in 40 (93%) of 43 HIV-negative and eight (57%) of 14 HIV-positive patients. Among 280 patients evaluated (i.e., all HIV-negative and 35 of 39 HIV-positive subjects), 254 (91%) were treated with meglumine antimoniate alone or in combination with other drugs; 23 (8%) received allopurinol or amphotericin B, either conventional or in liposomal form; and three terminally ill patients were not treated. Among the 245 HIV-negative patients, 236 (96%) were successfully cured, while nine (4%) (seven adults) died during the course of antimonial treatment. None of the 35 HIV-positive patients was definitively cured, although mortality was apparently associated with other opportunistic infections.

No Abstract

Objectives Currently louse-borne relapsing fever (LBRF) is primarily found in limited endemic foci in Ethiopia, Somalia and Sudan; no case of imported LBRF has been reported in Europe in the 9 years prior to 2015. The aim of our paper is to describe a new case of imported LBRF detected in Sicily, Italy, and to review all cases reported in migrants arrived in Europe in the last 10 years. Study design Mini review of all published cases of louse-borne relapsing fever in Europe in the last 10 years. Methods A computerized search without language restriction was conducted using PubMed combining the terms ‘(louse-borne relapsing fever or LBRF or recurrentis) and (refugee or Europe or migrant)’ without limits. Furthermore, the ‘Ahead-of-Print Articles’ of the top 10 journals (ranked by Impact factor – Web of Science) of Infectious diseases and of Epidemiology were checked. Results Our search identified 26 cases of LBRF between July and October 2015 in migrants recently arrived in Europe: 8 had been described in Italy; 1 in Switzerland; 2 in the Netherlands; 15 in Germany. We describe data regarding the clinical characteristics, diagnostic methods, therapy and outcome of these patients and of the new case. Conclusions LBRF by Borrelia recurrentis should be considered among the clinical hypotheses in migrants presenting with fever, headache, chills, sweating, arthralgia, myalgia, dizziness, nausea and vomiting.

The aim of the present study was to describe the epidemiologic and clinical characteristics of acute viral gastroenteritis in hospitalised Italian children. A total of 215 stool specimens were collected from January to December 2003 from patients hospitalised in Palermo for acute diarrhoea. Samples were tested for group A rotavirus, astrovirus, adenovirus, norovirus, enteropathogenic bacteria, and parasites. Rotaviruses, mostly belonging to types G1-G4, were detected in 25.1% of samples, astrovirus in 7%, adenovirus in 6%, norovirus in 18.6%, and bacterial agents in 17.2%. No parasitic infections were diagnosed. Mixed infections represented 9.8% of all cases. The mean and median ages of children with rotavirus gastroenteritis were lower than those of children with other viruses (p = 0.029), with the highest median ages being found in astrovirus-infected patients. Vomiting and dehydration were more frequent among patients with viral infection (p < 0.01), and the severity score was significantly higher for children infected with astrovirus or group A rotavirus (p = 0.008). Rotavirus was the leading cause of prolonged hospitalisation (p = 0.005). In conclusion, viruses were confirmed in Italy as the most common cause of severe enteric illness in childhood, with rotavirus types G1-G4, which correspond to those included in the rotavirus vaccines being developed, playing the main role. Routine testing should be introduced for noroviruses, since they seem to represent an important cause of sporadic paediatric gastroenteritis.

cytokines, an upregulation of adhesion molecules and MHC I and II molecules on mono/macrophages, and an expansion of inflammatory monocytes. This exaggerated inflammatory response is responsible for necrosis and organ failure and results in uncontrolled proliferation and phagocytic activity of histiocytes [2]. Hypertriglyceridemia (fasting, greater than or equal to 265 mg/100 ml) is one of the current diagnostic criteria for HLH [2]. Several studies link hypertriglyceridemia to inhibition of lipoprotein lipase (LPL) by tumor necrosis factor-α (TNF-α), and TNF-α is a powerful autocrine and paracrine regulator of adipose tissue [3]. Indeed, many different sources of intense and prolonged T-lymphocyte/macrophage activation may be associated with dyslipidemia (particularly with hypertriglyceridemia) through inappropriate release of TNF-a, IFN-g, GM-CSF and respectively, of IL-1/IL-6, leading to adipose tissue lipolysis with increased VLDL secretion, decreased VLDL clearance, increased hepatic fatty acid synthesis, and suppression of fatty acid oxidation with HIV infection being the wellknown paradigm of this mechanism (possibly enhanced by some antiretroviral drugs). In PubMed there are at least 70 papers in which the association leishmaniasis/(hemophagocytic or haemophagocytic) is present. Leishmania parasites have been found to be the most common protozoan trigger of acquired HLH. In a multicenter prospective study conducted to determine the frequency of HLH syndrome in children with VL, ten children out of 24 (41 %) with VL developed HLH syndrome [4]. HLH incidence in European adult population is about 1/800,000/year, with a reported prevalence of parasitic infections of 2.4 % (53 out of 2197 subjects), and of Leishmania spp. of 0.77 % (17 out of 2197) as a trigger. The clinical picture of VL with HLH initially can be indistinguishable from HLH of other etiology, potentially Dear Sir

Appropriate therapy (dexamethasone, cyclosporin, and etoposide) could save the patient in those cases in which the pathogen-direct therapy has not been sufficient by itself to control the disease.

Il contributo intende esplorare le modalità con cui la cogente e complessa tematica delle migrazioni dovrebbe essere oggi proposta agli studenti delle Scuole di ogni ordine e grado, con particolare attenzione alle recenti innovazioni riguardanti le Scuole Secondarie di secondo grado, anche offrendo opportuni suggerimenti operativi volti ad ottimizzare i processi di insegnamento/apprendimento.

Nel contributo si esaminano i caratteri tipici delle nuove forme di schiavitù che si stanno manifestando un po’ dovunque, nel contesto della globalizzazione economica in corso. In particolare vengono focalizzati gli aspetti legati al traffico internazionale di esseri umani. Questo fenomeno, che ha richiamato la stabile attenzione dei mass media, per alcune delle modalità con cui si svolge può venire considerato la versione moderna della tratta, quale frutto dell’adattamento di questa attività criminale alle nuove forme dell’economia.