title: Diagnosis of dengue fever in North West Italy in travelers from endemic areas: a retrospective study.
abstract: BACKGROUND
  Domestic outbreaks of Dengue (DENV) fever from imported cases have to be considered a possible risk in non-endemic countries where Dengue vectors are present, such as in Italy.
  
  
  OBJECTIVE
  To review imported acute/recent DENV infections in a one-year survey in a North West Italy region where the presence of Aedes albopictus is documented.
  
  
  METHODS
  We retrospectively reviewed laboratory and clinical records of Italian febrile travelers from Dengue endemic areas referring to the local reference Centre for Infectious Disease, covering a population of about 4 million people.
  
  
  RESULTS
  Acute/recent DENV infection was identified in 15 out of 91 travelers from endemic areas (16.5%) including 12 primary and 3 secondary infections; in 6 patients the virus was detectable in blood according to molecular real-time Polymerase Chain Reaction-based assays: in 9 patients the diagnosis of DENV infection was accomplished by the combination of specific IgM reactivity, high IgG titers, IgG seroconversion from negative to positive and increasing (four-fold) IgG titers in paired serum samples. Two cases of DENV infections were imported from South Egypt in patients travelling together, confirming the importance of returning travelers as sentinels of a rapidly changing epidemiology in specific geographic areas.
  
  
  CONCLUSIONS
  Our findings outline the high rate of imported Dengue infection in North West Italy and emphasize the need for a continued Dengue surveillance in non-endemic countries as well as a careful evaluation and follow-up of febrile patients returning from Dengue endemic countries.
authors.affiliation: Microbiology and Virology Laboratory, Amedeo di Savoia Hospital, Corso Svizzera 164, 10149 Torino, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Burdino
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Milia
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Sergi
authors.forename: Gabriella
authors.initials: G
authors.lastname: Gregori
authors.forename: Tiziano
authors.initials: T
authors.lastname: Allice
authors.forename: Maria Lucia
authors.initials: ML
authors.lastname: Cazzato
authors.forename: Anna
authors.initials: A
authors.lastname: Lucchini
authors.forename: Filippo
authors.initials: F
authors.lastname: Lipani
authors.forename: Guido
authors.initials: G
authors.lastname: Calleri
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Orofino
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Perri
authors.forename: Valeria
authors.initials: V
authors.lastname: Ghisetti
mesh_terms: D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood; D001769:Blood / Q000821:virology; D003715:Dengue / Q000175:diagnosis* / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D003716:Dengue Virus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D014195:Travel
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D012367:RNA, Viral