title: Clinical and Microbiological Characteristics of Visceral Leishmaniasis Outbreak in a Northern Italian Nonendemic Area: A Retrospective Observational Study.
abstract: Background. Visceral leishmaniasis (VL) caused byLeishmania infantumis endemic in the Mediterranean area. In the last decades a northward spread of the parasite has been observed in Italy. This paper describes a VL outbreak in Modena province (Emilia-Romagna, Northern Italy) between 2012 and 2015.Methods. Retrospective, observational study to evaluate epidemiological, microbiological characteristics, and clinical management of VL in patients referring to Policlinico Modena Hospital.Results. Sixteen cases of VL occurred in the study period. An immunosuppressive condition was present in 81.3%. Clinical presentation included anemia, fever, leukopenia, thrombocytopenia, and hepatosplenomegaly. Serology was positive in 73.3% of cases, peripheral blood PCR in 92.3%, and bone marrow blood PCR in 100%. Culture was positive in 3/6 cases (50%) and all the isolates were identified asL. infantumby ITS1/ITS2 sequencing. The median time between symptom onset and diagnosis was 22 days (range 6-131 days). All patients were treated with liposomal amphotericin b. 18.8% had a VL recurrence and were treated with miltefosine. Attributable mortality was 6.3%.Conclusions. VL due toL. infantumcould determine periodical outbreaks, as the one described; thus it is important to include VL in the differential diagnosis of fever of unknown origin, even in low-endemic areas.
authors.affiliation: Infectious Disease Unit, Azienda Ospedaliero-Universitaria Policlinico Modena, Modena, Italy.
authors.forename: E
authors.identifier: 0000-0001-6922-5759
authors.initials: E
authors.lastname: Franceschini
authors.affiliation: Infectious Disease Unit, Azienda Ospedaliero-Universitaria Policlinico Modena, Modena, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Puzzolante
authors.affiliation: Infectious Disease Unit, Azienda Ospedaliero-Universitaria Policlinico Modena, Modena, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Menozzi
authors.affiliation: Infectious Disease Unit, Azienda Ospedaliero-Universitaria Policlinico Modena, Modena, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Rossi
authors.affiliation: Infectious Disease Unit, Azienda Ospedaliero-Universitaria Policlinico Modena, Modena, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bedini
authors.affiliation: Infectious Disease Unit, Azienda Ospedaliero-Universitaria Policlinico Modena, Modena, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Orlando
authors.affiliation: Microbiology Laboratory, Azienda Ospedaliero-Universitaria Policlinico Modena, Modena, Italy.
authors.forename: W
authors.initials: W
authors.lastname: Gennari
authors.affiliation: Microbiology Laboratory, Azienda Ospedaliero-Universitaria Policlinico Modena, Modena, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Meacci
authors.affiliation: Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna, Brescia, Italy.
authors.forename: G
authors.identifier: 0000-0001-7437-1929
authors.initials: G
authors.lastname: Rugna
authors.affiliation: Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna, Brescia, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Carra
authors.affiliation: Infectious Disease Unit, Azienda Ospedaliero-Universitaria Policlinico Modena, Modena, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Codeluppi
authors.affiliation: University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Mussini
mesh_terms: D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D007898:Leishmaniasis, Visceral / Q000453:epidemiology*; D008297:Male