High prevalence of high-risk HPV genotypes in individuals attending an infectious diseases clinic from 2018 to 2022 in Milan, Italy.

Human papillomavirus (HPV) is the most common sexually transmitted infection, linked to several types of lesions. HPV, specifically HPV 16, accounts for most of anal cancer cases. In this study, we evaluated the proportion of samples tested positive for HPV and characterized genotypes distribution in anal specimens collected from individuals at risk of anal HPV infection attending from 2018 to 2022 a large Infectious Diseases Department in Italy. The presence of HPV DNA was investigated through a commercial kit detecting 12 HR-HPV, 8 probable/possible HR-HPV, and 8 LR-HPV genotypes. Among 1514 samples, 84% (1266/1514) resulted positive for any type of HPV. The prevalence of high-risk HPV types remained high during all the years of the study period, from 2018 to 2022, ranging from 65% to 73%. Most of HR-HPV, LR-HPV and HPV 16 positive samples were collected from men >45 years. HPV 16 was also the most frequent type in men and women. We did not observe significant variations between years in detection of HR-HPV, instead of LR-HPV, that significantly decreased. In conclusion, the high prevalence of oncogenic HPV genotypes underlines the necessity of clear anal HPV screening guidelines and, along with frequent HR-HPV coinfections, reinforces the urge to intensify the anti-HPV vaccination campaign.

First imported case of Candida auris infection in Milan, Italy: genomic characterisation.

PURPOSE: Candida auris, an emerging multidrug-resistant yeast, has been reported worldwide. In Italy, the first case was reported in 2019. We describe the first case of C. auris, imported from Greece, in Milan, using whole genome sequencing to characterise mutations associated with antifungal resistance. CASE PRESENTATION: On October 2022 an 80-year-old Italian man was hospitalised in Greece. In the absence of clinical improvement, the patient was transferred to our hospital, in Italy, where blood culture resulted positive for C. auris. Despite therapy, the patient died of septic shock. In a phylogenetic analysis the genome was assigned to Clade I with strains from Kenya, United Arab Emirates and India. D1/D2 region resulted identical to a Greek strain, as for many other strains from different World regions, highlighting the diffusion of this strain. CONCLUSION: Importation of C. auris from abroad has been previously described. We report the first case of C. auris imported into Italy from Greece, according to phylogenetic analysis. This case reinforces the need for monitoring critically ill hospitalised patients also for fungi and addresses the need for the standardisation of susceptibility testing and strategies for diagnosis and therapy.

Concomitant diagnosis of sexually transmitted infections and human monkeypox in patients attending a sexual health clinic in Milan, Italy.

In 2022, many monkeypox (MPX) outbreaks have been documented in countries where MPX was not endemic. It spread all around the world, especially in European Union and United States. While MPX is classically considered to be transmitted through close contact with lesions, the hypothesis of sexual transmission has been proposed. This study considered a total of 49 patients suspected for MPX that were also tested for other sexually transmitted infections (STIs), including Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and Trichomonas vaginalis. The data from coinfected patients suggested that MPXV and STIs might share the same route of inoculum, corroborating the hypothesis of possible sexual transmission for the emerging poxvirus. And like any other STI, MPX should be considered without stigmatization.

Isolation of viable monkeypox virus from anal and urethral swabs, Italy, May to July 2022.

Anal and urethral samples from confirmed cases of monkeypox were screened for monkeypox virus (MPXV) by real-time PCR. Isolation of the virus was subsequently attempted in cell culture. Actively-replicating virus was demonstrated in 13 of 18 and 11 of 15 PCR-positive anal and urethral swabs, respectively, collected within 7 days from symptoms onset. Two asymptomatic secondary cases had detectable MPXV genetic material in urethral secretion and for one, MPXV was successfully isolated, supporting a potential MPXV sexual transmission hypothesis.

Short communication: Technological and seasonal variations of vitamin D and other nutritional components in donkey milk.

Vitamin D is an essential nutrient that plays a crucial role in calcium homeostasis and bone metabolism and also acts as a hormone. Although several studies on the content of vitamin D in bovine milk have been conducted, little information is available regarding donkey milk. In the context of the nutritional assessment of donkey milk, the aim of this study was to assess the vitamin D content in donkey milk and its chemical profile, with particular reference to seasonal and technological modifications after pasteurization. The study was conducted on a dairy farm that produces donkey milk for human consumption located in central Italy. At sampling time, an aliquot of total bulk milk production was sampled before and after pasteurization (63°C for 30 min without homogenization) with a total of 20 raw and 20 pasteurized milk samples. The samples were collected for 10 mo, every 15 d, from May to February 2017. All the samples were analyzed for the chemical composition and vitamin D2 and D3 content by HPLC after saponification. The donkey milk analyzed showed a higher average vitamin D content (raw milk: vitamin D2 = 1.68, vitamin D3 = 0.60 µg/100 mL; pasteurized milk: vitamin D2 = 1.38, vitamin D3 = 0.30 µg/100 mL) than reported for bovine and human milk. The results of the effect of pasteurization on milk did not highlight significant differences in the total content of vitamin D. However, vitamin D3 has a poor thermal stability, which led to a significant reduction in content in pasteurized milk compared with raw milk. The total vitamin D content of donkey milk did not show significant variations between seasons; however, a higher concentration of vitamin D3 was found in spring and summer. In conclusion, raw and pasteurized donkey milk showed a high content of vitamin D, which could be useful in meeting the deficiencies of this vitamin in humans. Further investigations are needed to improve the vitamin D content in donkey milk by increasing its endogenous synthesis or its transfer in milk and to clarify other variability factors.

Effects of pasteurization and storage conditions on donkey milk nutritional and hygienic characteristics.

Until now there are only few data on the effects of thermal treatments on the nutritional and hygienic characteristics of donkey milk. This Research Communication aims to provide information on the effects of pasteurization (at +65 °C for 30 min) and prolonged storage at refrigeration and freezing temperatures (21 d at + 3 °C ± 2 °C and up to 90 d at -20 °C ± 5 °C) on some nutritional and hygienic characteristics of Amiata donkey milk. The milk was monitored by chemical and microbiological analysis. Pasteurization ensured compliance with EC Regulation No 1441/2007, as Enterobacteriaceae were never found in the milk, or during storage at refrigeration and freezing temperatures. Colony count at 30 °C in pasteurized milk never went beyond 1 log CFU/ml. The heat treatment and the storage did not result in any variations in the main constituents of the milk. Only a decrease in lactose and few variations in some fatty acids at 90 d of freezing were observed. In conclusion, pasteurization was able to achieve and maintain a high hygienic-sanitary quality over time; storage at refrigeration or freezing temperatures did not alter the nutritional quality of fat and the gross composition of the product. These findings are useful to improve knowledge on the milk shelf life in order to guarantee safety and nutritional quality for infants who need small quantities of daily milk.

The Macrostructure of Milk Lipids: The Fat Globules.

The aim of this review article is to summarize the information available related to milk fat globules (MFGs) in order to highlight their contribution to the nutritional and technological characteristics of milk and dairy products. The macrostructure of milk lipids is composed of globules made up of triglycerides with different melting points, enveloped by a biological membrane from the mammary epithelial cell. In milks of different animal species, there are different-sized MFGs, ranging from diameters of less than 0.2 µm to a maximum of 15 µm. The average diameter and the number of globules are affected by endogenous, physiological, and exogenous factors. The size of the globules in turn affects the qualitative characteristics of milk and cheese. In addition, the average diameter of the globules and their surface that is exposed to the digestive system affect fat digestibility in different ways. Finally, the components of the MFG membranes have been shown to take part in the secretion process of globules and to have a beneficial effect on human health. In conclusion, by acting on factors influencing the dimensions of the fat globules and by increasing the content of the milk membrane could help adapt milk production to specific consumer targets and improve milk nutritional properties.

Short communication: Monitoring nutritional quality of Amiata donkey milk: effects of lactation and productive season.

Milk nutritional characteristics are especially interesting when donkey milk is aimed at consumption by children and the elderly. The aim of this study was to monitor the nutritional quality of Amiata donkey milk during lactation and productive season to provide information on the milk characteristics and to study action plans to improve milk yield and quality. Thirty-one pluriparous jennies belonging to the same farm were selected. Individual samples of milk from the morning milking were taken once per month starting from the d 30 of lactation until d 300. Milk yield and dry matter, fat, and ash content were constant throughout the experimental period. Milk total protein content showed a progressive decrease during the first 6 mo of lactation; after this period, the protein percentages remained constant (1.50%). Caseins and lactose were lower until d 60 of lactation and remained constant thereafter. During summer and autumn, milk yield and casein and lactose contents were higher, whereas during the spring season, higher protein and ash contents were found. The percentages of fat and dry matter were stable as were most of the minerals in the milk, except for calcium, which was higher in the spring. In conclusion, Amiata donkey milk was found to be relatively stable during lactation. This is an advantage in terms of the production and trade of a food product with consistent characteristics. The different milk yield and quality during the productive seasons were probably related to better adaptability of the animals to warm and temperate periods.

Risk Categorization in On-Farm Welfare in Different-Sized Dairy Sheep Flocks.

The objective of the present work was to categorize the risks in the on-farm welfare of dairy sheep in semi-extensive systems in order to highlight if risks in welfare vary according to the farm size. To the best of our knowledge, this study constitutes one of the few categorizations of the risks in the welfare of dairy sheep reared semi-extensively. The survey was conducted on 12 semi-extensive dairy sheep farms in Tuscany (Central Italy), which were classified according to flock size: <500, from 500 to 1000, and >1000. The results showed an adequate rating for all the farms included in the study. The most critical issues concerned the ratio between the number of stockpersons and the number of animals within the farms, the small decubitus areas, the lack of udder cleaning procedures during milking operations, and, in terms of biosecurity, the lack of prevention, control, and eradication plans for the most important infectious ovine diseases. The results show that different items in the five areas evaluated, including the assessments of management of the flock, the number of daily inspections, and the hygiene of the water supplies are associated with the farm size. In large farms, the assessment of management of the flock was better, but the number of daily inspections and the hygiene of the water supplies were worse.

Report on a Milking Mule: Milk Qualitative Characteristics during Lactation.

Despite their inability to reproduce naturally, mules can host embryos and be surrogate dams. The aim of this investigation was to increase our knowledge of the qualitative composition of mule's milk and its variations throughout the whole lactation period-namely, from 6 h after foaling to 180 days in milk (DIM). Milk was obtained from a mule dam that had foaled after receiving a mule embryo transfer. For each sample, the gross, mineral, and fatty acid composition was evaluated. The average quality of the mule milk was as follows: protein 1.97 g 100 mL-1, fat 0.90 g 100 mL-1, and ash 0.39 g 100 mL-1. Saturated fatty acids made up, on average, 50.00 g 100 g-1 of fat. Monounsaturated and polyunsaturated fatty acids made up half of the total fatty acid content (31.80 g 100 g-1 and 18.2 g 100 g-1 of fat, respectively). Linoleic acid and linolenic acid were the main polyunsaturated fatty acids in the milk. The milk composition changed throughout lactation. Dry matter, protein, fat, and ash decreased significantly from early lactation (6 h to 14 DIM). The n3 polyunsaturated fatty acids decreased at the end of lactation. The changes in milk composition throughout lactation are probably due to adaptations to the growth requirements of the foal.

Evaluation of analytical performance of the STANDARDTM M10 MPX/OPX assay for the simultaneous DNA detection and clade attribution of Monkeypox virus.

Monkeypox virus (MPXV) infection confirmation needs reliable polymerase chain reaction (PCR) assays; in addition, viral clade attribution is a key factor in containment measures, considering a more severe syndrome in clade I and the possibility of simultaneous circulation. This study evaluates the performance of all-in-one STANDARD M10 MPX/OPX (SD BIOSENSOR, South Korea - M10). Frozen samples from 205 subjects were selected and stratified according to routine test results (RealStar® Orthopoxvirus PCR Kit 1.0, Altona DIAGNOTICS, Germany - RS; RS-1): in detail, 100 negative skin lesions (SL) and 200 positive samples at the variable stage of infection were analysed. Positive samples were retested with RS (RS-2). Positive and Negative Percent Agreements (PPA, NPA) were calculated. The median (IQR) Ct values of RS and M10 (OPXV target) assays were highly similar. The PPA of M10 compared to RS-1 was 89.5% considering system interpretation, and 96.0% when the operator classified results as positive if any target was detected; NPA was 100%. Comparing the RS-2 run and M10, an overall concordance of 95.3% between assays was found; however, considering operator interpretation, M10 returned more positive results than RS-2. The occurrence of False-Negative results was likely associated with the influence of thawing on low viral concentration; no False-Positive tests were observed. All samples collected at the time of Mpox diagnosis were positive and M10 correctly attributed the clade (West-Africa/II). The M10 MPX/OPX assay demonstrated high reliability in confirming MPXV infection and clade attribution.

Detection and typization of HPV genotypes in subjects with oral and upper respiratory tract lesions, Milan, Italy.

BACKGROUND: Oral human papillomavirus (HPV) is common among healthy individuals but causes and implications of persistent infections are under evaluation in the pathogenesis of head and neck neoplasms. METHODS: This was a retrospective study evaluating the prevalence of high-risk (HR), probable HR and low-risk (LR) HPV types in patients reporting signs/symptoms of oral and upper respiratory tract lesions. Individuals attending between 2019 and 2022 a University Hospital in Milan, Italy, with risk factors for HPV (unprotected oral sex and/or previous documentation of HPV infection in oral and upper respiratory tract and/or another anatomical site) were included. RESULTS: Fourteen out of 110 (12.7%) individuals tested positive for HPV DNA. The prevalence of HR-HPV and LR-HPV was 3.6% (4/110) and 9.1% (10/110), respectively. No probable/possible HR-HPV was detected. Specifically, 10/110 (9.1%) were diagnosed with 1 LR-HPV genotype, 3/110 (2.7%) were infected with 1 HR-HPV and 1/110 had 3 concomitant HR-HPV types. HPV 16 (2.7%, 3/110) and 6 (4.5%, 5/110) were the most common HR and LR types, respectively. One patient positive for HPV 16, 33 and 35 was diagnosed with cancer at the base of the tongue. Two individuals among those who tested positive for HPV DNA reported previous HPV vaccination. CONCLUSIONS: Our data, in line with observations from previous prevalence studies, support the potential role of HPV in head and neck neoplasms. HPV DNA testing should be performed in patients presenting lesions in oral/respiratory tracts and risk factors for HPV. Improvement in HPV vaccination coverage is warranted.

Dynamics of viral DNA shedding and culture viral DNA positivity in different clinical samples collected during the 2022 mpox outbreak in Lombardy, Italy.

BACKGROUND: Mpox virus (MPXV) has recently spread outside of sub-Saharan Africa. This large multicentre study was conducted in Lombardy, the most densely populated Italian region accounting for more than 40% of Italian cases. The present study aims to: i) evaluate the presence and the shedding duration of MPXV DNA in different body compartments correlating the MPXV viability with the time to onset of symptoms; ii) provide evidence of MPXV persistence in different body compartment as a source of infection and iii) characterize the MPXV evolution by whole genome sequencing (WGS) during the outbreak occurred in Italy. MATERIAL AND METHODS: The study included 353 patients with a laboratory-confirmed diagnosis of MPXV infection screened in several clinical specimens in the period May 24th - September 1st, 2022. Viral isolation was attempted from different biological matrices and complete genome sequencing was performed for 61 MPXV strains. RESULTS: MPXV DNA detection was more frequent in the skin (94.4%) with the longest median time of viral clearance (16 days). The actively-replicating virus in cell culture was obtained for 123/377 (32.6%) samples with a significant higher viral quantity on isolation positive samples (20 vs 31, p < 0.001). The phylogenetic analysis highlighted the high genetic identity of the MPXV strains collected, both globally and within the Lombardy region. CONCLUSION: Skin lesion is gold standard material and the high viral load and the actively-replicating virus observed in genital sites confirms that sexual contact plays a key role in the viral transmission.

Gastrointestinal Parasite Infections and Environmental Sustainability of the Ovine Sector: Eimeria spp. Infections and Nitrogen and Phosphorus Excretions in Dairy Sheep in Italy.

In sheep farming, gastrointestinal parasites can be responsible for significant reductions in animal health and production. Nitrogen (N) and phosphorus (P) fecal excretions are the main determining factors for N2O emissions from manure management and may pose other environmental problems, such as the acidification and eutrophication of natural habitats. By using the Mini-FLOTAC technique on fecal samples from sheep of different ages and physiological status from 19 dairy sheep farms in Tuscany (central Italy), gastrointestinal parasite infections were evaluated. The animal N and P fecal contents were also assessed, with the aim of evaluating possible relationships between the identified parasites and the environmental sustainability of the examined farms. The obtained results showed that Eimeria spp. (86.36%) and gastrointestinal strongyle (54.55%) infections are prevalent in the examined farms. Moreover, significantly higher (p ≤ 0.05) P and Eimeria oocyst/gram-of-feces (OPG) values were found in fecal samples from animals < 1 year of age, and a significant (p ≤ 0.05) positive correlation resulted between N content and Eimeria OPG in fecal samples from animals in the first month of lactation. The findings from this study suggest for the first time that Eimeria spp. infections may have an impact on the environmental sustainability of sheep farming.

Traditional Cultures versus Next Generation Sequencing for Suspected Orthopedic Infection: Experience Gained from a Reference Centre.

(Background) The diagnosis and the antimicrobial treatment of orthopedic infection are challenging, especially in cases with culture-negative results. New molecular methods, such as next-generation sequencing (NGS), promise to overcome some limitations of the standard culture, such as the detection of difficult-to-grow bacteria. However, data are scarce regarding the impact of molecular techniques in real-life scenarios. (Methods) We included cases of suspected orthopedic infection treated with surgery from May 2021 to September 2023. We combined traditional cultures with NGS. For NGS, we performed a metagenomic analysis of ribosomal 16s, and we queried dedicated taxonomic libraries to identify the species. To avoid false positive results, we set a cut-off of 1000 counts of the percentage of frequency of reads. (Results) We included 49 patients in our study. Our results show the presence of bacteria in 36/49 (73%) and 29/49 (59%) cases studied with NGS and traditional cultures, respectively. The concordance rate was 61%. Among the 19/49 discordant cases, in 11/19 cases, cultures were negative and NGS positive; in 4/19, cultures were positive and NGS negative; and in the remaining 4/19, different species were detected by traditional cultures and NGS. (Conclusions) Difficult-to-grow microorganisms, such as slow-growing anaerobic bacteria, were better detected by NGS compared to traditional culture in our study. However, more data to distinguish between true pathogens and contaminants are needed. NGS can be an additional tool to be used for the diagnosis of orthopedic infections and the choice of appropriate antimicrobial therapy.

Disinfectant caps in vitro effectiveness.

Background: Catheter-related bloodstream infections (CRBSIs) are a major cause of morbidity and mortality among hospitalized patients. Different studies suggest that the use of disinfectant caps (DCs) significantly reduces the rate of CRBSIs. The first purpose of this study is to analyze, through an in-vitro-model, the antiseptic effect of DCs produced by two manufacturers; the second aim is to assess potential differences in terms of effectiveness between the two manufacturers' products. Methods: A know concentration of thirteen different microorganisms was incubated with the sponge drenched in antimicrobial fluid inside DCs and cultured through several assays to investigate the disinfectant effectiveness of some commercially available caps. Disinfectant properties were evaluated under two different conditions: baseline (DCs placed on the needle-free connectors (NFCs) and stress test (DCs directly applied to the catheter hub). Results: Both manufacturers overcame the basal tests (fourteen different assays). Regarding stress tests: the only significant bacterial load was found for Serratia marcescens (104 CFU/mL in ICU Medical™), both at 90 and 180 minutes after incubation; due to the low load, MDR Acinetobacter baumannii was not considered significant (<103 CFU/mL in BD PureHub™). Conclusions: Our results confirm what was reported in BD PureHub™ datasheet and add data not previously shown by ICU Medical™. Moreover, no difference was observed between the two manufacturers products: the use of both DCs on NFCs was able to reclaim the catheter lumen. These findings support the routine use of DCs with NFCs, as part of a structured bundle of interventions, to reduce the incidence of CRBSIs.

Impact of Variability Factors on Hair Cortisol, Blood Count and Milk Production of Donkeys.

The increased interest in donkeys because of their milk has led to changes in their farm management. Little is known about the effect of the farming systems on donkey health and welfare. Measuring hair cortisol concentrations is an emerging method to assess stress in animals. To the best of our knowledge, no cortisol assessment has been done on dairy donkeys; similarly, only a few studies have investigated donkey haematological values. The aim of this study was to evaluate the effects of the lactation phase, parity and season on blood parameters, milk yield and quality and hair cortisol in dairy donkeys. Individual samples of milk, blood and mane hair were taken from twenty jennies at 1, 6 and 10 months after parturition. Higher values of hair cortisol were found in the first sampling, suggesting temporary stress during the peri-parturition. The parity influenced the number of blood cells, which was lower in the pluriparous jennies. The season affected milk quality and mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration. The latters might represent the adaptation to the environmental conditions. This study contributes to a better understanding of the biochemical processes occurring in lactating jennies, and to their physiological and wellbeing status.