Malaria in pediatric age in the Piedmont Region.

INTRODUCTION: Pediatric malaria, even in countries considered as free as Italy, is an important problem of public health because children have a high variability of the clinical picture. The objective of this brief note is to determine the incidence of pediatric malaria in the Piedmont Region during the period 1989-2015. MATERIALS AND METHODS: All cases of pediatric malaria notified were considered thanks to the regional information flow over the period 1989-2015. Cases of congenital malaria, unconfirmed malaria cases, and aged 14 and older were excluded of the study. RESULTS: In Piedmont in the period 1989-2015, pediatric malaria accounts for 8.8% of the total (172/1946 cases). 74% of patients are of foreign nationality, to which must be added the 14% represented by those born in Italy from foreign parents, while it is 100% the fraction of patients who have made a trip to the abroad. The notification of cases is greater in the autumn months. Only 7.6% of the sample carried out a complete chemoprophylaxis. In 79% of cases, the primary care physician advised chemoprophylaxis on trips to endemic areas. CONCLUSIONS: At present, lacking an effective vaccine, the prevention and implementation of standard precautions such as chemoprophylaxis, represent the safest strategy to put into practice to eradicate the disease especially for the groups at greater risk as visiting friends and relatives.

Virulence of Legionella pneumophila strains isolated from hospital water system and healthcare-associated Legionnaires' disease in Northern Italy between 2004 and 2009.

BACKGROUND: Worldwide, L. pneumophila sg 1 is the most common agent of Legionnaires' disease ( 80 to 90% of the reported cases). In contrast, L. pneumophila sg 2-14 account for only 15 to 20% of community-acquired cases, although they account for over 50% of the environmental isolates. The discrepancy between environmental isolates and clinical cases of disease suggested that there are differences in virulence.We decided to subtype the environmental Legionella strains isolated from health care facilities (HCFs) and to compare the distribution of strains with the occurrence of hospital-acquired legionellosis. METHODS: Observational ecological study based on the data provided by the regional surveillance of legionellosis and on data obtained from hospitals environmental monitoring.Using the monoclonal antibody MAb 3/1 of the Dresden Panel we collected and typed environmental strains of L. pneumophila sg 1 obtained during routine testing in 56 health care facilities from 2004 to 2009.The results of the laboratory analyses of the environmental samples were compared with the number of cases that each health care facility reported during the study period. RESULTS: The association between the type of colonisation (L. pneumophila sg 1 vs others serogroups) and the incidence of reported cases was statistically significant (p = 0.03 according to the χ2 test).Legionella strains with the virulence-associated epitope recognised by MAb 3/1 were isolated in 8 of the 26 HCFs colonised by L. pneumophila sg 1; 7 of the HCFs colonised by MAb 3/1-positive strains accounted for 85% of the cases of hospital-acquired legionellosis reported during the 6-year study period. There was a statistically significant association (p = 0.003) between the presence of cases and colonisation by MAb 3/1-positive Legionella strains. CONCLUSION: This study suggests that hospitals colonised by more virulent strains should be aware of the increased risk and consider the opportunities of increase their monitoring efforts and implement more effective contamination control strategies.