Large community-acquired Legionnaires' disease outbreak caused by Legionella pneumophila serogroup 1, Italy, July to August 2018.

In July 2018, a large outbreak of Legionnaires' disease (LD) caused by Legionella pneumophila serogroup 1 (Lp1) occurred in Bresso, Italy. Fifty-two cases were diagnosed, including five deaths. We performed an epidemiological investigation and prepared a map of the places cases visited during the incubation period. All sites identified as potential sources were investigated and sampled. Association between heavy rainfall and LD cases was evaluated in a case-crossover study. We also performed a case-control study and an aerosol dispersion investigation model. Lp1 was isolated from 22 of 598 analysed water samples; four clinical isolates were typed using monoclonal antibodies and sequence-based typing. Four Lp1 human strains were ST23, of which two were Philadelphia and two were France-Allentown subgroup. Lp1 ST23 France-Allentown was isolated only from a public fountain. In the case-crossover study, extreme precipitation 5-6 days before symptom onset was associated with increased LD risk. The aerosol dispersion model showed that the fountain matched the case distribution best. The case-control study demonstrated a significant eightfold increase in risk for cases residing near the public fountain. The three studies and the matching of clinical and environmental Lp1 strains identified the fountain as the source responsible for the epidemic.

Tuberculosis outbreak in a primary school, Milan, Italy.

Investigation of an outbreak of tuberculosis (TB) in a primary school in Milan, Italy, found 15 schoolchildren had active TB disease and 173 had latent TB infection. TB was also identified in 2 homeless men near the school. Diagnostic delay, particularly in the index case-patient, contributed to the transmission of infection.

Wild rats as monitors of environmental lead contamination in the urban area of Milan, Italy.

Twenty-one wild brown rats (Rattus norvegicus) were collected from four areas of Milan (Italy). Main organs were harvested from each rat, fixed in 10% neutral buffer formalin, and embedded in paraffin. Organ sections were stained with hematoxylin and eosin, kidney sections were also stained with the Ziehl-Neelsen method. Graphite furnace atomic absorption spectrophotometry was performed on all kidney samples. The presence of inclusion bodies and karyocytomegaly was scored. Six adult rats out of 21 (28.6%) showed kariocytomegaly and intranuclear inclusion bodies of the renal proximal tubules, characteristic of lead toxicity. The nuclear inclusion bodies were always Ziehl-Neelsen positive. The six rats which showed the characteristic histological alterations ascribed to lead, had lead concentrations statistically higher than the three control rats (4 microg/g wet wt. versus 0.09 microg/g wet wt., P<0.001) and than the captured wild rats. Intranuclear inclusion bodies were found in rats with kidney lead concentrations greater than 0.6 microg/g wet weight. There were significant differences between the four areas of capture. The incidence of intranuclear inclusion bodies and karyocytomegaly in proximal tubular cells was higher in rats with high lead levels detected by spectrophotometry. The present results indicate a renal lead concentration of 0.6 microg/g wet weight as a threshold to detect histologic kidney changes due to lead absorption. Results demonstrate that the examination of adult free-living rats may be considered an appropriate method to obtain a rapid, sensitive, easy, cost effective estimate of lead contamination in urban areas. Animal models allow us to evaluate potential human health risk associated with environmental contamination.