Two clusters of Toscana virus meningo-encephalitis in Livorno Province and Elba Island, July-September 2018.

BACKGROUND: Toscana virus (TOSV) is an arbovirus transmitted to humans by Phlebotomus spp sandflies. It causes aseptic meningitis and meningoencephalitis with marked seasonality. Here we describe the clinical, microbiological and epidemiological features of two clusters of cases occurred in Tuscany in 2018. METHODS: A confirmed case was defined as the detection of anti-TOSV IgM and IgG in serum sample, in presence of typical clinical manifestations. We consulted hospital records of hospitalized patients to collect clinical information and obtained epidemiological information from the local health authority investigation report. We telephonically interviewed patients using a standard questionnaire for a 6 months follow-up. RESULTS: A total of 12 cases of TOSV meningo-encephalitis with onset between 4th of July and 12th of September accessed health care services in the province of Livorno. Eight cases were males with median age 41,5 and four were not resident in the area. Serological investigations confirmed a recent TOSV infection. Eight cases reported visiting Elba Island and four had a possible occupational-related exposure. CONCLUSIONS: This surge of infection emphasizes the need of information campaigns coupled with adequate surveillance and control interventions against TOSV that, among other arboviruses, is a growing issue of concern in Italy.

[Current epidemiological and clinical aspects of tuberculosis: A study in the Hospital of Pisa]. / Attuali aspetti epidemiologici e clinici della tubercolosi: indagine nell'Ospedale di Pisa.

OBJECTIVES: To describe epidemiological and clinical features of tuberculosis (tbc) cases identified recently in the Pisa area (Tuscany, Italy). MATERIALS AND METHODS: We performed a retrospective study of all cases of tbc notified to the Public Health Service in Pisa during January 1996-December 1998. The diagnosis of tbc was made following the criteria of the Public Health Ministry. RESULTS: Eighty-eight patients affected by tbc were identified. Diagnosis was microbiologically proven (positive culture for M. tuberculosis) in 42 patients. Sixty-nine patients had pulmonary tbc, 14 extrapulmonary and 5 mixed tbc. Mean age was 56.4 years (range 16-87 years). Nineteen patients were extra European Community citizens. The incidence of tbc (N./100,000) was 8.4 in 1996, 10 in 1997 and 3.2 in 1998. In 5.7% of the cases tbc was associated with advanced HIV infection. The chest X-ray showed pleural effusion in 12 patients and cavitation in 26 patients. Fever was not present in 36.4% of the patients at the moment of diagnosis. 12% of the isolated strains of M. tuberculosis were in vitro multidrug-resistant. CONCLUSIONS: The data presented showed an important rate of tbc in Pisa, similar to the incidence of tbc reported by other studies carried out on a national scale. We have yet to understand if the decreased rate observed in 1998 represents a new trend. The isolation rate of multidrug-resistant strains of M. tuberculosis in Pisa seems higher than the rates reported in other geographical areas. Therefore monitoring of M. tuberculosis susceptibility to antimicrobial agents is necessary.