West Nile virus transmission through organ transplantation in north-eastern Italy: a case report and implications for pre-procurement screening.

PURPOSE: West Nile virus (WNV) transmission through organ transplantation occurs rarely and screening of organ donors for WNV infection remains controversial. This report describes the case of WNV encephalitis in a kidney recipient and the case of asymptomatic WNV infection in the organ donor, both observed at Treviso Hospital, northeastern Italy. After briefly reviewing the literature, we discuss the implications for WNV screening. METHODS: We reviewed medical, laboratory and epidemiological records at our hospital, and the literature concerning cases of organ-transmitted WNV infections and WNV screening of organ donors in Italy and worldwide. RESULTS: The kidney recipient was the first confirmed case of WNV infection notified in northeastern Italy in 2011, and the first case of WNV infection in a cluster of four transplant recipients who acquired the infection from a common organ donor. The organ donor, whose WNV infection was only retrospectively diagnosed by IgM detection, represents the index case of a WNV outbreak in the Treviso Province. Screening of her blood prior to organ recovery did not show detectable levels of WNV nucleic acid with the use of quantitative real-time polymerase chain reaction. CONCLUSIONS: This report emphasizes that transplant-acquired WNV neuroinvasive disease can be particularly severe. We suggest that pre-procurement screening of organ donors by testing blood with both WNV IgM capture ELISA and a sensitive nucleic acid testing should be adopted during the transmission season in the present Italian epidemiological setting.

[Brucellosis outbreak in Treviso province caused by infected cheese from an endemic area]. / Outbreak di brucellosi nella provincia di Treviso da formaggio pecorino importato.

Brucellosis is one of the most common zoonoses in the world. Its distribution has changed in recent years due to socioeconomic factors and international travel. In Italy its trend has followed the international pattern, albeit with major differences between the north and south of the country. In northern Italy brucellosis is import-related and rarely laboratory acquired. We describe an outbreak of five cases of brucella infection occurred in Treviso province during August 2005. All the patients had a positive Wright test and two of them had a positive blood culture for Brucella abortus. The source of infection was cheese from an area of Italy where brucellosis is endemic. All the people who consumed the cheese had clinical and laboratory signs of brucellosis. All of them received six weeks of rifampin and doxycycline treatment; none developed any complication or relapse during the two follow-up years. In conclusion, brucellosis should be considered as a differential diagnosis of fever of unknown origin even in countries where it is not endemic; it is necessary not only to rule out travels to endemic regions through clinical history, but also the consumption of infected foods imported from such areas.

[Abdominal actinomycosis] / Actinomicosi addominale.

The authors present a case of abdominal actinomycosis in a 65-year old woman undergoing explorative laparatomy for suspected colic neoplasm. Only histological examination allowed a correct diagnosis to be made, showing once again the considerable difficulty of differential diagnosis.

[Disulfiram-induced hepatitis] / Epatite indotta da disulfiram.

Overt disulfiram-induced hepatitis is rare; it has a high mortality rate, especially when the etiology is non suspected and when the treatment is not promptly discontinued. The Authors describe a case of disulfiram-induced acute hepatitis and emphasize close clinical and biochemical monitoring.