We report 2 outbreaks of Opisthorchis felineus infection caused by the consumption of tench fi lets (Tinca tinca) from a lake in Italy. Of the 22 infected persons, 10 (45.4%) were asymptomatic. When present, symptoms (fever, nausea, abdominal pain, and myalgias) were mild. Eosinophilia occurred in all infected persons.

Abstract. We describe the diagnostic difficulties experienced during an opisthorchiasis outbreak. Of 31 infected individuals, 61.3% were asymptomatic, and in the 12 symptomatic individuals, the duration of non-pathognomonic symptoms was shorter than 4 weeks. Serology by enzyme-linked immunosorbent assay and polymerase chain reaction fecal analysis were shown to be the most sensitive diagnostic tools.Opisthorchiasis and clonorchiasis are zoonotic infections caused by liver flukes of the genera Opisthorchis and Clonorchis reported in Asia and Europe, where they affect an estimated 10 million people.1 However, most of the cases are from Asia, where the etiological agents are O. viverrini and C. sinensis. In Europe, the etiological agent is O. felineus, and cases of human infection have been documented in Byelorussia, Germany, Greece, Italy, Lithuania, Poland, Romania, Russia, Spain, and the Ukraine.2-5 Humans acquire the infection by consuming raw freshwater fish of the family Cyprinidae, which harbor the larval stage, metacercariae, in their muscles. 6 Because the clinical picture of infection depends on the number of fluke worms, persons who ingest a low number of parasites may have only mild or asymptomatic infection, 6,7 which could result in delayed or missed diagnosis. In fact, fluke parasites cannot multiply in the human body, and therefore, high fluke infection intensities can only be reached by repeated exposure to raw fish consumption. The importance of a timely diagnosis is in the fact that untreated infection can result in severe complications. In fact, in Asia, opisthorchiasis and clonorchiasis caused by a great number of O. viverrini and C. sinensis worms have been shown to cause cholangiocarcinoma, which can develop even 20 years after infection.1 In Italy, opisthorchiasis in humans was first reported in 2003, and since that time, a number of outbreaks have occurred. 5,8 In the present study, we describe an outbreak that occurred in 2009 to illustrate how diagnosis can be delayed when a high proportion of individuals have nonspecific symptoms or no symptoms at all.A case of opisthorchiasis was defined as the presence of opistorchidae eggs in feces and/or anti-Opisthorchis immunoglobulin G (IgG) in serum of persons who had consumed raw freshwater fish. Eggs were searched for in fecal samples after formol-ether concentration using a light microscope (150-400 + magnification). The fecal sediment was preserved in absolute ethyl alcohol for the molecular diagnosis and identification of the parasite. Parasite DNA was amplified by polymerase chain reaction (PCR) performed according to a published protocol.9 The 250-bp amplicon was sequenced and compared with the internal transcribed spacer 2 (ITS2) sequences of O. felineus, O. viverrini, and C. sinensis present in the GenBank database. Serology was performed with enzymelinked immunosorbent assay (ELISA) in accordance with a standard protocol using excretory/secretory (E/S) antigens from adult worms of O. felineus maintained in vitro.On March 15, 2010, a 46-...

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Tuberculosis is still considered a worldwide health problem. In recent years, the stable decrease of tuberculosis notification in Europe is probably due to a particular underlying epidemiological trend: increase of tuberculosis notification in foreign born people living in low endemic countries, and a proportional decrease in the native population. This trend exists also in Italy, where tuberculosis incidence is low (5.2/100.000 inhabitants).Considering the high number of migrants in Viterbo Province after the humanitarian operation“Mare Nostrum”, we analyzed the local health unit (ASL) database to calculate tuberculosis notifications in this area. During the period 2013-2014, Viterbo Province data were similar to European data. Data on age, gender, and nationality are provided and discussed.It is noteworthy the identification of two cases in Nigerian patients that triggered a difficult epidemiological investigation due to the high number of people (migrants, social and healthcare workers) with whom they came into contact (174) and the problems in locating migrants moved to other Italian regions, thus highlighting the need for a constantly updated record of the migrant-hosting facilities.

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