02613nas a2200361   4500000000100000008004100001260001200042653005000054653002700104653001300131653001000144653002100154653002600175653002400201100001900225700001700244700001400261700001200275700001300287700001400300700001400314700001300328700001200341700001200353700001600365700001400381245016000395856006600555300000800621490000900629520159900638022001402237       2016                            d  c01/201610aClinical and Microbiological Characteristics 10aVisceral Leishmaniasis10aOutbreak10aItaly10aNon-endemic area10aRetrospective Studies10aObservational study1 aFranceschini E1 aPuzzolante C1 aMenozzi M1 aRossi L1 aBedini A1 aOrlando G1 aGennari W1 aMeacci M1 aRugna G1 aCarra E1 aCodeluppi M1 aMussini C00aClinical and Microbiological Characteristics of Visceral Leishmaniasis Outbreak in a Northern Italian Nonendemic Area: A Retrospective Observational Study.  uhttps://onlinelibrary.wiley.com/doi/epdf/10.1155/2016/6481028  a1-70 v20163 a<p><strong>Background</strong></p>

<p>Visceral leishmaniasis (VL) caused by&nbsp;<em>Leishmania infantum</em>&nbsp;is endemic in the Mediterranean area. In the last decades a northward spread of the parasite has been observed in Italy. This paper describes a VL outbreak in Modena province (Emilia-Romagna, Northern Italy) between 2012 and 2015.&nbsp;</p>

<p><strong>Methods</strong></p>

<p>Retrospective, observational study to evaluate epidemiological, microbiological characteristics, and clinical management of VL in patients referring to Policlinico Modena Hospital.&nbsp;</p>

<p><strong>Results</strong></p>

<p>Sixteen cases of VL occurred in the study period. An immunosuppressive condition was present in 81.3%. Clinical presentation included anemia, fever, leukopenia, thrombocytopenia, and hepatosplenomegaly. Serology was positive in 73.3% of cases, peripheral blood PCR in 92.3%, and bone marrow blood PCR in 100%. Culture was positive in 3/6 cases (50%) and all the isolates were identified as&nbsp;<em>L. infantum</em>&nbsp;by ITS1/ITS2 sequencing. The median time between symptom onset and diagnosis was 22 days (range 6-131 days). All patients were treated with liposomal amphotericin b. 18.8% had a VL recurrence and were treated with miltefosine. Attributable mortality was 6.3%.&nbsp;</p>

<p><strong>Conclusions</strong></p>

<p>VL due to&nbsp;<em>L. infantum</em>&nbsp;could determine periodical outbreaks, as the one described; thus it is important to include VL in the differential diagnosis of fever of unknown origin, even in low-endemic areas.</p>
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