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The abandonment of inland areas has become a major demographical challenge, causing a condition of local fragility in terms of spatial marginalization. To deal with this issue in Italy, a number of policy actions have been implemented over the time, namely the National Strategy for Inland Areas, established a decade ago, and more recently the Next Generation EU (NGEU) to foster local economic recovery and employment. In this context, RI.P.R.O.VA.RE., a project funded by the former Italian Ministry of the Environment and Protection of Land and Sea (MATTM), was aimed at strengthening the resilience features of communities and territories, focusing on areas within the Matese and Ufita in the Campania region and the Medio Agri in the Basilicata region (southern Italy). Besides the ability to respond to different pressure factors (e.g., of demographic and economic origin), the project also addressed issues concerning seismic and flood risks. This paper synthesizes the methods and tools provided for their analysis and mitigation as a prerequisite for regenerating inland areas. After presenting the developed methods and tools, the results obtained for the Matese study area are presented and discussed. While, on the one hand, the retrieved risk zoning maps allow individuating those municipalities requiring priority structural interventions, on the other hand, the latter are properly individuated based on the peculiar characteristics of urban fabrics. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the impact of obesity on nonrespiratory complications in patients dying with coronavirus disease (COVID‐19). Methods: Medical charts of 3,694 of patients dying with COVID‐19 in Italy were reviewed to extract information on demographics, preexisting comorbidities, and in‐hospital complications leading to death. Multivariate logistic regressions were performed to assess the association of obesity with nonrespiratory complications. These analyses were adjusted for age, gender, and number of preexisting comorbidities. Results: Obesity was present in 411/3,694 (11.1%) patients dying with COVID‐19. Obesity was significantly associated with increased probability of experiencing acute renal failure (adjusted odds ratio [OR], 1.33; 95% CI: 1.04‐1.71) and shock (adjusted OR, 1.54; 95% CI: 1.19‐1.99). The associations of obesity with acute renal failure and shock were stronger in patients aged < 60 years (adjusted OR, 2.00; 95% CI: 1.09‐3.67 and OR, 2.37; 95% CI 1.29‐4.36) than in those aged 60 years or older (adjusted OR, 1.20; 95% CI: 0.90‐1.60 and OR, 1.22; 95% CI: 0.91‐1.65). Conclusions: In patients dying with COVID‐19 in Italy, obesity is associated with an increased probability of nonrespiratory complications, particularly shock and acute renal failure. These associations seem stronger in younger than in older adults. Strategies should be put in place in patients with COVID‐19 with obesity to prevent these complications. [ABSTRACT FROM AUTHOR]

A centralized solar hybrid heating and cooling system satisfying the thermal, cooling and sanitary water demands of a typical Italian small district composed of six residential buildings situated in Naples (southern Italy) is modelled, simulated and analysed through the software TRNSYS over a period of 5 years. The plant is based on the operation of solar thermal collectors coupled with seasonal borehole storage; the solar field is also composed of photovoltaic solar panels connected with electric energy storage. An adsorption chiller powered by solar energy is adopted for cooling purposes, while a condensing boiler is used as an auxiliary unit. The performance of the proposed system has been assessed from energy, environmental and economic points of view and contrasted with the operation of a typical Italian heating and cooling plant, highlighting the following main results: saving of primary energy consumption up to 40.2%; (decrease of equivalent CO2 emissions up to 38.4%; reduction of operating costs up to 40.1%; and simple pay-back period of about 20 years. [ABSTRACT FROM AUTHOR]

In this paper a centralized hybrid renewable district heating system based on the exploitation of solar energy and integrated with a seasonal borehole thermal energy storage is investigated with reference to a 5-year period by means of the dynamic simulation software TRNSYS. The plant is devoted to satisfy the energy demand for heating purposes and domestic hot water (DHW) production of a small-scale district composed of six residential buildings and three schools under the climatic conditions of Naples (south of Italy). Four configurations of the solar field consisting of different combinations of solar thermal collectors (SCs) and photovoltaic/thermal panels (PVTs) are analyzed upon varying both (i) the technology of SCs (flat plate or evacuated tube heat pipe) as well as (ii) the control logic of solar circuit (operation with constant or variable flow rate of heat carrier fluid). The simulation results have been compared with those associated to a conventional decentralized heating system in terms of primary energy consumption, carbon dioxide equivalent emissions and operating costs in order to assess (i) the potential energy, environmental and economic benefits as well as (ii) the impact of solar field design on the overall system performance. • A solar district heating system with a seasonal thermal energy storage is analyzed. • The impact of solar circuit design on the overall performance is assessed. • The effects of solar thermal technology and control logic are investigated. • The results are compared with those associated to a conventional heating system. • The comparison is performed form energy, environmental and economic points of view. [ABSTRACT FROM AUTHOR]

In recent years, landslide events have extensively affected pyroclastic covers of the Campania Region in southern Italy, causing victims and conspicuous economic damages. Due to the high criticality of the area, a proper assessment of future variations in landslide occurrences and related risk is crucial for policy-makers, administrators and infrastructure stakeholders. This paper addresses work performed within the FP7 INTACT project, having the goal to provide a risk framework for critical infrastructure while accounting for climate change. The study is a part of the testing and application of the framework in the Campania region, assessing the temporal variation in landslide hazard specifically for a section of the Autostrada A3 Salerno-Napoli motorway, which runs across the toe of the Monte Albino relief in the Municipality of Nocera Inferiore. In the study, hazard is defined as the yearly probability of a spatial location within a study area to be affected by landslide runout given the occurrence of rainfall-related triggering conditions. Hence, hazard depends both on the likelihood of rainfall-induced landslide triggering within the study area and the likelihood that the specific location will be affected following landslide runout. Landslide triggering probability is calculated through the application of Bayesian theory and relying on local historical rainfall data. Temporal variations in triggering probability due to climate change are estimated from present-day to the year 2100 through the characterization of rainfall patterns and related uncertainties using the EURO-CORDEX Ensemble. Reach probability, defining the probability that a given spatial location is affected by debris flows, is calculated spatially through numerical simulation of landslide runout. The temporal evolution of hazard is investigated specifically in the proximity of the motorway, as to provide a quantitative support for landslide risk analysis. [ABSTRACT FROM AUTHOR]

In different areas of the world, shallow landslides represent a remarkable hazard inducing fatalities and economic damages. Then, the evaluation about potential variation in frequency of such hazard under the effect of climate changes should be a priority for defining reliable adaptation measurements. Unfortunately, current performances of climate models on sub-daily scales, relevant for heavy rainfall events triggering shallow landslides, are not reliable enough to be used directly for performing slope stability analysis. In an attempt to overcome the constrains by gap in time resolution between climate and hazard models, the paper presents an integrated suitable approach for estimating future variations in shallow landslide hazard and managing the uncertainties associated with climate and sub-daily downscaling models. The approach is tested on a small basin on Amalfi coast (southern Italy). Basing on available basin scale critical rainfall thresholds, the paper outlines how the projected changes in precipitation patterns could affect local slope stability magnitude scenarios with different relevances as effect of investigated time horizon and concentration scenario. The paper concludes with qualitative evaluations on the future effectiveness of the local operative warning system in a climate change framework. [ABSTRACT FROM AUTHOR]

Introduction: Rickettsioses represent a group of emerging infectious diseases in Europe. Climate changes and the anthropization of rural environment have favored vectors' biological cycle and geographic spread. In Sardinia, Mediterranean spotted fever (MSF) is endemic and represents an important public health problem. Purpose: We investigated the etiology and the clinical presentation of MSF-like illness in northern Sardinia by enrolling patients admitted to the Infectious Disease Unit of the University of Sassari. Results: Diagnostic tests included ELISA, Indirect immunofluorescence (IFI), DNA isolation from blood and from eschar samples with real-time PCR and genotyping. Eighty-seven patients with a mean age of 53 ± 14 years, of whom 65 (75 %) males, were included in the study. The most common diagnosis was MSF (79 %), followed by Q fever (8 %), and anaplasmosis (2 %). A tache noire was found in 58 % of rickettioses and 28 % of Coxiella burnetii infections. MSF was confirmed in 47 % of the cases by IFI and 43 % by ELISA antibody tests. The isolation of rickettsial DNA from the eschar was positive in 10/13 (77 %) of the cases due to Rickettsia conorii. Using this method, we identified the first case of R. monacensis infection in Italy. Conclusions: In conclusion, antibody-based tests confirmed the diagnosis in less than 50 % of the cases, whereas DNA isolation confirmed the diagnosis in 77 % of tested cases and allowed the identification of a new pathogenic species in Italy. Therefore, DNA isolation should be implemented to better identify the etiology of MSF-like illnesses and help the clinician in the management of patients. [ABSTRACT FROM AUTHOR]

The hydrological and hydraulic processes of the flash flood that affected Atrani village (Amalfi Coast of Southern Italy) on 9 September 2010 are analysed using post-flood surveys and numerical modelling. Observations in this case are particularly challenging because of the small spatial and temporal scales of the event, relative to the sampling characteristics of conventional rain and discharge measurement networks. Given these aspects, some of the relevant characteristics of the event were deduced by analysing field data that were collected immediately after the event.A width function instantaneous unit hydrograph (WFIUH) rainfall-runoff model is applied to derive a flow hydrograph for the area immediately upstream of the village. This hydrograph is inputted as an upstream boundary condition for the simulation of the propagation processes. A two-dimensional innovative hydraulic model is used to reproduce the flood within the village. The use of an unstructured mesh enabled a detailed simulation of water flow within the narrow and winding alleyways of the village. The results of the simulations indicate agreement with the field observations. The implemented approach is suitable for simulating flash floods in similar contexts and, therefore, may be used to predict potential future events. [ABSTRACT FROM AUTHOR]

A serious respiratory tract infection due to Corynebacterium ulcerans was observed in a 70-year-old woman. Clinical presentation included pseudomembranes in the upper respiratory tract and lung involvement. C. ulcerans was recovered from the nose of the patient's dog. Both dog's and patient's isolates belonged to Sequence Type 331. [ABSTRACT FROM AUTHOR]

Introduction. Limited information is available about the presence of tick-borne pathogens in urban parks in Italy. To fill this gap, ticks were collected in a public parkin Rome over a 1-year period and screened by molecular methods for tick-borne pathogens. Results and conclusion. The most abundant tick species were Rhipicephalus turanicus and Ixodes ricinus. The predominant pathogens detected were Borrelia. burgdorferi sensu lato (36%), Rickettsia spp. (36%), and Coxiella burnetii (22%). Among less frequently detected pathogens, Babesia microti was detected for the first time in Italy, with a prevalence of 4%. Neither Bartonella spp. nor Francisella tuiarensis were detected. With regard to co-infections, the most frequent double and triple infections involved Rickettsia spp., B. burgdorferi si., and C. burnetii.. A positive correlation was detected between pathogens and I. ricinus. Further studies are needed in order to assess risk associated with tick-borne pathogens in urban areas. [ABSTRACT FROM AUTHOR]

The aim of this article, using a paradigmatic approach, is to understand the evolution of agritouristic activity in Italy, to evaluate the possible local impacts referring to Itria Valley and considering the case of study of the organic firm 'Raggio Verde' in Cisternino (Brindisi, Italy) with its project of multifunctional initiatives through the creation of an organic ecological agritourism. The thesis supported is that the local impact of the agritouristic activity is different according to the reference's paradigm (market liberalism or ecological-territorial) and to the agritourism model (with reference to environmental and social relations, and to the dependence's level from external sources). The methodology is inductive, based on qualitative and quantitative analysis, on indirect, direct and participant observation by a research on the field. [ABSTRACT FROM AUTHOR]

Rickettsial diseases continue to be the cause of serious health problems in Italy. From 1998 to 2002, 4,604 clinical cases were reported, with 33 deaths in the period from 1998 to 2001. Almost all the cases reported in Italy are cases of Mediterranean spotted fever (MSF). Other rickettsioses that have been historically documented are murine typhus and epidemic typhus. Since 1950, only sporadic cases of murine typhus have been reported, and Italy currently appears to be free of epidemic typhus. As in other European countries, imported cases of rickettsialpox, African tick-bite fever (ATBF), and scrub typhus have been reported. In 2004, three cases of a mild form of rickettsiosis were serologically attributed to Rickettsia helvetica. [ABSTRACT FROM AUTHOR]

A micro-scale district heating network based on the operation of solar thermal collectors coupled to a long-term borehole thermal storage is modeled, simulated and investigated over a period of five years. The plant is devoted to covering the domestic hot water and space heating demands of a district composed of six typical residential buildings located in Naples (southern Italy). Three alternative natural gas-fueled back-up auxiliary systems (condensing boiler and two different technologies of micro-cogeneration) aiming at balancing the solar energy intermittency are investigated. The utilization of electric storages in combination with the cogeneration systems is also considered with the aim of improving the self-consumption of cogenerated electric energy; heat recovery from the distribution circuit is also evaluated to pre-heat the mains water for domestic hot water production. The performances of the proposed plant schemes are contrasted with those of a typical Italian decentralized heating plant (based on the utilization of natural gas-fueled non-condensing boilers). The comparison highlighted that the proposed configurations can decrease the primary energy consumption (up to 11.3%), the equivalent emissions of carbon dioxide (up to 11.3%), and the operation costs (up to 14.3%), together with an acceptable simple pay-back period (about 4.4 years). [ABSTRACT FROM AUTHOR]

The article discusses a case of Mediterranean spotted fever (MSF)-like illness in a 28-year-old man from Sassari in Sardinia, Italy. Serologic tests were positive for spotted fever group (SFG) Rickettsia spp., and Rickettsia monacensis was identified as the cause of MSF-like illness in the patient. Concerns about possible misdiagnosis and therapeutic delay due to the cocirculation of R. monacensis are addressed. Ticks that might act as vectors for R. monacensis in Sardinia are also mentioned.

The article describes three cases of louseborne relapsing fever (LBRF) in migrants from Somalia to refugee camps in Sicily, Italy from July to September 2015. It discusses the cause of LBRF, risk factors for epidemics of LBRF, symptoms experienced by the patients, and treatments given to the patients.

A correction is presented to the article "Respiratory diphtheria due to Corynebacterium ulcerans transmitted by a companion dog, Italy 2014" which appeared on the August 7, 2017 issue.

• Surface contamination by GEM and 5-FU in 68% and 42% of wipes/swaps respectively. • GEM deposition on workers' pads. • Higher induction of geno-cytotoxicity on administrators by BMCyt assay. • XRCC1399 polymorphism could be a susceptibility factor for MN in buccal cells. Health-care personnel handling antineoplastic drugs could be at risk for adverse health effects. We aimed to evaluate genotoxic and cytotoxic effects of antineoplastic drug exposure of personnel preparing and administering such drugs in three Oncology Hospitals in Italy enrolling 42 exposed subjects and 53 controls. Furthermore, we aimed to study the possible influence of XRCC1 and hOGG1 DNA repair genes polymorphisms on genotoxicity induced on buccal cells. We performed workplace and personal monitoring of some drugs and used exposure diary informations to characterize the exposure. Urinary 5-FU metabolite (α-fluoro-β-alanine) was measured. Buccal Micronucleus Cytome (BMCyt) assay was used to evaluate DNA damage and other cellular anomalies. GEM and 5-FU contamination was found in 68% and 42% of wipe/swab samples respectively. GEM deposition was found on workers' pads while no α-fluoro-β-alanine was found. BMCyt-assay showed higher genotoxicity and cytotoxicity on nurses administering antineoplastics than on preparators and controls. Among micronucleus (MN) positive (with MN frequency higher than 1.5‰) exposed subjects, the percentage of those carrying XRCC1 mut/het genotype was higher than in MN positive-controls. Using the sensitive BMCyt assay, we demonstrated that handling antineoplastics still represents a potential occupational health risk for workers that should be better trained/informed regarding such risks. [ABSTRACT FROM AUTHOR]

Data on Streptococcus pneumoniae carriage in adults with co-morbidities are limited. In this study we estimated the pneumococcal carriage among adults with co-morbidities and evaluated socio-demographic and clinical risk factors. The potential coverage of the current pneumococcal vaccines recommended for adults (PCV13 and PPV23) was also investigated. A cross-sectional study on S. pneumoniae carriage among unvaccinated adults ≥50 years with co-morbidities, presenting with or without acute respiratory symptoms at general practitioners in Rome, Italy, between October 2015 and July 2016 was conducted. Pneumococcal carriage was investigated by both cultural and molecular methods. Socio-demographic variables and co-morbidities were evaluated by logistic models as possible risk factors for pneumococcal carriage. Out of 248 patients (median age: 73 yrs; IQR: 65–79), 12 (4.8%) and 83 (33.5%) individuals were found colonized using cultural or molecular methods, respectively. Potential risk factors for pneumococcal colonization as ascertained by molecular methods were: low level of education (adjusted OR = 3.71, 95% CI: 1.62–9.40), winter months (December-March vs other months, adjusted OR = 2.56, 95% CI: 1.29–5.14), and presence of chronic lung diseases (adjusted OR = 2.18, 95% CI: 1.15–4.16). The combination of serotype-specific multiplex RT-PCR and conventional PCR allowed to identify 22 serotypes/group of serotypes, of which the most common were: 24F/24A/24B, 12F/12A/12B/44/46, 6A/6B, 14, 15B/15C, and 22F/22A. Prevalence of pneumococcal carriage due to PCV13 serotypes and non-PCV13 serotypes was 23.6% and 67.3%, respectively. Prevalence of colonization due to PPV23 serotypes was estimated to be 54.6%. A high prevalence of S. pneumoniae carriage was observed among adults with co-morbidities, especially among individuals affected by chronic lung diseases. These results support vaccine strategies based on the sequential administration of PCV13 and PPV23 to control potentially invasive pneumococcal strains in adults, especially in subjects with co-morbidities. [ABSTRACT FROM AUTHOR]

Bartonella henselae has been identified and characterized for the first time in Italy. A strain, designed Pavia-1, was isolated from the blood of a cat whose owner developed cat scratch disease (CSD). Pavia-1 and two American B. henselae strains (Houston-1, ATCC 49882, type I and strain 269608, UC Davis, type II) were compared by whole-cell fatty analysis (CFA), sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) for protein profiles, Western immunoblotting (WB) for reactivity with polyclonal antibodies, polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), type-specific 16S rRNA PCRs, and pulsed-field gel electrophoresis (PFGE). Bartonella clarridgeiae (ATCC 51734) was also included for comparison. Pavia-1 was identified as a B. henselae type I. PFGE allowed differentiation between B. clarridgeiae and B. henselae and furthermore, between all the B. henselae strains. The fingerprints of PFGE observed for Pavia-1 were distinct from those of B. henselae type II and also of Houston-1, suggesting that the two type I strains derived from two different clones. These results show the capability of B. henselae to develop genotypic variability between genetically related strains. [ABSTRACT FROM AUTHOR]

The article focuses on various studies carried out to find the prevalence of Bartonella infections in Italy. Bartonella clarridgeiae, bartonella henselae and Bartonella quintana subspecies have been found to be pathogenic for humans in the country. The principal cause of cat-scratch disease is Bartonella henselae. Studies reveal that people have limited knowledge about Bartonella species.

We aimed to evaluate whether TiO 2 production process induces genotoxic and cytotoxic effects on the first target organ of inhalable particles by a sensitive and noninvasive biomarker of effect. Final aim was to find a useful and suitable tool to assess and manage the risk of TiO 2 occupational exposure. We enrolled 40 workers employed in TiO 2 production, 5 office workers, and 18 external controls. Buccal micronucleus cytome assay (BMCyt assay) was applied because it allows to evaluate micronucleus (MN), nuclear buds (NB), and broken eggs (BE) indicating the presence of chromosomal instability and gene amplification and binucleated cells (BIN), karyolytic cells (KL), and condensed chromatin (CC) indicating cytokinesis defect or arrest, cell death and apoptosis respectively. We characterized the exposure measuring inhalable and respirable particles by personal monitoring. BMCyt-assay showed in exposed workers compared with external controls a higher value of MN frequency (2.57 vs. 0.05‰, p < .001) and MN positivity, evaluated as percentage of subjects with MN frequency higher than a 1.5‰ cut-off value (52.5 vs. 0%). We also found in exposed workers higher frequency of BE + NB (2.41 vs. 0.22‰, p = .002), BIN (9.45 vs. 8.44‰, p = .047) and CC (1.80 vs. 0.21, p = .001) than in controls. Moreover, we found a relationship between personal monitoring results and presence of MN and other cellular anomalies. This study demonstrates induction of genotoxic and cytotoxic effects on buccal cells of workers involved in TiO 2 production, suggesting the suitability of BMCyt assay as tool for risk assessment and management of TiO 2 exposure., (© 2021 Environmental Mutagen Society.)

Background: The spread of carbapenems resistance is a public health concern. The main group of carbapenemases encoding the β-lactamases activity (bla genes) is the Metallo-β-lactamases (MBLs)., Methods: The presence of carbapenemase blaOXA-23-like, blaOXA-40-like, blaOXA-51-like, blaOXA-58-like, and blaNDM-1 genes was screened by real time PCR in 26 Pediculus humanus insects identified from second-hand clothes in a local market in Central Italy. Bacteria diversity was also characterized through shotgun metagenomic amplification for a deep sequencing of the host-associated bacterial microbiomes., Results: The blaOXA-23 and blaNDM-1 carbapenemases genes were found and metagenomic analysis showed a great presence of Acinetobacter species., Conclusions: These results suggest a new potential transmission path for carbapenemase gene spread through bacteria ingested by insects infesting humans.

BackgroundOn 20 February 2020, a locally acquired coronavirus disease (COVID-19) case was detected in Lombardy, Italy. This was the first signal of ongoing transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the country. The number of cases in Italy increased rapidly and the country became the first in Europe to experience a SARS-CoV-2 outbreak.AimOur aim was to describe the epidemiology and transmission dynamics of the first COVID-19 cases in Italy amid ongoing control measures.MethodsWe analysed all RT-PCR-confirmed COVID-19 cases reported to the national integrated surveillance system until 31 March 2020. We provide a descriptive epidemiological summary and estimate the basic and net reproductive numbers by region.ResultsOf the 98,716 cases of COVID-19 analysed, 9,512 were healthcare workers. Of the 10,943 reported COVID-19-associated deaths (crude case fatality ratio: 11.1%) 49.5% occurred in cases older than 80 years. Male sex and age were independent risk factors for COVID-19 death. Estimates of R 0 varied between 2.50 (95% confidence interval (CI): 2.18-2.83) in Tuscany and 3.00 (95% CI: 2.68-3.33) in Lazio. The net reproduction number R t in northern regions started decreasing immediately after the first detection.ConclusionThe COVID-19 outbreak in Italy showed a clustering onset similar to the one in Wuhan, China. R 0 at 2.96 in Lombardy combined with delayed detection explains the high case load and rapid geographical spread. Overall, R t in Italian regions showed early signs of decrease, with large diversity in incidence, supporting the importance of combined non-pharmacological control measures.

Objectives: to describe the integrated surveillance system of COVID-19 in Italy, to illustrate the outputs used to return epidemiological information on the spread of the epidemic to the competent public health bodies and to the Italian population, and to describe how the surveillance data contributes to the ongoing weekly regional monitoring and risk assessment system., Methods: the COVID-19 integrated surveillance system is the result of a close and continuous collaboration between the Italian National Institute of Health (ISS), the Italian Ministry of Health, and the regional and local health authorities. Through a web platform, it collects individual data of laboratory confirmed cases of SARS-CoV-2 infection and gathers information on their residence, laboratory diagnosis, hospitalisation, clinical status, risk factors, and outcome. Results, for different levels of aggregation and risk categories, are published daily and weekly on the ISS website, and made available to national and regional public health authorities; these results contribute one of the information sources of the regional monitoring and risk assessment system., Results: the COVID-19 integrated surveillance system monitors the space-time distribution of cases and their characteristics. Indicators used in the weekly regional monitoring and risk assessment system include process indicators on completeness and results indicators on weekly trends of newly diagnosed cases per Region., Conclusions: the outputs of the integrated surveillance system for COVID-19 provide timely information to health authorities and to the general population on the evolution of the epidemic in Italy. They also contribute to the continuous re-assessment of risk related to transmission and impact of the epidemic thus contributing to the management of COVID-19 in Italy.

Whole genome sequences of SARS-CoV-2 obtained from two patients, a Chinese tourist visiting Rome and an Italian, were compared with sequences from Europe and elsewhere. In a phylogenetic tree, the Italian patient's sequence clustered with sequences from Germany while the tourist's sequence clustered with other European sequences. Some additional European sequences in the tree segregated outside the two clusters containing the patients' sequences. This suggests multiple SARS-CoV-2 introductions in Europe or virus evolution during circulation.

Background: Idiopathic Pulmonary Fibrosis (IPF) is an aggressive interstitial lung disease with an unpredictable course. Occupational dust exposure may contribute to IPF onset, but its impact on antifibrotic treatment and disease prognosis is still unknown. We evaluated clinical characteristics, respiratory function and prognostic predictors at diagnosis and at 12 month treatment of pirfenidone or nintedanib in IPF patients according to occupational dust exposure., Methods: A total of 115 IPF patients were recruited. At diagnosis, we collected demographic, clinical characteristics, occupational history. Pulmonary function tests were performed and two prognostic indices [Gender, Age, Physiology (GAP) and Composite Physiologic Index (CPI)] calculated, both at diagnosis and after the 12 month treatment. The date of long-term oxygen therapy (LTOT) initiation was recorded during the entire follow-up (mean = 37.85, range 12-60 months)., Results: At baseline, patients exposed to occupational dust [≥ 10 years (n = 62)] showed a lower percentage of graduates (19.3% vs 54.7%; p = 0.04) and a higher percentage of asbestos exposure (46.8% vs 18.9%; p 0.002) than patients not exposed [< 10 years (n = 53)]. Both at diagnosis and after 12 months of antifibrotics, no significant differences for respiratory function and prognostic predictors were found. The multivariate analysis confirmed that occupational dust exposure did not affect neither FVC and DLCO after 12 month therapy nor the timing of LTOT initiation., Conclusion: Occupational dust exposure lasting 10 years or more does not seem to influence the therapeutic effects of antifibrotics and the prognostic predictors in patients with IPF.

Background: Pediculus humanus, the human body louse, is widespread where overcrowding and lack of hygiene are present, in areas of the world affected by poverty, war, famine and presence of refugees. It has recently been considered re-emerging among homeless populations in developed countries. In Italy, it was last reported in 1945. Pediculus humanus is a vector of highly relevant human pathogens., Methods: In October 2018, a woman found small insects on a T-shirt bought second-hand in a local street market in a village 35 km south of Rome (central Italy). Insects were identified both morphologically and by molecular analysis. Moreover, they were analyzed molecularly for the presence of Rickettsia prowazekii, Borrelia recurrentis, Bartonella quintana, Coxiella burnetii and Yersinia pestis., Results: Morphological and molecular analyses of the insects identified them as 26 lice (12 females, 10 males and 4 nymphs) of the species P. humanus. Many nits were found on the T-shirt seams. DNA of the investigated pathogens was not detected in any of the lice., Conclusions: The exceptionality of the described case lies both in the report of P. humanus from a country where it had not been reported since 1945, and in its finding from second-hand clothes for sale in a market, constituting a potential source of infection for people buying this type of goods. The question arises, how did adults and nits of P. humanus infest clothes for sale on a market stall in a country where it had not been reported for decades. Given that the body louse requires frequent blood meals to survive and develop, its arrival on clothes imported from abroad is highly improbable. Hence, it must be presumed that people infected with the human body louse are present in Italy. This report points out a serious regulatory problem regarding the management of second-hand clothes prior to sale and, more generally, of controls in street markets.

Background: A study on tick species characterization and tick borne pathogens detection was performed by a survey conducted during 2012 and 2013 in the Viterbo province (Lazio Region, Central Italy). Seven sites were selected for the study investigation, including two farms and a military zone., Methods: A total of 255 ticks, Rhipicephalus (Boophilus) annulatus (n = 215), Rhipicephalus bursa (n = 28), and Hyalomma marginatum (n = 12) were screened individually by molecular methods for the tick borne bacterial agents: Borrelia burgdorferi sensu lato group, Bartonella spp., Coxiella burnetii, Ehrlichia spp., Francisella spp., and Rickettsia spp., Results and Conclusion: Overall, 182 ticks (71%) were infected with at least one pathogen; among these co-infections were found in 94 ticks. Tick borne pathogens identified were C. burnetii, B. burgdorferi s.l., Bartonella spp., Rickettsia spp., Francisella spp., and Ehrlichia spp. In R. bursa and H. marginatum, the presence of B. burgdorferi s.l. was positively correlated with that of C. burnetii, Rickettsia spp., and Bartonella spp. and their coinfection probabilities were 29.8%, 22.7% and 11.7%, respectively; the probability of coinfection for Francisella spp. and Rickettsia spp. and for Francisella spp. and Bartonella spp. was 14.9% and 17.9%, respectively. In R. (Boophilus) annulatus, the probability of coinfection between C. burnetii and B. burgdorferi s.l. was 11.3%, while those between C. burnetii and Bartonella spp. and between B. burgdorferi s.l. and Bartonella spp. were 0.8%. Further studies are needed in order to assess the risk associated with these unusual tick-borne pathogens in Central Italy.

The Mediterranean spotted fever (MSF) rickettsiosis is the predominant rickettsial disease among the spotted fever group (SFG) rickettsiae in the Mediterranean countries and North Africa. Its causative agent is Rickettsia conorii, although, SFG rickettsiosis - cases due to Rickettsia monacensis, Rickettsia massiliae and Rickettsia aeschlimannii were also described. A retrospective study based on hospital discharge records with a diagnosis of SFG rickettsiosis was carried out to describe the spatial pattern, the trend of the disease, and the epidemiological characteristics of persons hospitalized in the period 2001-2015. Standardized hospitalization ratios were calculated at municipal level using the European population. Smoothed maps were produced using a localised smoothing Poisson model. The mean annual standardized hospitalization rate was 1.36/100,000 person years (95%CI: 1.34; 1.39). Rates showed strong summer seasonality and tended to decrease over time. During the study period, 28.89% of municipalities had smoothed standardized hospitalization ratios greater than 1 and 14.01% above 20. Higher standardized hospitalization ratios were found in areas along the Tyrrhenian coast, especially in the south of Calabria and in the islands of Sardinia and Sicily, where the disease is of public health relevance., (Copyright © 2018 Elsevier GmbH. All rights reserved.)

Tick species characterization and molecular studies were performed within ornithological surveys conducted during 2010 and 2011 in the Lazio Region of central Italy. A total of 137 ticks were collected from 41 migratory birds belonging to 17 species (four partial migrants and 13 long-distance migrants). Most ticks were nymphs, with a predominance of Hyalomma marginatum marginatum and H. m. rufipes, and a small portion of Ixodes and Amblyomma species. All tick species analyzed were infected, and the molecular pathogen recognition revealed the presence of Rickettsia aeschlimannii, Rickettsia africae, Erlichia spp., Coxiella burnetii, Borrelia burgdorferi sensu lato group, and Babesia microti, whereas no genomic DNA of Bartonella spp. or Francisella tularensis was detected. The results of the survey show that H. marginatum ticks appear to be a vector of microbial agents that may affect human and animal health and that migratory birds may be an important carrier of these ticks. Additional studies are needed to better investigate the role of migratory birds in the epidemiology of these pathogens.

Objectives: Cerebrovascular diseases are leading cause of death worldwide. Plaque rupture and embolization account for one-third of ischemic stroke. The causes are not fully known, but inflammation plays a pathogenic role. Recently, HCV infection has been identify as risk of atherosclerosis. HCV replicates within carotid plaques and brain endothelia cells; moreover, HCV patients showed higher levels of inflammation. Thus, we hypothesized that subjects carrying HCV are at higher risk of stroke. Accordingly, we evaluated prevalence and role of HCV infection in patients with stroke., Methods: A priori sample size was calculated. Overall, 820 consecutive patients were enrolled, 123 with stroke and, as control, 697 age- and gender-matched (295 with COPD; 402 with diseases other than HCV-associated). Patients were evaluated for HCV and conventional risk of stroke., Results: Prevalence of HCV was higher in patients with stroke than that observed in control (26.8% vs. 6.6%, p = 0.0001). An analysis of stroke patients showed that those HCV positive were younger (p = 0.017) had lower serum levels of cholesterol (p = 0.001), triglycerides (p = 0.045), and higher serum levels of inflammation markers (ESR, p = 0.001; CRP, p = 0.0001; fibrinogen, p = 0.012). A multivariate analysis showed that HCV infection was an independent risk factor of stroke (O.R. 2.04, 95% C.I. 1.69-2.46; p = 0.0001). A secondary analysis showed that HCV patients had higher (p = 0.031) prevalence of past ischemic heart disease., Conclusions: HCV infected patients are at higher and earlier risk of stroke. Inflammation is a key mediator. Clinicians in clinical practice and researchers in future trials should take into account these new findings., (Copyright © 2013. Published by Elsevier Ireland Ltd.)

The role of migratory birds in circulation tick-borne viruses needs to be better defined. In order to assess the potential role of migratory birds in exotic virus spread, we conducted a study to identify ticks collected from migratory birds in the Central Region of Italy, and performed molecular investigation for Crimea-Congo Hemorrhagic Fever (CCHFV), West Nile fever (WNFV) and Usutu (USUV) in the vectors. A total of 137 competent ticks were collected with predominance of Hyalomma species. Although, negative results were obtained for all viruses considered, the high proportion of Hyalomma ticks highlights the potential risk for the dissemination of tick-borne viruses through infested migratory birds.

A mass-screening protocol for the diagnosis of anthrax from nasal swabs based on an enrichment step in liquid medium was devised. Incubation for growth was performed in autoclavable vials and racks which allow real-time PCR analysis of sterilized cultures. A dual-color PCR was set up with primers and probes for the chromosomal marker rpoB and the plasmid marker lef. Specific primer and probe sets were designed for the differentiation of Bacillus anthracis from B. cereus and for the differentiation of the Sterne vaccine strain from field isolates and the Ames strain, which was used in the recent anthrax bioterrorist attack. The present protocol thus combines the high specificity and sensitivity of real-time PCR with excellent biosafety and the low hands-on time necessary for the processing of large numbers of samples, which is extremely important during control programs involving the processing of large numbers of samples.

The aim of this study was to characterize a Bartonella strain (BA-1) isolated from a blood culture of an Italian, human immunodeficiency virus-positive patient with bacillary angiomatosis. We analyzed the isolate using molecular biology methods such as whole-cell fatty acid analysis, PCR-restriction fragment length polymorphism analysis, type-specific 16S rRNA PCRs, sequence analysis of the 16S rRNA, pulsed-field gel electrophoresis, and arbitrarily primed PCR. The BA-1 isolate turned out to be a Bartonella quintana strain, similar but not identical to B. quintana Oklahoma, which was used as a control strain.

Between 1993 and 1998, we isolated Borrelia burgdorferi sensu lato from 55 of the 119 patients with clinically diagnosed Lyme borreliosis who were admitted to "San Martino" Hospital in Belluno, Veneto, an Adriatic region in northeastern Italy where Lyme borreliosis is endemic. Upon hospitalization, all patients presented erythema migrans. Isolates were typed using ribosomal DNA PCR-restriction fragment length polymorphism (RFLP) analysis of the rrfA-rrlB intergenic spacer. Of the 41 isolates typed, 37 belonged to Borrelia afzelii, 2 to Borrelia garinii, and 2 to B. burgdorferi sensu stricto. Pulsed-field gel electrophoresis, performed on 21 strains (13 new isolates and 8 controls), revealed different RFLP patterns within the B. garinii and B. afzelii strains; among the five B. garinii strains and the 12 B. afzelii strains, three or two different RFLP patterns were identified, according to the restriction enzyme used. The protein patterns of the new isolates confirmed their genotypic classification and revealed the level of expression of some immunodominant proteins like OspA and other characteristic Osps. These findings constitute the first report of such a high recovery rate of B. burgdorferi from patients in a very restricted area in Italy; they also indicate the predominance of the genospecies B. afzelii in the study area and the heterogeneity of the circulating strains.