department of infectious diseases “cà foncello” regional ... · tick-borne encephalitis in...

Department of Infectious Diseases“Cà Foncello” Regional Hospital

Chief: Dott. A. Vaglia

TrevisoREGIONE VENETO REGIONE VENETO

ITALY

• Northeastern Italian territorybetween the Alps and the Adriatic Sea

• It is bordered by Austria and Balkanic States

• Infectious diseases referral centre for 1 million people (tertiary care no university-Hospital)

Endemic Arbovirus in the area

TBE

Tick-Borne Encephalitis in Italy: Case Report and Review from 1975 to 2001G. Caruso MD (unpublished data)

Trento Province: from 1992 (2 TBE foci)Belluno Province: from 1994 (2 TBE foci; 60 cases)Bolzano, Sudtirol: 1 autochothonous case 2000

Diagnosed Arbovirus Infectionsin Treviso Infectious Diseases Department

1994-2002

Epidemiology Laboratorycentre

Dengue 1 DHF3 Dengue

C/S Americas ISS

TBE 1 meningitis4 encephalitis

3 Belluno1 Austria1 Hungary

BellunoTreviso

ISSJE 1 suspected Sud-East Asia ISS

Laboratory tests for encephalitis and aseptic meningitis

at Treviso (HIV - patient)

Always:

HSV-PCR, MT-PCR on CSF

serology for HIV, EBV, CMV, Enterovirus,TBE, Borrelia, Bartonella, M. pneumoniae, C. pneumoniae, Toxoplasmosis

Limited investigational panel

• badget constraints

• availability of therapy

Laboratory tests for encephalitis and aseptic meningitis

at Treviso (HIV - patient)

Sometimes:

EBV/HHV6-PCR, Enterovirus-PCR, Toxoplasmosis-PCR on CSF

HIV-RNA

serology for WN/JE

CNS “viral” infections 1994-2002

Diagnosis No diagnosis

Encephalitis+ mielitis

16 (34%) 31

Asepticmeningitis

5 (10%) 43

Sieroteca (-80°C)Treviso Infectious Diseases Department

Encephalitis 65

Meningitis 70

FUO (viral?) 52

CSF specimens 354

Serum specimens 856

How to improve the diagnostic sensitivityof CNS “viral”infections?

How to improve the detection of Arboviral infections? (autochthonous or imported cases)

How the “field physicians” can take part to the investigation?

Collect clinical specimens

for differed analysis?for actual case analysis?

1) Investigation of (human):

•Encephalitis

•Meningitis

•Viral-like sdr

2) Select the suitable sentinel centres

• vectors/hosts epidemiology• described human cases• unknown epidemics

• unknown autochthonous cases• imported cases• bioterrorism

Essential elements of a successful specimen-stocking program

•aware physicians of the matter the patients to studywhich specimens and when to collect

•recognize reliable people forcentrifugate and stocking the specimensfile the specimensbring up-to-date the files

3) In which ways to stock the specimens?

• ways to collect (PCR contamination?)

• - 80°C

• program to file

• early and double specimens

4-5) Where and in which ways to send the specimens?

• reference centres

• in which ways must the specimens travel?(biological projectile)

6) Which viruses to look for?

7) Which tests to perform?

One finds what one knows(good principle in clinical practice)

We must look for what is unknown

This paper was produced for a meeting organized by Health & Consumer Protection DG and represents the views of its author on the subject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumer Protection DG's views. The European Commission does not guarantee the accuracy of the data included in this paper, nor does it accept responsibility for any use made thereof.