Autopsy results confirm 4 year old Italian girl died from malaria

BMJ 2017; 358 doi: (Published 11 September 2017) Cite this as: BMJ 2017;358:j4235
  1. Michael Day
  1. Lecce, Italy

The death of a four year old girl from falciparum malaria in Italy has puzzled doctors in a country free of the disease since 1970.

Italy’s health ministry sent inspectors to two hospitals in the north of the country on 8 September after some experts speculated that the child may have been infected while being treated in hospital for complications related to her diabetes.

Results from an autopsy in Brescia confirmed the death, on 4 September, was from cerebral malaria.

One explanation is that the child, Sofia Zago, contracted the disease during her stay at one of the hospitals, the Santa Chiara in Trento, from two girls from Burkina Faso who were being treated for malaria in a separate room. They had contracted the disease in Africa, health officials said, and had subsequently recovered.

Raniero Guerra, the director general of public health, said that DNA tests were being carried out to try to establish if the strain of parasite that killed Zago was the same as that contracted by the other children.

Matteo Salvini, the leader of the anti-immigrant Northern League party, said that it was “undeniable that a certain sort of disease long since eradicated is linked to the current phenomenon of migration.”

Italy is currently bearing the brunt of the migration crisis that has seen hundreds of thousands arrive from the Middle East and sub-Saharan African through Libya. Some officials have speculated that the African family, who had recently returned from a trip to Burkina Faso, might have brought an infected mosquito in a bag or rucksack.

But Luigi Gradoni, an infectious disease expert at the National Institute of Health in Rome, dismissed the notion that immigrants could bring malaria to Italy. “Even if they arrive here with it, it cannot spread,” he said.

Paediatricians who treated Zago said that she received no blood transfusions.

The anopheles mosquito that transmits falciparum malaria is thought to have been eradicated in Italy. Guerra said, however, that it could not yet be discounted that the child contracted the disease during a holiday in Bibione, on the coast near Venice.

Local press reports have suggested, however, that blood samples taken from the child after she was admitted to the hospital at Portogruaro on 13 August may have already been discarded, making it harder to establish whether she had already contracted malaria when she was admitted.

Some health officials, including Paolo Bordon, the director general of health services for the Trentino province, have said that the mode of transmission may never be established.

Malaria used to be widespread in Italy, but eradication campaigns reduced the incidence of the disease and the World Health Organization declared Italy free of malaria in 1970. Subsequent cases of the disease recorded in Italy were contracted abroad.

Meanwhile, people who have recently stayed in the coastal town of Anzio, have been ordered not to give blood for 28 days after three cases of the mosquito borne viral infection Chikungunya were reported. The Lazio regional government has also ordered town officials to begin spraying against mosquitoes. Chikungunya, which first appeared in Italy in 2007, causes acute fever and joint pain but is rarely fatal.

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