Gaffuri et al.
Tick-borne encephalitis, Lombardy, Italy. 
Emerg Infect Dis. 2024;30(2):341-344. doi:10.3201/eid3002.231016

TBE is well known in northeastern Italy, but other regions of Italy are mostly regarded TBE-free – an exception is, for example, a single autochthonous case in Emilia-Romagna (see, e.g., Snapshot week 33/2022).

Recently, surveillance studies on screening of ticks and serological analyses of wild ungulates as well as analyses of human cases of neurologic symptoms revealed TBE cases in Lombardy, a region in northern Italy, which is bordered on the north by Switzerland and by the region of Emilia-Romagna (south), Trentino-Alto-Adige and Veneto (east) and Piedmont (west).

Case 1
A 49-year-old male hunter with fever and fatigue was treated in a hospital in Bergamo, Lombardy. The patient showed neurologic symptoms with a 2-phase clinical picture of TBE. The serologic examination showed TBE IgM and IgG positivity.

Case 2
In Bergamo province, a chamois (Rupicapra rupicapra) was observed that had neurologic symptoms. Postmortem analyses of this animal revealed massive tick infestation and histopathology showed meningoencephalitis. Immunohistochemical analysis showed neural positivity for TBE virus, and the blood was TBE antibody positive. A PCR was carried out on ticks separated from this animal and the TBE virus of the European subtype was identified.

These results indicate the presence of TBE virus in northwestern Italy, and the authors highlight the need to raise awareness of the spread of TBE virus westward.

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