Live nativity and brucellosis, Sicily.To the Editor: Worldwide, brucellosis brucellosis (br'səlō`sĭs) or Bang's disease, infectious disease of farm animals that is sometimes transmitted to humans. remains a major zoonosis Zoonosis Definition
Zoonosis, also called zoonotic disease refers to diseases that can be passed from animals, whether wild or domesticated, to humans. and an important cause of travel-associated illness (1). Brucellosis is transmitted to humans through the consumption of infected, unpasteurized Adj. 1. unpasteurized - not having undergone pasteurization
unpasteurised , animal-milk products; direct contact with infected animal parts; or inhalation of infected aerosolized particles. We report an outbreak of brucellosis in a small village of the Ionic coast of Messina province (eastern Sicily).
In 2003, health authorities in the Messina province were notified of 29 cases of brucellosis; 18 of the patients were members of 9 different families. All patients had observed a Nativity pantomime that used live animals and was organized by the local population. Nativities in Sicily last [approximately equal to] 1 month, during which the sheep are milked, cheese and ricotta ri·cot·ta
1. A soft Italian cheese that resembles cottage cheese.
2. A similar soft cheese made in the United States. are produced, and these products are sold or offered fresh to tourists. All 29 patients had consumed dairy products: tuma cheese by 29 (100%) and tuma and ricotta by 16 (55%). No other risk factors for brucellosis were reported. Symptoms appeared after a median of 45 days (range 30-70). Eight patients were children (3 male), and 21 were adults (10 male). The median age of the children was 10.5 years (range 6-13) and of the adults, 42 years (range 16-67). Hospitalization was required for 5 patients. For 2 adults, brucellosis was complicated by spondylitis spondylitis /spon·dy·li·tis/ (spon?di-li´tis) inflammation of vertebrae.
spondylitis ankylopoie´tica , ankylosing spondylitis .
The real extent of the outbreak was likely large because in Sicily [approximately equal to] 60% of cases may go unreported. Furthermore, we report only the cases that occurred in the villages of Messina province and that were reported to health authorities; but tourists from many other areas in Italy and some from outside Italy generally attend such events. Southern Italy has commonly been implicated as a venue for travel-associated brucellosis (2).
In Italy, the overall incidence of brucellosis has gradually declined in the past 30 years, especially in northern Italy, where the disease is now reported only sporadically. This trend, however, has led to an increase in the percentage of total cases in Italians reported from the southern provinces of Calabria, Campagna, Puglia, and Sicily; of the 520 cases reported in 2003, 488 (93.8%) were reported from 4 southern regions, compared with 63.7% in 1994. Sicily alone reported 57.6% of the 2003 cases and for the past decade has had an average annual incidence of >100 cases per million (1,3). The disease is almost always caused by Brucella melitensis (4). The southern localization Customizing software and documentation for a particular country. It includes the translation of menus and messages into the native spoken language as well as changes in the user interface to accommodate different alphabets and culture. See internationalization and l10n. of the disease in Italy is obviously related to the relative high prevalence of infections in sheep and goats (5). Ovine ovine
pertaining to, characteristic of, or derived from sheep.
ovine atopic dermatitis
symmetrical erythema, alopecia, lichenification, excoriation on woolless areas; sporadic cases, recur each summer. and caprine cap·rine
pertaining to or emanating from goats.
caprine arthritis-encephalitis (CAE) population density is higher in the southern regions of Italy than in the rest of the country (6).
The Italian brucellosis eradication plan consists of a test-and-slaughter practice. However, in Sicily a vaccination campaign with B. melitensis Rev. 1 strain has been started. In 2003, [approximately equal to] 99% of the stock farms were tested, and [approximately equal to] 18% of them were infected (3). The major problems reside with small flocks that undergo frequent transhumance transhumance
a husbandry procedure in which livestock are moved to another climatic region at particular seasons, e.g. mountain grazing in summer. It is a system which encourages the spread of some diseases such as pneumonic pasteurellosis. (seasonal movement of herds between regions with different climates) in isolated regions where testing by veterinarians is difficult or avoided by the owners (a typical drawback of test-and-slaughter practices).
Technically, ricotta is not a cheese, but rather is a cheese by-product. The name "ricotta" means cooked again, referencing the production method. Ricotta is made from whey drained from tuma, provolone pro·vo·lo·ne
A hard, usually smoked Italian cheese.
[Italian, augmentative of provola, a kind of cheese.] , and other cheeses. Heat is then used to separate, by precipitation, the remaining albumin from the whey left after making lactic acid/rennet-precipitated cheeses. It is eaten as is or used for food seasoning (e.g., classic Italian lasagna and ravioli). A cream made of sieved ricotta and sugar is used to prepare many desserts, like cannoli and cassata cake. Being cooked 2 times, ricotta should not contain viable Brucella Brucella /Bru·cel·la/ (broo-sel´ah) a genus of schizomycetes (family Brucellaceae). B. abor´tus causes infectious abortion in cattle and is the most common cause of brucellosis in humans. B. organisms; however, shepherds sprinkle fresh milk on wicker baskets to refresh the ricotta they contain, thereby contaminating the product.
Tuma is a typical Sicilian fresh cheese made from sheep's milk. It has a cylindrical appearance and is sold fresh, no more than 2 days old. It has no crust, and the dough is white or ivory-white without holes. The texture is very soft, tender, and wet. It is generally served with ham, wines, and fruits as a table cheese.
Tuma cheese should be considered as the major vehicle of B. melitensis infection in Sicily. Although most similar dairy products produced in Sicily are derived from organized dairy companies and have been pasteurized pas·teur·ize
tr.v. pas·teur·ized, pas·teur·iz·ing, pas·teur·iz·es
To subject (a beverage or other food) to pasteurization.
pas , traditional delicacies from small villages may still cause brucellosis outbreaks.
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(2.) Chanet V, Gourdon F, Baud O, Beytout J, Romazko JR Brucella melitensis in a married couple after a trip through Sicily. South Med J. 2005;98:843-4.
(3.) Ministry of Health, Italy. Results of epidemiological research. [cited 2006 Jul 18]. Available from http://www.ministerosalute. it/promozione/malattie/datidefcons.jsp
(4.) Caporale V, Nannini D, Giovannini A, Morelli D, Ramasco M. Prophylaxis and control of brucellosis due to Brucella melitensis in Italy: acquired and expected results. In: Prevention of brucellosis in the Mediterranean countries. Proceedings of the International Seminar of the International Center for Advanced Mediterranean Agronomic Studies (CIHEAM CIHEAM Centre International de Hautes Etudes Agronomiques Mediterraneennes (France; International Center for Advanced Mediterranean Agronomic Studies) ), the Commission of the European Communities, and the Ministry of Agriculture and Fisheries. Valletta (Malta): CIHEAM, 1992. p. 127-45.
(5.) De Massis F, Di Girolamo A, Petrini A, Pizzigallo E, Giovannini A. Correlation between animal and human brucellosis in Italy during the period 1997-2002. Clin Microbiol Infect. 2005;11:632-6.
(6.) Caracappa S. Livestock production and animal health in Sicily, Italy. Parassitologia. 1999;41(Suppl 1):17-23.
Chiara Iaria, * Filippo Ricciardi, * Fernanda Marano, ([dagger]) Giovanni Puglisi, ([dagger]) Georgios Pappas, ([double dagger]) and Antonio Cascio *
* Dipartimento di Patologia Umana, Universita di Messina, Messina, Italy; ([dagger]) Dipartimento di Prevenzione Azienda Unita Sanitaria Locale 5, Messina, Italy; and ([double dagger]) Institute for Continuing Medical Education continuing medical education See CME. of Ioannina, Ioannina, Greece
Address for correspondence: Antonio Cascio, Clinica delle Malattie Infettive, Policlinico G Martino, Via Consolare Valerian valerian, in botany
valerian, common name for some members of the Valerianaceae, a family chiefly of herbs and shrubs of temperate and colder regions of the Northern Hemisphere; a few species, however, are native to the Andes. . 1, 98125 Messina, Italy; email: email@example.com
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