Foodborne Trematodiasis and Opisthorchis felineus Acquired in Italy

determination of eggs of opisthorchiid and heterophyid flukes using scanning electron microscopy. Dekumyoy P, et al. Discovery of Opis-thorchis lobatus (Trematoda: Opisthorchi-idae): new recorded species of small liver flukes in the greater Mekong sub-region. diagnosis of opisthorchiid and hetero-phyid metacercariae (Trematoda) infecting fish of cyprinid fish from Nam Ngum Dam. Foodborne Trematodiasis and Opisthorchis felineus Acquired in Italy To the Editor: Opisthorchiasis comprises diverse clinical manifestations caused by infections with Opis-thorchis felineus or O. viverrini liver flukes, which are transmitted by eating infected raw or undercooked fish and other aquatic products. In regions outside Western Europe where human opisthorchiasis is endemic, the disease is mainly described as being chronic and asymptomatic. Recent studies indicate cases of O. felineus infection in the Mediterranean region, particularly Italy (1–4). Patients with acute infection have signs/symptoms ranging from fever to hepatitis-like signs/symptoms (e.g., pain in upper right abdominal quadrant, weakness, fatigue, loss of appetite, diarrhea, weight loss); sign/symptom onset occurs ≈2 3 weeks after infection, depending on the number of ingested flukes (2–4). Acute opisthorchiasis is a feature of O. felineus infection that is not often reported for other trematode infections. Opisthorchiasis is characterized by hepatosplenomegaly, abdominal tenderness, eosinophilia, chills, and fever (2); left untreated, it can lead to obstructive jaundice, cholangitis, cholecystitis, and intra-abdominal masses (1,2,4). Transmission of O. viverrini mainly occurs in Southeast Asia, but O. felineus transmission expands further westward to parts of Western and Central Eurasia (1,2,4). Recent outbreaks of O. felineus infection have been described in Italy (5–7). In 2010, two travelers from the Netherlands who ate raw tench near Lake Bolsena in Tuscany, Italy, were infected (8). We describe 3 additional cases of O. felineus infection in Dutch travelers who ate raw fish near Lake Bolsena. In August 2011, a 54-year-old woman in the Netherlands with no relevant medical history sought medical care for fever, chills, and myalgia lasting 2 weeks. Symptoms began after the patient returned from a vacation in Tuscany. Physical examination showed no abnormalities; her temperature was 37.4°C. Laboratory examinations showed eosinophilic leukocytosis, an elevated C-reactive protein level, and elevated liver enzyme levels (Table). Opisthorchiasis was suspected because of the patient's travel history and report of eating carpaccio (Italian dish made with raw fish/meat) near Lake Bolsena (8). A fecal sample examined by microscopy was negative for eggs, cysts, and helminths. A serum sample was tested at Leiden University Medical Center by using an in-house …