Imported Chikungunya Infection, Italy

course and the role of Shiga toxin–pro-ducing Escherichia coli infection in the hemolytic-uremic syndrome in pediatric patients, 1997–2000, in Germany and Austria: a prospective study. To the Editor: Chikungunya virus (CHIKV) infection is a self-limiting illness characterized by fever, headache, weakness, rash, and arthral-gia. Some patients have prolonged weakness or arthralgia lasting several months. In 2006, several Indian Ocean states and India had an outbreak of CHIKV infection (1,2). During the epidemic's peak, some European and American travelers returning from these areas were infected (3–6). Because the foci of Aedes al-bopictus, 1 of the 2 main vectors of CHIKV, are now in Italy and many travelers visit CHIKV-epidemic areas , surveillance for imported cases is mandatory in Italy (7). From July to September 2006, a total of 17 con-fi rmed cases of CHIKV infection were observed in travelers at 5 Gruppo di Interesse e Studio delle Patologie di Importazione (GISPI) centers (Italian network of Institutes of Infectious and Tropical Diseases). Serologic diagnosis was performed with a hemagglu-tination-inhibition test and confi rmed by a plaque-reduction neutralization test (8). Demographic and epidemio-logic characteristics of these patients are reported in the Table. Cases were distributed throughout the year with a peak from March to May 2006 (n = 10). Nine patients (53%) were men. Median age was 43 years (range 31–66 years). Several reasons for travel were reported: tourism (64.6%), visits to relatives or friends (11.8%), business (11.8%), and missionary work (5.9%). One patient was a resident in the disease-epidemic area. The median exposure time in the CHIKV-endemic area for the 15 travelers was 15 days (range 9–93 days) (missionary and resident patients were excluded). The median delay before being seen at a clinic after return was 2 days (range 0–73 days). Only 7 patients (41.2%) were hospitalized. The remainder were outpatients. All patients had fever; arthralgia (88.2%, n = 15), weakness (70.6%, n = 12), headache (11.8%, n = 2), diarrhea (11.8%, n = 2), and gum bleeding and epistaxis (5.9%, n = 1) were other reported symptoms. The median duration of fever was 5 days (range 2–12 days). Only 7 of 16 patients (43.8%) were still febrile when fi rst seen. Physical examination showed diffuse macular erythematous rash in 13 patients (76.5%), a similar rate to that reported among French travelers (4). Hepatomegaly was found in 2 patients (11.8%), splenomegaly in 2 (11.8%), and peripheral lymphadenopathy in 2 (11.8%). Twelve acute-phase …