The virus was also isolated from the stools of the hydrocephalic patient. The discrepancy between the number of enterovirus CSF-positive patients (6/6) and enterovirus selleck chemical stool-positive ones

(4/6) is likely due to a much higher sensitivity of PCR technique compared with viral isolation in cell culture. Enterovirus detection on rectal and pharyngeal swabs was done according to the WHO recommended protocols, by 37°C incubation on MRC-5, BGM, Hep2 and Vero cell lines, and examined for cytopathic effect daily for 21 days. Species identification was carried out by indirect fluorescent assays with monoclonal antibodies anti-enterovirus (Dako Cytomation, Glostrup, Denmark), anti-coxsackievirus, poliovirus, and echovirus (Chemicon International Inc., Temecula, CA, USA). Echovirus serotyping was done by seroneutralization of cytopathic effect by Lim and Benyesh-Melnick pools. Viral genome TGF-beta inhibitor was detected by nested RT-PCR, after nucleic acid extraction and precipitation (Nested Enterovirus and Extragen, Amplimedical, Milan, Italy), with a test sensitivity of 200 copies/mL. Serological tests performed, challenging patient serum with the isolated echovirus-4 in all 17 travelers, resulted negative at baseline in all cases but one (an asymptomatic girl). When they were repeated

3 weeks later, all the symptomatic and one of the asymptomatic travelers showed seroconversion. Chest X-ray, cranial TC, and standard laboratory findings were all within normal limits. All patients recovered and no sequelae were recorded. The duration of the symptoms as well as of hospitalization ranged from 3 to 5 days for all patients. All of them, including those who did not develop symptoms, had drunk tap water in a hostel 1 day before returning to Italy, ie, 2 to 3 days before Rutecarpine the symptoms onset, and this was probably the only risk factor for enterovirus infections, compatible with the incubation period. Every year about 80

million people travel from industrialized countries to developing regions.8 Wilson et al. reported that a substantial proportion (22%) of returned travelers with fever have an unspecified febrile episode.3 In studies of patients in a tertiary care hospital, unidentified febrile syndrome accounted for 21% of cases,9 25% of cases among in-patients were not diagnosed,10 and “viral illness” accounted for 34% of cases among children.11 Steffen et al. states that health problems (related or unrelated to travel) are reported by 22% to 64% of travelers to the developing world: most of these diseases are mild and self-limited, such as diarrhoea, as the most frequent illness occurring in 13.6% to 54.6% of travelers depends on travel conditions and destinations.12 Many of these cases remain undiagnosed due either to lack of laboratory facilities or to self-limiting short-duration diseases. As our report shows, enteroviruses may play a role in undiagnosed fevers in travelers.