Following the mysterious death of toddler Sofia Zago, health experts fear that the disease could have made its way back to the country after 55 years.

The mysterious death of the Italian girl is the first home-grown case in the country, prompting experts to point at climatic conditions as a possible link to the mosquito-borne disease.

Prior to the onset of the disease, Sofia was basking with her family at a seaside resort in Bibione, on the Adriatic coast near Venice.

The death of Sofia Zago, pictured here with her family, has baffled doctors as she had never travelled to a risk-prone country. Photo credit: Dailymail
The death of Sofia Zago, pictured here with her family, has baffled doctors as she had never travelled to a risk-prone country. Photo credit: Dailymail

She developed a fever upon her return to her Alpine hometown. When the condition worsened, the girl was admitted to a hospital in the northern city of Trento, on last Saturday. Tests confirmed she was infected with the deadliest cerebral malaria.

The disease progressed within an hour – sending the toddler into a coma – and she was transferred to the intensive care unit (ICU) at a hospital in neighbouring Brescia, which specialises in the treatment of tropical diseases.

However, she did not regain consciousness and died in the hospital in the wee hours of Monday.

Doctors still seeking answers to the perplexing mystery

The contraction of malaria in a country that is supposedly free from the disease have baffled doctors; especially when the girl had never travelled to a country classified as at risk. Healthcare experts suspect the hot weather, which is conducive to helping mosquitoes adapt and spread the disease, could be a likely cause.

“I've never seen a case like it, it's a mystery. It shouldn't have been possible for her to get malaria,” explained Dr Claudio Paternoster, head of the infectious diseases department at the Trento's Santa Chiara Hospital.

However, Dr Paternoster remarked that only some types of mosquito are able to transmit the disease from person to person, and they don't exist in Italy.

“While there are a few cases of malaria in Italy a year, they are so-called "suitcase" cases, in which someone has brought an infected mosquito back with them from Africa,” he explained.

Malaria was endemic in Italy in the 19th century. In 1947, a campaign to eradicate malaria, mainly through pesticides, managed to wipe it out – and the World Health Organisation (WHO) declared Italy malaria-free in 1970.

Since then, the reported cases of malaria have been mostly imported, says the Centres for Disease Control and Prevention (CDC). Paolo Bordon, general manager of the provincial health service in Italy, expressed that, "it's a mystery, almost impossible."

According to sources, Sofia had been in contact with two children recovering from the disease when she was treated for her diabetes at the Trento hospital. Though occurrences of patient-to-patient transmission of the disease are rare, it is however, possible. According to Dr Paternoster, the girl was treated in a different ward from the infected children and did not undergo a blood transfusion.

Mosquito could have been brought in by travellers

Amid clues and questions, officials are looking at the "mosquito in a suitcase" theory, where an infected insect could have been packed along with a traveller.

The Anopheles mosquito – only the female of the species – can transmit the disease, and it is not known to live in Italy. "(To) our knowledge, there are no vectors suitable for transmitting malaria in Trentino and Italy," explained Paternoster.

He added that an investigation is underway to check if mosquitoes have once again found a breeding place in the region after a long lapse.

Dr Paternoster said he had not seen a single case of 'indigenous malaria' during his 30-year career. He feared that it might be linked to climate change.

“It was a very hot summer, and with climate change, we cannot rule out the adaptation of some species [of mosquito] or the re-introduction of others which could transmit the disease,” he added.

A team of experts from the country’s Ministry of Health is looking into the case of Sofia.

Meanwhile, WHO has hosted a meeting in Moscow to discuss how to keep Europe free of the disease. No cases of home-grown malaria were reported in Europe in 2015.

According to WHO, there were 212 million cases of malaria worldwide in 2015, and 429,000 deaths. Africa saw the highest number of malaria cases, as high as 99% – and children under five are most at risk.

The United Nations agency says Italy could be vulnerable to a return of malaria if mosquitoes are not properly controlled. MIMS

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Sources:
http://www.dailymail.co.uk/health/article-4854324/Girl-4-dies-malaria-leaving-doctors-baffled.html
http://www.npr.org/sections/thetwo-way/2017/09/05/548624097/in-a-case-that-is-almost-impossible-girl-dies-of-malaria-in-italy
http://www.bbc.com/news/world-europe-41161133