25Hepatitis E virus (HEV) causes acute hepatitis in humans, and infects several animal species, 26 mostly asymptomatically. Swine and human HEV strains are genetically related suggesting 27 both a zoonotic and a possible foodborne transmission. The prevalence of swine HEV was 28 investigated in 274 randomly selected pigs from 6 different swine farms of Northern Italy, 29 testing viral RNA in stools by nested reverse-transcription-polymerase chain reaction. HEV 30 genome was detected in 115 stools (42%). All farms resulted positive for HEV, with a 31 prevalence ranging between 12.8% and 72.5%. HEV positive pigs were detected in all age 32 groups and production stages tested, although infection was more prevalent in weaners than in 33 the older fatteners (42.2% vs. 27.0%). Genetic characterization of swine strains identified was 34 performed by sequencing and database alignment. Phylogenetic analysis on the nucleotide 35 sequences from 16 positive PCR products indicated that all strains belonged to genotype 3. In 36 particular, one group of seven Italian strains clustered close (91.6% to 96.2% identity) to 37 human and swine European HEV strains. 38 39

Two unconnected cases of type E botulism involving a 19-year-old woman and a 9-year-old child are described. The hospital courses of their illness were similar and included initial acute abdominal pain accompanied by progressive neurological impairment. Both patients were suspected of having appendicitis and underwent laparotomy, during which voluminous Meckel's diverticula were resected. Unusual neurotoxigenic Clostridium butyricum strains that produced botulinum-like toxin type E were isolated from the feces of the patients. These isolates were genotypically and phenotypically identical to other neurotoxigenic C. butyricum strains discovered in Italy in 1985-1986. No cytotoxic activity of the strains that might explain the associated gastrointestinal symptoms was demonstrated. The clinical picture of the illness and the persistence of neurotoxigenic clostridia in the feces of these patients suggested a colonization of the large intestine, with in vivo toxin production. The possibility that Meckel's diverticulum may predispose to intestinal toxemia botulism may warrant further investigation.

Human hepatitis E virus (HEV) is considered an emerging pathogen in industrialized countries. In Italy, the true burden of HEV infection is unknown. Molecular HEV screening of raw sewage samples from 11 wastewater treatment plants yielded 19 positives (16%; 18 genotype I, 1 genotype III) evenly distributed throughout Italy. Evidence that HEV could be establishing itself in our region is accumulating and may justify more active surveillance to monitor its spread.

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Noroviruses (NoVs) give rise to clinically relevant gastroenteritis in all age groups and are widely distributed in both clinical and environmental settings. NoVs are classified into five genogroups (GI to GV), of which GI, GII and GIV infect humans. While data on the epidemiology of human NoVs GI and GII have been steadily increasing, very little information has been published on the spread of GIV in either the health care system or the environment, resulting in a lack of information about its clinical significance and pathogenesis. In order to investigate the distribution of GIV strains in the environment, we analyzed sewage samples collected from five treatment plants, by using newly designed nested RT-PCR assays. A collection of clinical stool samples, originating from pediatric patients with symptoms of acute gastroenteritis, previously analyzed in our laboratory for the presence of NoV GI or GII, was also analyzed for the presence of GIV norovirus. Results of this work attest to the presence of GIV in both clinical and environmental contexts and underline the importance of routinely screening for this genogroup, along with GI and GII, in order to better understand its distribution, prevalence and role during epidemics, which is probably underestimated.