QUANDARY

A Malaria Medical Mystery Case Stumps Everybody but Italy’s Far-Right

A 4-year-old who never left the country is dead of an inexplicable case of malaria. Italy’s anti-migrant forces are fanning parents’ resulting fears to target refugees’ kids.

ROME—Four-year-old Sofia Zago should not have died of cerebral malaria. Even though the disease is extremely deadly in the parts of Africa where it is most prevalent, infected Westerners who contract the disease traveling to regions where it exists generally survive with prompt access to adequate medical care.

But Zago did die this week in an infectious-disease hospital in the northern Italian town of Brescia, mostly because no one thought she could have possibly contracted the disease. Her parents brought her to the emergency room on Aug. 31 with a high fever and a sore throat that doctors attributed to laryngitis. Four days later, she was in a coma with cerebral malaria. Five days later, she was dead.

Malaria was officially eradicated from Italy in 1970 after years of heavy pesticide use and a successful campaign to drain the country’s swamps. Even so, the child had never been abroad, so she could not have contracted it anywhere but Italy.

The disease can only be spread by the female Anopheles mosquito, which is no longer present in Italy unless one somehow ends up in a suitcase. Even then, the breed supposedly cannot survive to mate and multiply. Only one case of suitcase malaria has ever been reported in Italy since 1970, and the two infections the traveling mosquito caused were immediately caught.

Doctors perplexed by just how Zago caught the disease have not ruled out another traveling mosquito. Zago had been in a hospital in the town of Trento, where she lived, in mid-August to treat complications for her diabetes. She had no blood transfusions, but she did play in a common area with two little girls from Burkina Faso who were being treated for cerebral malaria. Because malaria can not be passed person-to-person, the girls were not in isolation or considered a risk to other patients. Zago may have somehow been the victim of a contaminated syringe, although the hospital says the girls were being treated for two different things in two separate wings and it would be almost impossible for such a cross-contamination through bad hospital hygiene.

One other theory: If an Anopheles mosquito somehow got loose in the hospital, it might have bitten one of the Burkina Faso children and then transmitted the disease to Zago, though scientists say that is highly unlikely—the carrier mosquitos can only transmit malaria several days after they bite the infected person, a timeframe that exceeds the overlap between the Burkina Faso girls and Zago.

Still, both the hospital where Zago was initially treated and the one where she died have since been fumigated and those patients who were in the hospital at the same time as the Burkina Faso children have all been contacted to see if they exhibit signs of the disease.

Prior to falling ill on Aug. 31, Zago had been to the Italian tourist resort of Bibione on the Adriatic Sea near Venice with her family. A suitcase mosquito could have theoretically infected the child there, but no other infections have been reported associated with the resort—and someone would have had to have malaria to pass it to the rogue mosquito in the first place.

Anti-migrant activists have a different theory, and have been quick to blame refugees, with some from Italy’s racist “alt-right” groups even demanding refugee children not be allowed to start school next week. “The migrants bring the diseases,” said Paolo Grimoldi, a parliamentarian with the far-right Northern League, after Zago died Monday. He called for all refugee and migrant children to be checked before they are allowed into the classrooms when school resumes across Italy.

Loredana De Petris, a parliamentarian for the center-left, which has a softer stance on the migration issue, disagrees. “The attempt by the [Northern] League to exploit the tragedy of the dead little girl from malaria for their xenophobic campaign is one of the most ignominious things we have ever seen,” she said. “It is also a mirror to incredible ignorance.”

Italian facilities treat an average of 637 malaria cases each year, according to the Italian Health Ministry. Around 20 percent of those cases affect Italians who traveled abroad. The rest are migrants who just arrived or refugees resident in the country who were infected after returning to their countries of origin for a visit. The Burkina Faso children had contracted the disease in July when they were visiting relatives and had been diagnosed when they returned home to Italy, where they have refugee status. But even with so many malaria cases in the country, they cannot be spread without a vector like the Anopheles mosquito.

Luigi Gradoni, a researcher in infectious disease with the health ministry, is heading an investigation to try to clear up how Zago contracted the disease, and urged parents not to panic. “People should not be alarmed because it cannot be transmitted in Italy,” he told an Italian television station, in direct contradiction to the circumstances around Zago’s case since she had not been out of the country. “For now the case is unclear because we cannot explain how she contracted malaria.”

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Meanwhile, Italy’s green party has an alternative and far more disturbing theory: that thanks to climate change, which is being blamed for a severe drought across most of Italy, the Anopheles mosquito could be making a comeback here.

Maria Rita Gismondo, director of the Laboratory of Microbiology, Virology and Bio-Emergency Hospital at the Sacco Hospital in Milan, also told the online publication Italian Affairs that the Zago case could point to a return of malaria to Italy. “Of course, climate change can play a major role in spreading diseases that we thought we had beat,” she said. “There are several studies that show how, due to climate change, the malarial belt is destined to expand north and south over the next few decades.”

A full autopsy on Zago, due in the coming weeks, may provide additional clues to how she contracted the deadly disease. In the mean time, researchers in Italy have started sample checks across the country to determine if the deadly mosquito is back—or if the mystery malaria case will remain unsolved.