Image copyright Science Photo Library Image caption The female Anopheles mosquito passes on the malaria parasite by feeding on human blood 
 
 A four-year-old Italian girl has died of cerebral malaria in northern Italy, a region free of the disease, in what doctors see as a very mysterious case. 
 
 Sofia Zago died in Brescia on Sunday night, after being rushed to hospital with a high fever on Saturday. 
 
 Italy is free of the Anopheles mosquito that carries cerebral malaria, the deadliest form of the blood disease. But after a scorching August, some fear that it might have reached Italy. 
 
 A flight could have brought it in. 
 
 Sofia had been on holiday with her parents at Bibione, an Adriatic resort near Venice. 
 
 Trento, where the girl's malaria was diagnosed on Saturday, lies within the Trentino region in the foothills of the Alps. 
 
 "It's the first time in my 30-year career that I've seen a case of malaria originating in Trentino," said Dr Claudio Paternoster, an infectious diseases specialist at Trento's Santa Chiara Hospital. 
 
 Since the 1950s, Italy has not had a malaria problem because mosquito-infested marshes were drained. 
 
 There is speculation that Sofia might have caught malaria from one of two children treated for it at the Trento hospital after 15 August. They had caught it in Africa, and recovered. 
 
 Sofia had had treatment there for child diabetes and there was a break before her emergency readmission to the hospital at the weekend. 
 
 A Trentino health official, Paolo Bordon, said Sofia had not been in the same ward as the other two children. Sofia had not had a blood transfusion, he added, stressing that the treatments for malaria and diabetes were utterly different. 
 
 The Plasmodium Falciparum parasite carried by the Anopheles mosquito can kill a human within 24 hours. 
 
 About 438,000 people died of malaria in 2015 in the 95 tropical countries where it is endemic, Italy's Corriere della Sera daily reports. 
 
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 Only some types of mosquito are able to transmit the disease from person to person. 
 
 Risky insects are found in large areas of Central and South America, Africa, Asia, the South Pacific and some parts of Eastern Europe, but not in the rest of Europe. 
 
 As a result, malaria is largely limited to tropical areas - cases appearing within the European Union are typically "suitcase" ones, linked to recent travel to other parts of the world where malaria is present. 
 
 The latest case in northern Italy has baffled experts. It is not clear how the girl caught it, but her case is not unique. 
 
 The European Centre for Disease Prevention Control closely monitors cases and has found a few cases of "locally acquired" malaria in the EU - two in France and three in Spain in 2014. 
 
 But there were explanations for how some of these might have occurred. One was a patient who had received a kidney from a donor with malaria; another was a newborn whose mother had recently returned from Equatorial Guinea. 
 
 One of the Spanish patients had no history of travel, but lived a few kilometres from a town where a "suitcase" malaria person lived. No infected local mosquitoes were found, but lab tests showed two people had an identical strain of the disease. ||||| In A Case That Is 'Almost Impossible,' Girl Dies Of Malaria In Italy 
 
 Enlarge this image toggle caption Sinclair Stammers/Getty Images/Science Photo Library RM Sinclair Stammers/Getty Images/Science Photo Library RM 
 
 A 4-year-old girl has died of malaria in Italy, where the disease is thought to have been wiped out. Troubled health officials are looking for answers. 
 
 The girl was taken to the hospital Saturday in her Alpine hometown of Trento after she developed a high fever, according to the Italian newspaper, Corriere della Sera. Lab tests confirmed she was infected with cerebral malaria, the deadliest kind. The girl had already fallen into a coma. She was transferred to a hospital specializing in tropical diseases in neighboring Brescia, where she died in the early morning hours Monday, reports the daily newspaper. 
 
 "This is the first time in 30 years of career that I have been involved in a case of native malaria in Trentino," Dr. Claudio Paternoster, an infectious disease specialist at Trento's Santa Chiara Hospital, told the newspaper. 
 
 Malaria was endemic throughout Italy until the first half of the 20th century, especially in coastal and marshy areas hospitable to the mosquitoes carrying the disease. But a campaign launched in 1947 to eradicate malaria, mainly through pesticides, proved to be successful. 
 
 The World Health Organization declared Italy malaria-free in 1970. Since then there have been cases of malaria reported, but almost all of them have been imported, says the Centers for Disease Control and Prevention. 
 
 Now health officials are trying to piece together how and where the girl may have been infected. 
 
 "It's a mystery, almost impossible," Paolo Bordon, general manager of the provincial health service, tells Corriere della Sera. 
 
 The child had never traveled abroad, but she had recently returned from a vacation in Bibione, a coastal resort northeast of Venice on the Adriatic Sea. 
 
 Corriere della Sera reports that the trip — in the first weeks of August — is compatible with the incubation period for malaria. 
 
 The BBC reports that the child had previously been treated for her diabetes at the Trento hospital, where two other children were recovering from malaria they had caught in Africa. 
 
 While patient-to-patient transmission of the disease is rare, it is possible. Yet Paternoster tells Corriere della Sera that the girl was treated in a different ward from the infected children and she did not have a blood transfusion. 
 
 Officials are also considering the "mosquito in a suitcase" theory, where an infected insect could have been brought over by a traveler. 
 
 Just one kind of mosquito — the Anopheles — (and only females at that) 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," Paternoster told Corriere della Sera. But he says an investigation is underway to see if the mosquito is once again present in the region. 
 
 "It has been a hot summer and with climate change it is not possible to exclude the adaptation of some species," Paternoster said. 
 
 But as NPR's Michaeleen Doucleff has reported, it can be tricky to definitively link climate change to the spread of vector-borne diseases, in part, because the life span of mosquitoes is so short and may only be made shorter in warmer weather. 
 
 Malaria is caused by a parasite that leads to flu-like symptoms. And every year, millions of people are sickened with the disease. Many recover, but small children are especially vulnerable. 
 
 Ninety percent of malaria cases occur in sub-Saharan Africa, where it kills about 3,000 children every day, according to UNICEF. 
 
 Europe was declared malaria-free in 2015. 
 
 This week the World Health Organization is hosting a meeting in Moscow to discuss keeping Europe malaria-free. ||||| Breaking News Emails Get breaking news alerts and special reports. The news and stories that matter, delivered weekday mornings. 
 
 / Updated By Claudio Lavanga 
 
 ROME — Malaria killed a 4-year-old girl in Italy, raising fears that the mosquito-borne disease has returned to the country after decades. 
 
 Sonia Zago developed a high fever after returning home from a vacation in Bibione, a seaside town on the Adriatic coast near Venice. 
 
 As her condition worsened, she was taken to a hospital in the northern city of Trento. Within an hour of arriving, the girl had fallen into a coma and was diagnosed with malaria. Zago was then transferred to a hospital in Brescia that treats tropical diseases, but she died on Sunday night. 
 
 The girl had never traveled to a risk-prone country, raising questions about how she contracted the disease. 
 
 "It baffles us how she could have been infected" 
 
 The Ministry of Health confirmed Tuesday that it had dispatched a team of experts to investigate. 
 
 Dr. Claudio Paternoster, director of the infectious diseases ward at Santa Chiara hospital in Trento, said that he had not seen a case of home-grown malaria during his 30-year career. 
 
 He said that Zago had been admitted to the facility about two weeks ago due to suspected diabetes and had shared a ward with two children who had contracted malaria while in Burkina Faso. 
 
 "It’s not probable, almost impossible, to pass on the [parasite] from patient to patient," Paternoster told NBC News. "So the only option I can think of is that the mosquito that carried the disease may have traveled to Italy, and survived somehow." 
 
 Tropical diseases expert Alberto Matteelli, left, is flanked by Ezio Belleri, general manager of the "Spedali Civili" hospital, as they meet the media in Brescia, Italy on Sept. 5, 2017. Italy's health ministry has ordered an investigation into the death of a 4-year-old girl from malaria after checks determined she hadn't traveled to any country at risk for the disease. Filippo Venezia / ANSA via AP 
 
 He added: "It baffles us how she could have been infected.” 
 
 Italy has been malaria-free since the 1950s, with most recorded cases linked to tourists who returned from countries where it is common. 
 
 Paternoster speculated that climate change may be to blame. 
 
 ”It was a long and very hot summer," Italian daily Corriere della Sera quoted Paternoster as saying. 
 
 On Tuesday, the World Health Organization was hosting a meeting in Moscow to discuss how to keep Europe malaria-free. Zero cases of home-grown malaria were reported in Europe in 2015. 
 
 The WHO says Italy could be vulnerable to a return of malaria if mosquitoes are not properly controlled. 
 
 Malaria is caused by a parasite that has a complex life cycle dependent on both animals, including humans, and mosquitoes. 
 
 CORRECTION (Sept. 5, 2017, 2:45 p.m. ET): Due to a mistranslation in a quotation from Dr. Paternoster, a previous version of this article incorrectly described the nature of malaria. It is a parasite, not a virus. ||||| ROME (AP) — Italy's health ministry has ordered an investigation into the death of a 4-year-old girl from malaria after checks determined she hadn't traveled to any country at risk for the disease. 
 
 The child died Monday at the Brescia public hospital after being transferred from Trento. Italy is not known to have the kind of mosquitoes that spread malaria. 
 
 The health ministry said Tuesday it is sending a team of experts to the Trento hospital to determine how the girl got infected, since she hadn't made any trips to countries with the parasitic disease. 
 
 Malaria is a tropical disease that mostly strikes children in Africa, although parts of Asia, Latin America and the Middle East are also at risk. The disease is estimated to have killed more than 420,000 people last year. 
 
 In recent years, European health officials have noted several isolated cases of locally acquired malaria, including one case in Rome in 2009. 
 
 Suspicion fell on the Trento facility because it was treating two other children with malaria. But the disease does not spread easily between people and typically either requires a mosquito bite or blood transfusion. The ANSA news agency quoted the head of the Trento health service, Paolo Bordon, as saying that the child received no blood transfusions and that the malaria-infected children were being treated in other rooms with single-use equipment. 
 
 Bordon suggested the girl might have caught it earlier, given the timing of her symptoms. 
 
 Malaria symptoms, which include fever, a headache and chills, typically appear about 10 days after an infected mosquito bite. Bordon said it was possible the girl might have contracted the disease before arriving at the Trento hospital, possibly from a mosquito trapped in luggage. 
 
 According to the European Centre for Disease Prevention and Control, there have been 75 cases of malaria linked to mosquitoes in luggage arriving in Western Europe from malaria-endemic countries in the past few decades.
– The death of a 4-year-old girl from malaria on Monday in Italy has local health authorities searching for answers and worrying about a resurgence of the deadly disease, NPR reports. Italy was declared malaria-free in 1970, and the mosquito that carries the disease no longer lives in the country. "It baffles us how she could have been infected,” NBC News quotes a doctor at a hospital in Trento as saying. Sofia Zago was brought to the hospital on Saturday with a high fever and quickly fell into a coma. Tests showed she had cerebral malaria, the deadliest form of the disease, and she died Monday after being moved to a hospital in Brescia. A doctor says it was the first case of native malaria he's seen in Trento in 30 years. "It's a mystery, almost impossible," the general manager of the provincial health service says regarding the case. Doctors believe Sofia may have been infected during a trip to a beach resort near Venice. It's possible she was infected by a mosquito that had managed to travel to Italy inside of luggage. It's also possible, though very unlikely, Sofia contracted the disease a few weeks ago when she was hospitalized for childhood diabetes. The BBC reports there were two children at the hospital at the same time recovering from malaria they picked up in Africa, though they were in a different ward and Sofia received no blood transfusions. Italy's health ministry has ordered an investigation, according to the AP. While Europe was declared malaria-free in 2015, there have been several individual cases of locally transmitted malaria in recent years, including one in Rome in 2009. (After decades of work, a malaria vaccine is finally here.)