Leptospirosis is a re-emerging zoonosis responsible for approximately 1 million human infections and 59,000 deaths annually worldwide. In Europe, notification rates have increased by 5% per year since 2010, a trend compounded by climate change. The study was performed to document a fatal occupational case acquired through an under-recognised environmental exposure pathway, and to establish what regional surveillance data can and cannot support regarding its burden and exposure profile. We report a fatal case of occupational leptospirosis in a 56-year-old male beef cattle farmer in Lombardy (Po Valley, Italy) and describe the subsequent epidemiological investigation. Regional surveillance data, veterinary notifications, ECDC data, and an analysis of occupational and climate-related exposure pathways were reviewed. The index case was caused by a strain of serogroup Javanica (microscopic agglutination test titre 1:3,200 against serovar Poi), absent from standard regional animal serological screening panels, probably acquired through contaminated irrigation water. Among 16 confirmed leptospirosis cases in Lombardy over 22 months, 3 (18.8%) died and 1 (6.3%) had permanent disability (severe-outcome rate 25.0%, likely an underestimate given surveillance failures). Twelve of 16 cases (75.0%) had an agricultural-environmental exposure nexus. Leptospirosis risk in irrigated agriculture extends beyond livestock contact to environmental contamination of surface water by wildlife reservoirs. Climate change is expected to expand the disease's European distribution and extend the transmission season. A One Health approach integrating occupational medicine, veterinary surveillance, engineering controls, and climate-adaptive prevention is needed.

Evidence from the literature indicates that workers in the dental care sector are routinely exposed to hazardous airborne agents, particularly mineral and metal dusts. This occupational risk is further amplified in settings with inadequate ventilation and insufficient use of personal protective equipment. We discuss the case of a dental technician with a significant history of occupational exposure who presented to our clinic with exertional dyspnea. High-resolution computed tomography revealed fibrosing nonspecific interstitial pneumonia associated with emphysema, and spirometry showed a severe reduction in carbon monoxide diffusion capacity. After a multidisciplinary evaluation, we performed bronchoscopy with bronchoalveolar lavage (BAL), which revealed an abundance of macrophages. Scanning electron microscopy with energy-dispersive spectrometry of the BAL detected silicon oxide, calcium, iron, and traces of metals typical of dental alloys (titanium, aluminum), as well as rare earth elements and toxic pollutants. These findings supported the diagnosis of interstitial lung disease due to long-term occupational exposure in dental laboratories, enabling a minimally invasive diagnostic approach. This strategy obviated the need for transbronchial biopsy, thereby avoiding a procedure associated with a high risk of pneumothorax in this patient.

Occupational physicians (OPs) and general practitioners (GPs) manage overlapping aspects of the same patient's health yet rarely communicate with one another. By assigning OPs a role in promoting cancer screening, Law 198/2025 has created in Italy a regulatory link between occupational surveillance and public health prevention-a link that cannot function without a structured exchange of data between the two professional roles. This commentary argues that the new regulatory framework, together with Legislative Decree 135/2024 on carcinogens, mutagens, and substances toxic to reproduction, and Legislative Decree 29/2024 on active aging, offers an unprecedented-yet narrow-window of opportunity to build formal collaboration between OPs and GPs in Italy. Another argument concerns the growing presence of foreign-born workers, who may carry undiagnosed endemic conditions and face language barriers that make OP-GP coordination essential for safe fitness-for-work assessments. Drawing on documented challenges from similar initiatives in the Netherlands, Germany, France, and Finland, we identify the main structural obstacles in the Italian context and propose a three-tiered roadmap for implementation, progressing from immediate consensus-based models to the long-term integration of occupational health data into the Electronic Health Record 2.0.