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Israeli Spotted Fever in Sicily. Description of two cases and minireview
Claudia Colomba1, Marcello Trizzino1, Anna Giammanco1
1Dipartimento di Scienze per la Promozione Della Salute e Materno-Infantile, Università di Palermo, Italy.
Abstract:
Mediterranean spotted fever (MSF) is endemic in Italy, where Rickettsia conorii subsp. conorii was thought to be the only pathogenic rickettsia and Rhipicephalus sanguineus the vector and main reservoir. R. conorii subsp. israelensis, which belongs to the R. conorii complex, is the agent of Israeli spotted fever (ISF); apart from Israel, it has also been found in Italy (Sicily and Sardinia) and in different regions of Portugal. We describe here two severe cases of ISF which occurred in otherwise healthy Italian adults. Their characteristics are analyzed and discussed in the light of other 91 cases found through a systematic review of international literature.
Insights
Israeli spotted fever (ISF) caused by Rickettsia conorii subsp. israelensis is emerging in Italy. This study details two severe cases and reviews 91 international cases, highlighting the expanding geographic range of this tick-borne illness.
Area of Science:
- Infectious Diseases
- Microbiology
- Epidemiology
Background:
- Mediterranean spotted fever (MSF) is endemic to Italy, historically attributed solely to Rickettsia conorii subsp. conorii.
- Rhipicephalus sanguineus ticks are considered the primary vector and reservoir for R. conorii in Italy.
- Rickettsia conorii subsp. israelensis, a distinct subspecies, causes Israeli spotted fever (ISF) and has been identified in Italy and Portugal.
Observation:
- Two severe cases of ISF in previously healthy Italian adults are presented.
- These cases occurred in regions of Italy where ISF was not previously considered endemic.
- The clinical presentation and outcomes of these patients were analyzed.
Findings:
- The study confirms the presence and significant clinical impact of R. conorii subsp. israelensis in Italy.
- A systematic literature review identified 91 additional cases of ISF internationally.
- The findings suggest an expanding geographic distribution and potential underdiagnosis of ISF.
Implications:
- This research underscores the need to consider ISF in the differential diagnosis of spotted fevers in Italy and surrounding regions.
- Enhanced surveillance and diagnostic capabilities for R. conorii subsp. israelensis are crucial for public health.
- Understanding the vector-host dynamics is essential for controlling the spread of ISF.