Current Knowledge of Rickettsial Diseases in Italy LORENZO CICERONI, ANTONELLA PINTO, SIMONETTA CIARROCCHI, AND ALESSANDRA CIERVO Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanit` a, Viale Regina Elena, 299-00161 Rome, Italy ABSTRACT: Rickettsial diseases continue to be the cause of serious health problems in Italy. From 1998 to 2002, 4,604 clinical cases were reported, with 33 deaths in the period from 1998 to 2001. Almost all the cases reported in Italy are cases of Mediterranean spotted fever (MSF). Other rickettsioses that have been historically documented are murine typhus and epidemic typhus. Since 1950, only sporadic cases of murine typhus have been reported, and Italy currently appears to be free of epidemic typhus. As in other European countries, imported cases of rickettsialpox, African tick-bite fever (ATBF), and scrub typhus have been reported. In 2004, three cases of a mild form of rickettsiosis were serologically attributed to Rickettsia helvetica. KEYWORDS: rickettsial diseases; spotted fever group rickettsiosis; Mediterranean spotted fever; murine typhus; epidemic typhus; spotted fever group rickettsiae; Rickettsia conorii; Italy In Italy, as in a number of countries, rickettsial diseases continue to be the cause of serious health problems. According to the most recent data from the Italian Ministry of Health, in the 5-year period from 1998 to 2002, 4,604 cases of rickettsiosis were reported, 1 with an average of 921 cases per year (1.6 per 100,000 population) (T ABLE 1; FIG. 1) (though provisional data show that only 534 cases were reported in 2003). With regard to individual rickettsial diseases, no data on the number of cases are available from the Ministry of Health, nor are data available on those rickettsioses that have not been historically documented in Italy. In fact, in the Ministry’s “Bolletino Epidemiologico” (Epidemiological Bulletin), the data on all rickettsioses, with the exception of epidemic typhus, are pooled. Nonetheless, current knowledge indicates that nearly all the cases of rick- ettsiosis reported in Italy are cases of Mediterranean spotted fever (MSF) (also known as “boutonneuse fever,” given the characteristic skin eruptions). MSF Address for correspondence: Dr. Lorenzo Ciceroni, Department of Infectious, Parasitic and Immune- Mediated Diseases, Istituto Superiore di Sanit` a, Viale Regina Elena 299, 00161 Rome, Italy. Voice: +39-06-49902741; fax: +39-06-49387112; +39-06-49902934. e-mail: ciceroni@iss.it Ann. N.Y. Acad. Sci. 1078: 143–149 (2006). C  2006 New York Academy of Sciences. doi: 10.1196/annals.1374.024 143