{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T16:32:45Z","timestamp":1788021165378,"version":"build-2784847793"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,9,9]],"date-time":"2021-09-09T00:00:00Z","timestamp":1631145600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,9,9]],"date-time":"2021-09-09T00:00:00Z","timestamp":1631145600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004913","name":"Universit\u00e0 degli Studi di Palermo","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004913","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Infection"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The most common Italian rickettsiosis is Mediterranean Spotted Fever (MSF). MSF is commonly associated with a symptom triad consisting of fever, cutaneous rash, and inoculation eschar. The rash is usually maculopapular but, especially in severe presentations, may be petechial. Other typical findings are arthromyalgia and headache. Herein, we describe for the first time an unusual case of Israeli spotted fever (ISF) associated with interstitial pneumonia and pleural effusion in which <jats:italic>R. conorii <\/jats:italic>subsp<jats:italic>. israelensis<\/jats:italic> was identified by molecular methods in the blood, as well as in the pleural fluid.\n<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 72-year-old male presented with a 10-day history of remittent fever. On admission, the patient\u2019s general condition appeared poor with confusion and drowsiness; the first assessment revealed a temperature of 38.7\u00b0, blood pressure of 110\/70\u00a0mmHg, a blood oxygen saturation level of 80% with rapid, frequent, and superficial breathing using accessory muscles (28 breaths per minute), and an arrhythmia with a heart rate of 90 beats per minute. qSOFA score was 3\/3. Chest CT revealed ground-glass pneumonia with massive pleural effusion. Petechial exanthema was present diffusely, including on the palms and soles, and a very little eschar surrounded by a violaceous halo was noted on the dorsum of the right foot. Awaiting the results of blood cultures, broad-spectrum antibiotic therapy with meropenem 1\u00a0g q8h, ciprofloxacin 400\u00a0mg q12h, and doxycycline 100\u00a0mg q12h was initiated. Doxycycline was included in the therapy because of the presence of petechial rash and fever, making us consider a diagnosis of rickettsiosis. This suspicion was confirmed by the positivity of polymerase chain reaction on whole blood for <jats:italic>R. conorii <\/jats:italic>subsp<jats:italic>. israelensis.<\/jats:italic> Thoracentesis was performed to improve alveolar ventilation. <jats:italic>R. conorii <\/jats:italic>subsp<jats:italic>. israelensis<\/jats:italic> was again identified in the pleural fluid by PCR technique. On day 4 the clinical condition worsened. Blood exams showed values suggestive of secondary hemophagocytic lymphohistiocytosis; 4 out of 8 diagnostic criteria were present and empirical treatment with prednisone was started resulting in a gradual improvement in general condition.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Israeli spotted fever may be a severe disease. A high index of suspicion is required to promptly start life-saving therapy. Pleural effusion and interstitial pneumonia may be part of the clinical picture of severe <jats:italic>rickettsial<\/jats:italic> disease and should not lead the physician away from this diagnosis.\n<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s15010-021-01693-8","type":"journal-article","created":{"date-parts":[[2021,9,9]],"date-time":"2021-09-09T15:06:05Z","timestamp":1631199965000},"page":"269-272","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["A severe case of Israeli spotted fever with pleural effusion in Italy"],"prefix":"10.1007","volume":"50","author":[{"given":"Cristoforo","family":"Guccione","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Colomba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaella","family":"Rubino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celestino","family":"Bonura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Anastasia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Agrenzano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Caputo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni Maurizio","family":"Giammanco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1992-1796","authenticated-orcid":false,"given":"Antonio","family":"Cascio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,9,9]]},"reference":[{"key":"1693_CR1","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1196\/annals.1374.024","volume":"1078","author":"L Ciceroni","year":"2006","unstructured":"Ciceroni L, Pinto A, Ciarrocchi S, Ciervo A. Current knowledge of rickettsial diseases in Italy. Ann N Y Acad Sci. 2006;1078:143\u20139. https:\/\/doi.org\/10.1196\/annals.1374.024.","journal-title":"Ann N Y Acad Sci"},{"key":"1693_CR2","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens10020181","author":"C Guccione","year":"2021","unstructured":"Guccione C, Colomba C, Tolomeo M, Trizzino M, Iaria C, Cascio A. Rickettsiales in Italy. Pathogens. 2021. https:\/\/doi.org\/10.3390\/pathogens10020181.","journal-title":"Pathogens"},{"key":"1693_CR3","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1086\/319347","volume":"32","author":"P Parola","year":"2001","unstructured":"Parola P, Raoult D. Ticks and tickborne bacterial diseases in humans: an emerging infectious threat. 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