{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T06:34:19Z","timestamp":1792478059856,"version":"4.5.0"},"reference-count":98,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,1,14]],"date-time":"2022-01-14T00:00:00Z","timestamp":1642118400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>Background: Motivated by a case finding of Mediterranean spotted fever (MSF) associated with atypical pneumonia and pleural effusion in which Rickettsia conorii subsp. israelensis was identified by molecular methods in the pleural fluid, we wanted to summarize the clinical presentations of rickettsiosis in Italy by systematic research and to make a systematic review of all the global cases of rickettsiosis associated with pleural effusion. Methods: For the literature search, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was followed. We chose to select only the studies published in last 25 years and confirmed both with serological and molecular assays. Results: Human cases of rickettsiosis in Italy were reported in 48 papers describing 2831 patients with very different clinical presentations; the majority was MSF accounted to R. conorii and was reported in Sicily. Pleural effusion associated with infection with microorganisms belonging to Rickettsiales was described in 487 patients. It was rarely associated with microorganisms different from O. tsutsugamushi; also rarely, cases of scrub typhus were reported outside Southeast Asia and in the largest majority, the diagnosis was achieved with serology. Conclusions: MSF, especially when caused by R. conorii subsp. israelensis, 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 rickettsial disease and should not lead the physician away from this diagnosis<\/jats:p>","DOI":"10.3390\/tropicalmed7010011","type":"journal-article","created":{"date-parts":[[2022,1,16]],"date-time":"2022-01-16T20:46:06Z","timestamp":1642365966000},"page":"11","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Rickettsiosis with Pleural Effusion: A Systematic Review with a Focus on Rickettsiosis in Italy"],"prefix":"10.3390","volume":"7","author":[{"given":"Cristoforo","family":"Guccione","sequence":"first","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaella","family":"Rubino","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Disease Unit, AOU Policlinico \u201cP. Giaccone\u201d, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Colomba","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Anastasia","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Caputo","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Iaria","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Disease Unit\u2014ARNAS Civico, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1992-1796","authenticated-orcid":false,"given":"Antonio","family":"Cascio","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy"},{"name":"Infectious and Tropical Disease Unit, AOU Policlinico \u201cP. Giaccone\u201d, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1196\/annals.1374.024","article-title":"Current Knowledge of Rickettsial Diseases in Italy","volume":"1078","author":"Ciceroni","year":"2006","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1086\/319347","article-title":"Ticks and Tickborne Bacterial Diseases in Humans: An Emerging Infectious Threat","volume":"32","author":"Parola","year":"2001","journal-title":"Clin. Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Guccione, C., Colomba, C., Rubino, R., Bonura, C., Anastasia, A., Agrenzano, S., Caputo, V., Giammanco, G.M., and Cascio, A. (2021). A Severe Case of Israeli Spotted Fever with Pleural Effusion in Italy. Infection, 1\u20134.","DOI":"10.1007\/s15010-021-01693-8"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Shamseer, L., Moher, D., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Shekelle, P., Stewart, L.A., and Group, P.-P. (2015). Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015: Elaboration and Explanation. BMJ Br. Med. J., 349.","DOI":"10.1136\/bmj.g7647"},{"key":"ref_5","first-page":"145","article-title":"I Macrolidi Nella Terapia Della Febbre Bottonosa Del Mediterraneo in Et\u00e0 Pediatrica [Macrolides in the Treatment of Children with Mediterranean Spotted Fever]","volume":"3","author":"Cascio","year":"2002","journal-title":"Infez. Med."},{"key":"ref_6","first-page":"421","article-title":"Coronary Involvement in Mediterranean Spotted Fever","volume":"34","author":"Cascio","year":"2011","journal-title":"New Microbiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1099\/jmm.0.025833-0","article-title":"Haemophagocytic Syndrome and Rickettsial Diseases","volume":"60","author":"Cascio","year":"2011","journal-title":"J. Med. Microbiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1007\/s004310050859","article-title":"Clinical and Laboratory Findings of Boutonneuse Fever in Sicilian Children","volume":"157","author":"Cascio","year":"1998","journal-title":"Eur. J. Pediatr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1099\/jmm.0.2008\/002162-0","article-title":"Atrial Fibrillation in Mediterranean Spotted Fever","volume":"57","author":"Colomba","year":"2008","journal-title":"J. Med. Microbiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1099\/jmm.0.053546-0","article-title":"A Case of Spotted Fever Rickettsiosis in a Human Immunodeficiency Virus-Positive Patient","volume":"62","author":"Colomba","year":"2013","journal-title":"J. Med. Microbiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.ijid.2014.01.024","article-title":"First Case of Mediterranean Spotted Fever-Associated Rhabdomyolysis Leading to Fatal Acute Renal Failure and Encephalitis","volume":"26","author":"Colomba","year":"2014","journal-title":"Int. J. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Colomba, C., Siracusa, L., Trizzino, M., Gio\u00e8, C., Giammanco, A., and Cascio, A. (2016). Myocarditis in Mediterranean Spotted Fever: A Case Report and a Review of the Literature. JMM Case Rep., 3.","DOI":"10.1099\/jmmcr.0.005039"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Colomba, C., Saporito, L., Polara, V.F., Rubino, R., and Titone, L. (2006). Mediterranean Spotted Fever: Clinical and Laboratory Characteristics of 415 Sicilian Children. BMC Infect. Dis., 6.","DOI":"10.1186\/1471-2334-6-60"},{"key":"ref_14","first-page":"248","article-title":"Mediterranean Spotted Fever in Paediatric and Adult Patients: Two Clinical Aspects of the Same Disease","volume":"19","author":"Colomba","year":"2011","journal-title":"Infez. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"6027","DOI":"10.1128\/JCM.43.12.6027-6031.2005","article-title":"Presence of Rickettsia Conorii Subsp. Israelensis, the Causative Agent of Israeli Spotted Fever, in Sicily, Italy, Ascertained in a Retrospective Study","volume":"43","author":"Giammanco","year":"2005","journal-title":"J. Clin. Microbiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1055\/s-2001-13290","article-title":"Fieber Und Exanthem Nach Mittelmeerurlaub\u2014Mediterranes Fleckfieber (\u00bbfi\u00e8vre Boutonneuse\u00ab)1","volume":"126","author":"Kreuzpaintner","year":"2001","journal-title":"DMW\u2014Dtsch. Med. Wochenschr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1007\/s15010-007-6291-9","article-title":"Retinopathy in Rickettsia Conorii Infection: Case Report in an Immunocompetent Host","volume":"36","author":"Leone","year":"2008","journal-title":"Infection"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1007\/s15010-016-0921-z","article-title":"Mediterranean Spotted Fever-like Illness in Sardinia, Italy: A Clinical and Microbiological Study","volume":"44","author":"Madeddu","year":"2016","journal-title":"Infection"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"702","DOI":"10.3201\/eid1804.111583","article-title":"Rickettsia Monacensis as Cause of Mediterranean Spotted Fever\u2013like Illness, Italy","volume":"18","author":"Madeddu","year":"2012","journal-title":"Emerg. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1046\/j.1365-2249.1998.00502.x","article-title":"Modifications of General Parameters of Immune Activation in the Sera of Sicilian Patients with Boutonneuse Fever","volume":"111","author":"Mansueto","year":"1998","journal-title":"Clin. Exp. Immunol."},{"key":"ref_21","first-page":"363","article-title":"Delayed Fatal Diagnosis in Atypical Rickettsial Infectious Disease","volume":"23","author":"Marturano","year":"2015","journal-title":"Infez. Med."},{"key":"ref_22","first-page":"94","article-title":"Postfebrile Telogen Effluvium: Hair Fall after Rickettsia Conorii Infection","volume":"154","author":"Rebora","year":"2019","journal-title":"G. Ital. Dermat. Venerol."},{"key":"ref_23","first-page":"91","article-title":"Mediterranean Spotted Fever Presenting as an Acute Pancreatitis","volume":"74","author":"Rombola","year":"2011","journal-title":"Acta Gastro-Enterol. Belg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.ijid.2015.04.005","article-title":"Mediterranean Spotted Fever and Hearing Impairment: A Rare Complication","volume":"35","author":"Rossio","year":"2015","journal-title":"Int. J. Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1099\/jmm.0.015891-0","article-title":"Severe Mediterranean Spotted Fever Complicated by Acute Renal Failure and Herpetic Oesophagitis","volume":"59","author":"Saporito","year":"2010","journal-title":"J. Med. Microbiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"174","DOI":"10.3201\/eid1201.050850","article-title":"Rickettsia Massiliae Human Isolation","volume":"12","author":"Vitale","year":"2006","journal-title":"Emerg. Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.ijid.2014.11.001","article-title":"Incidence of Mediterranean Spotted Fever in Sicilian Children: A Clinical-Epidemiological Observational Retrospective Study from 1987 to 2010","volume":"31","author":"Vitaliti","year":"2015","journal-title":"Int. J. Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1097\/ICB.0000000000000603","article-title":"Swept-Source Optical Coherence Tomography Angiography in Rickettsial Retinitis","volume":"13","author":"Kahloun","year":"2019","journal-title":"Retin. Cases Brief Rep."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Pinna, A. (2009). Ocular Manifestations of Rickettsiosis: 1. Mediterranean Spotted Fever: Laboratory Analysis and Case Reports. Int. J. Med. Sci., 6.","DOI":"10.7150\/ijms.6.126"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/j.clineuro.2007.02.007","article-title":"A Case of Acute Quadriplegia Complicating Mediterranean Spotted Fever","volume":"109","author":"Caroleo","year":"2007","journal-title":"Clin. Neurol. Neurosur."},{"key":"ref_31","first-page":"158","article-title":"Complications of Mediterranean Spotted Fever","volume":"9","author":"Bellissima","year":"2001","journal-title":"Infez. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"318","DOI":"10.4269\/ajtmh.2008.78.318","article-title":"Socio-Demographic and Climatic Factors as Correlates of Mediterranean Spotted Fever (MSF) in Northern Sardinia.Pdf","volume":"78","author":"Vescio","year":"2008","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.3201\/eid1806.110966","article-title":"Rickettsia Conorii Indian Tick Typhus Strain and R. Slovaca in Humans, Sicily","volume":"18","author":"Torina","year":"2012","journal-title":"Emerg. Infect. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.ijid.2017.04.003","article-title":"Israeli Spotted Fever in Sicily. Description of Two Cases and Minireview","volume":"61","author":"Colomba","year":"2017","journal-title":"Int. J. Infect. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1196\/annals.1374.107","article-title":"Two Cases of Human Granulocytic Ehrlichiosis in Sardinia, Italy Confirmed by PCR","volume":"1078","author":"Mastrandrea","year":"2006","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"De la Fuente, J., Torina, A., Naranjo, V., Caracappa, S., Marco, V.D., Alongi, A., Russo, M., Maggio, A., and Kocan, K. (2005). Infection with Anaplasma Phagocytophilum in a Seronegative Patient in Sicily, Italy: Case Report. Ann. Clin. Microb. Anti., 4.","DOI":"10.1186\/1476-0711-4-15"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1111\/j.1749-6632.2003.tb07387.x","article-title":"Human Granulocytic Ehrlichiosis in Italy","volume":"990","author":"Ruscio","year":"2017","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1196\/annals.1374.015","article-title":"Human Granulocytic Anaplasmosis in Northeastern Italy","volume":"1078","author":"Beltrame","year":"2006","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"817","DOI":"10.3201\/eid1405.070976","article-title":"Rickettsia Slovaca in Dermacentor Marginatus and Tick-Borne Lymphadenopathy, Tuscany, Italy","volume":"14","author":"Selmi","year":"2008","journal-title":"Emerg. Infect. Dis."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Barlozzari, G., Romiti, F., Zini, M., Magliano, A., Liberato, C.D., Corrias, F., Capponi, G., Galli, L., Scarpulla, M., and Montagnani, C. (2021). Scalp Eschar and Neck Lymphadenopathy by Rickettsia Slovaca after Dermacentor Marginatus Tick Bite Case Report: Multidisciplinary Approach to a Tick-Borne Disease. BMC Infect. Dis., 21.","DOI":"10.1186\/s12879-021-05807-3"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.tmaid.2018.08.002","article-title":"Rickettsia Massiliae Infection after a Tick Bite on the Eyelid","volume":"26","author":"Eldin","year":"2018","journal-title":"Travel Med. Infect. Dis."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Cascio, A., Torina, A., Valenzise, M., Blanda, V., Camarda, N., Bombaci, S., Iaria, C., Luca, F.D., and Wasniewska, M. (2013). Scalp Eschar and Neck Lymphadenopathy Caused by Rickettsia Massiliae. Emerg. Infect. Dis., 19.","DOI":"10.3201\/eid1905.121169"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1007\/s10096-001-0663-3","article-title":"Outbreak of African Tick-Bite Fever in Six Italian Tourists Returning from South Africa","volume":"21","author":"Caruso","year":"2002","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.tmaid.2012.05.003","article-title":"Imported Rickettsioses in Italy","volume":"10","author":"Beltrame","year":"2012","journal-title":"Travel Med. Infect. Dis."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Costa, C., Ferrari, A., Binazzi, R., Beltrame, A., Tacconi, D., Moro, L., Edouard, S., Parola, P., Buonfrate, D., and Gobbi, F. (2021). Imported Scrub Typhus in Europe: Report of Three Cases and a Literature Review. Travel Med. Infect. Dis., 42.","DOI":"10.1016\/j.tmaid.2021.102062"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.ijid.2014.05.027","article-title":"Spotted Fever from Rickettsia Typhi in an Older Woman: A Case Report from a Geographic Area Where It Would Not Be Expected","volume":"27","author":"Luciani","year":"2014","journal-title":"Int. J. Infect. Dis."},{"key":"ref_47","first-page":"2630","article-title":"Human Rickettsia Aeschlimannii Infection: First Case with Acute Hepatitis and Review of the Literature","volume":"20","author":"Tosoni","year":"2016","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.ijid.2014.10.017","article-title":"Rickettsia Africae Infection Complicated with Painful Sacral Syndrome in an Italian Traveller Returning from Zimbabwe","volume":"29","author":"Zammarchi","year":"2014","journal-title":"Int. J. Infect. Dis."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2141","DOI":"10.1007\/s10072-015-2313-z","article-title":"Mediterranean Spotted Fever: An Unusual Clinical and Neuroradiological Presentation","volume":"36","author":"Prete","year":"2015","journal-title":"Neurol. Sci."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1111\/jtm.12207","article-title":"A Case of Rickettsia Felis Infection Imported from Nepal","volume":"22","author":"Sulis","year":"2015","journal-title":"J. Travel Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1128\/JCM.42.2.816-818.2004","article-title":"Aneruptive Fever Associated with Antibodies to Rickettsia Helvetica in Europe and Thailand\u2020","volume":"42","author":"Fournier","year":"2004","journal-title":"J. Clin. Microbiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2233","DOI":"10.1055\/s-2004-831868","article-title":"Tsutsugamushi-Fieber Nach S\u00fcdostasienreise","volume":"129","author":"Seilmaier","year":"2004","journal-title":"DMW\u2014Dtsch. Med. Wochenschr."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.2147\/IDR.S253540","article-title":"Clinical Features, Laboratory Characteristics and Prognostic Factors of Severity in Patients with Rickettsiaceae at Two Military Hospitals, Northern Vietnam","volume":"13","author":"Van","year":"2020","journal-title":"Infect. Drug Resist."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Geier, C., Davis, J., and Siegel, M. (2016). Severe Human Monocytic Ehrlichiosis Presenting with Altered Mental Status and Seizures. BMJ Case Rep., 2016.","DOI":"10.1136\/bcr-2016-215967"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Kim, H.H., Chung, J.-H., Kim, D.-M., Yun, N.R., Lee, J., Kwon, Y.E., Yoon, S.H., Lee, S.I., and Han, M.A. (2016). The Clinical Characteristics of Pleural Effusion in Scrub Typhus. BMC Infect. Dis., 16.","DOI":"10.1186\/s12879-016-1613-0"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1055\/s-0030-1248118","article-title":"Ehrlichiosis as a Near-Fatal Cause of Postoperative Fever after Bilateral Total Knee Arthroplasty","volume":"19","author":"Tarantino","year":"2006","journal-title":"J. Knee Surg."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/S0732-8893(99)00066-8","article-title":"An Unusual Site of Chigger Bite in a Patient with Scrub Typhus","volume":"35","author":"Lau","year":"1999","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1007\/s15010-001-0139-5","article-title":"Scrub Typhus Pneumonitis Acquired through the Respiratory Tract in a Laboratory Worker","volume":"29","author":"Oh","year":"2001","journal-title":"Infection"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"668","DOI":"10.3346\/jkms.2004.19.5.668","article-title":"Clinical Role of Interstitial Pneumonia in Patients with Scrub Typhus: A Possible Marker of Disease Severity","volume":"19","author":"Song","year":"2004","journal-title":"J. Korean Med. Sci."},{"key":"ref_60","first-page":"600","article-title":"Scrub Typhus Chest Radiographic and Clinical Findings in 130 Thai Patients","volume":"89","author":"Charoensak","year":"2006","journal-title":"J. Med. Assoc. Thail."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Lee, C.-S., Min, I.-S., Hwang, J.-H., Kwon, K.-S., and Lee, H.-B. (2010). Clinical Significance of Hypoalbuminemia in Outcome of Patients with Scrub Typhus. BMC Infect. Dis., 10.","DOI":"10.1186\/1471-2334-10-216"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.4269\/ajtmh.2012.12-0306","article-title":"Scrub Typhus: Surveillance, Clinical Profile and Diagnostic Issues in Shandong, China","volume":"87","author":"Zhang","year":"2012","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"19","DOI":"10.2149\/tmh.2012-07","article-title":"Pancreatitis and MODS Due to Scrub Typhus and Dengue Co-Infection","volume":"40","author":"Iqbal","year":"2012","journal-title":"Trop. Med. Health"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1258\/ar.2012.120012","article-title":"High-Resolution Computed Tomography Findings of Swine-Origin Influenza A (H1N1) Virus (S-OIV) Infection: Comparison with Scrub Typhus","volume":"53","author":"Jo","year":"2012","journal-title":"Acta Radiol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1007\/s12098-012-0721-0","article-title":"Clinical Profile of Scrub Typhus in Children","volume":"79","author":"Palanivel","year":"2012","journal-title":"Indian J. Pediatr."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"235","DOI":"10.4103\/0022-3859.184662","article-title":"Chest Radiographic Manifestations of Scrub Typhus","volume":"62","author":"Abhilash","year":"2016","journal-title":"J. Postgrad. Med."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"439","DOI":"10.4103\/0970-2113.184923","article-title":"Scrub Typhus Infection Presenting as Acute Heart Failure: A Case Report and Systematic Review of Literature of Cardiopulmonary Involvement in Scrub Typhus Infection","volume":"33","author":"Ray","year":"2016","journal-title":"Lung India"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s11604-016-0607-6","article-title":"Scrub Typhus: Radiological and Clinical Findings in Abdominopelvic Involvement","volume":"35","author":"Kim","year":"2017","journal-title":"Jpn. J. Radiol"},{"key":"ref_69","first-page":"36","article-title":"Scrub Typhus Infection, Not a Benign Disease: An Experience from a Tertiary Care Center in Northern India","volume":"92","author":"Jain","year":"2019","journal-title":"Med. Pharm. Rep."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Yun, J.H., Hwang, H.J., Jung, J., Kim, M.J., Chong, Y.P., Lee, S.-O., Choi, S.-H., Kim, Y.S., Woo, J.H., and Kim, M.Y. (2019). Comparison of Chest Radiographic Findings between Severe Fever with Thrombocytopenia Syndrome and Scrub Typhus: Single Center Observational Cross-Sectional Study in South Korea. Medicine, 98.","DOI":"10.1097\/MD.0000000000017701"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Lin, M., Huang, A., Zheng, X., Ge, L., and He, S. (2019). Misdiagnosis of Scrub Typhus Complicated by Hemophagocytic Syndrome. BMC Pediatr., 19.","DOI":"10.1186\/s12887-019-1475-x"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"54","DOI":"10.23876\/j.krcp.19.122","article-title":"Clinical Significance of Abnormal Chest Radiographic Findings for Acute Kidney Injury in Patients with Scrub Typhus","volume":"39","author":"Yang","year":"2020","journal-title":"Kidney Res. Clin. Pract."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"161","DOI":"10.3947\/ic.2019.51.2.161","article-title":"Clinical and Laboratory Predictors Associated with Complicated Scrub Typhus","volume":"51","author":"Kim","year":"2019","journal-title":"Infect. Chemother."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1046\/j.1469-0691.2003.00539.x","article-title":"A Case of Pleurisy Associated with Antibodies to Rickettsia Conorii","volume":"9","author":"Tea","year":"2003","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.2214\/ajr.171.5.9798890","article-title":"Ehrlichiosis: Findings on Chest Radiographs in Three Pediatric Patients","volume":"171","author":"Fordham","year":"1998","journal-title":"Am. J. Roentgenol."},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Mansueto, P., Vitale, G., Cascio, A., Seidita, A., Pepe, I., Carroccio, A., di Rosa, S., Rini, G.B., Cillari, E., and Walker, D.H. (2012). New Insight into Immunity and Immunopathology of Rickettsial Diseases. Clin. Dev. Immunol., 2012.","DOI":"10.1155\/2012\/967852"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1002\/pbc.21039","article-title":"HLH-2004: Diagnostic and Therapeutic Guidelines for Hemophagocytic Lymphohistiocytosis","volume":"48","author":"Henter","year":"2007","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_78","first-page":"91","article-title":"Israeli Rickettsial Spotted Fever in Children. A Review of 54 Cases","volume":"44","author":"Gross","year":"1987","journal-title":"Acta Trop."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1196\/annals.1355.032","article-title":"The Presence of Eschars, but Not Greater Severity, in Portuguese Patients Infected with Israeli Spotted Fever","volume":"1063","author":"Sousa","year":"2005","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"835","DOI":"10.3201\/eid2405.171992","article-title":"Two Cases of Israeli Spotted Fever with Purpura Fulminans, Sharon District, Israel","volume":"24","author":"Cohen","year":"2018","journal-title":"Emerg. Infect. Dis."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"821","DOI":"10.3201\/eid1405.071278","article-title":"Fatal Rickettsia Conorii Subsp. Israelensis Infection, Israel","volume":"14","author":"Weinberger","year":"2008","journal-title":"Emerg. Infect. Dis."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1111\/j.1708-8305.2007.00179.x","article-title":"Fatal Israeli Spotted Fever in a UK Traveler to South Portugal","volume":"15","author":"Chai","year":"2008","journal-title":"J. Travel Med."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"1944","DOI":"10.3201\/eid1412.070641","article-title":"Fatal Case of Israeli Spotted Fever after Mediterranean Cruise","volume":"14","author":"Boillat","year":"2008","journal-title":"Emerg. Infect. Dis."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1086\/650172","article-title":"Scalp Eschar and Neck Lymphadenopathy Caused by Bartonella Henselae after Tick Bite","volume":"50","author":"Angelakis","year":"2010","journal-title":"Clin. Infect. Dis."},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Guccione, C., Colomba, C., Tolomeo, M., Trizzino, M., Iaria, C., and Cascio, A. (2021). Rickettsiales in Italy. Pathogens, 10.","DOI":"10.3390\/pathogens10020181"},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Pintore, E., Olivieri, E., Floriano, A.M., Sassera, D., Sanna, N., and Garippa, G. (2020). First Detection of Amblyomma Variegatum and Molecular Finding of Rickettsia Africae in Sardinia, Italy. Ticks Tick-Borne Dis., 12.","DOI":"10.1016\/j.ttbdis.2020.101561"},{"key":"ref_87","first-page":"655","article-title":"Use of Geographic Information Systems to Identify Areas at Risk of Introducing Amblyomma Variegatum and A. Hebraeum to Italy","volume":"43","author":"Pascucci","year":"2007","journal-title":"Vet. Ital."},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Dumic, I., and Severnini, E. (2018). \u201cTicking Bomb\u201d: The Impact of Climate Change on the Incidence of Lyme Disease. Can. J. Infect. Dis. Med. Microbiol., 2018.","DOI":"10.1155\/2018\/5719081"},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"Otranto, D., Dantas-Torres, F., Giannelli, A., Latrofa, M.S., Cascio, A., Cazzin, S., Ravagnan, S., Montarsi, F., Zanzani, S.A., and Manfredi, M.T. (2014). Ticks Infesting Humans in Italy and Associated Pathogens. Parasites Vectors, 7.","DOI":"10.1186\/1756-3305-7-328"},{"key":"ref_90","doi-asserted-by":"crossref","unstructured":"Matei, I.A., Estrada-Pe\u00f1a, A., Cutler, S.J., Vayssier-Taussat, M., Varela-Castro, L., Potkonjak, A., Zeller, H., and Mihalca, A.D. (2019). A Review on the Eco-Epidemiology and Clinical Management of Human Granulocytic Anaplasmosis and Its Agent in Europe. Parasites Vectors, 12.","DOI":"10.1186\/s13071-019-3852-6"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.cll.2017.01.006","article-title":"Tick-Borne Emerging Infections Ehrlichiosis and Anaplasmosis","volume":"37","author":"Ismail","year":"2017","journal-title":"Clin. Lab. Med."},{"key":"ref_92","doi-asserted-by":"crossref","unstructured":"Jiang, J., and Richards, A.L. (2018). No Longer Restricted to the Tsutsugamushi Triangle. Trop. Med. Infect. Dis., 3.","DOI":"10.3390\/tropicalmed3010011"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1007\/BF01833873","article-title":"Imported Rickettsioses in German Travelers","volume":"23","author":"Marschang","year":"1995","journal-title":"Infection"},{"key":"ref_94","first-page":"291","article-title":"Fever, Pericardial and Pleural Effusion in a 27-Year-Old Patient Following a Stay in Thailand","volume":"31","author":"Bosch","year":"1990","journal-title":"Internist"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"845","DOI":"10.4269\/ajtmh.1986.35.845","article-title":"Mediterranean Spotted Fever: Clinical, Laboratory and Epidemiological Features of 199 Cases","volume":"35","author":"Raoult","year":"1986","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_96","unstructured":"Lemenager, J., Morel, C., Bernard, Y., and Freymuth, F. (1972). Rickettsioses pleuro-pulmonaires. A propos de 30 observations [Pleuropulmonary rickettsial diseases. Apropos of 30 cases]. Nouv. Presse Med., 1."},{"key":"ref_97","first-page":"161","article-title":"Manifestations pulmonaires, pleurales et p\u00e9ricardiques des rickettsioses [Pulmonary, pleural and pericardial manifestations of rickettsiosis]","volume":"32","author":"Lesobre","year":"1976","journal-title":"Poumon. Coeur."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1093\/clinids\/7.5.635","article-title":"Mediterranean Spotted Fever: A Cooperative Study of 227 Cases","volume":"7","year":"1985","journal-title":"Rev. Infect. Dis."}],"container-title":["Tropical Medicine and Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2414-6366\/7\/1\/11\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T14:02:22Z","timestamp":1760364142000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2414-6366\/7\/1\/11"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,14]]},"references-count":98,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1]]}},"alternative-id":["tropicalmed7010011"],"URL":"https:\/\/doi.org\/10.3390\/tropicalmed7010011","relation":{},"ISSN":["2414-6366"],"issn-type":[{"value":"2414-6366","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,14]]}}}