title: Incidence of Mediterranean spotted fever in Sicilian children: a clinical-epidemiological observational retrospective study from 1987 to 2010.
abstract: BACKGROUND
  Zoonoses are human infectious diseases caused by pathogens that primarily infect animals. Mediterranean Spotted Fever (MSF) represents one such example, affecting the Mediterranean region, in which household animals can be immune-carriers of infected ticks.
  
  
  METHODS
  We retrospectively analysed the incidence and the clinical and laboratory features of MSF caused by R.Conorii in children admitted to the Paediatric Operative Unit from 1987 to 2010, for persistent fever and generalised macular-popular erythematous lesions. Clinical, immunological and serological parameters of 55 cases of Rickettsia infections observed in children between 2 and 11 years of age were collected.
  
  
  RESULTS
  We found an increasing incidence of MSF in childhood from 1987 to 2010. Diagnosis of MSF at the moment of hospital admission was done in 16 patients (29.09%). The presence of the typical Tache noire was observed in 16 cases out of 55 patients (29.09% of cases). We noticed a different representation of R. conorii antigens in serological testing over the time period of the study, corresponding to overall higher incidence rates for infection in the latter years. We also observed a higher incidence of infection in those years in which all four antigens were found positive at serum testing with respect to those years in which only two of the four antigens were observed (1987-1990: 0-16%; 2007-2010: 0.46%; P<0.005).
  
  
  CONCLUSIONS
  These changes in R. conorii antigenicity may be the cause of higher pathogenicity in this parasite, perhaps linked to increased immigration along with consequent changes in the epidemiology of infectious diseases in host countries.
authors.affiliation: Acute and Emergency Paediatric and General Paediatric Operative Unit, Policlinico-Vittorio Emanuele Hospital, University of Catania, Italy. Electronic address: giovitaliti@yahoo.it.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Vitaliti
authors.affiliation: Acute and Emergency Paediatric and General Paediatric Operative Unit, Policlinico-Vittorio Emanuele Hospital, University of Catania, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Falsaperla
authors.affiliation: Pediatric Department, Pediatric Nephrology Operative Unit of the Sapienza University of Rome, Rome, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Lubrano
authors.affiliation: Occupational Medicine, Vittorio Emanuele - Policlinico Hospital, University of Catania, Catania, Italy.
authors.forename: Vererando
authors.initials: V
authors.lastname: Rapisarda
authors.affiliation: Department of Medical Surgical Specialties - ENT Clinic - University of Catania, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cocuzza
authors.affiliation: Department of Infectious Disease, AUO Garibaldi Nesima, University of Catania, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nunnari
authors.affiliation: Acute and Emergency Paediatric and General Paediatric Operative Unit, Policlinico-Vittorio Emanuele Hospital, University of Catania, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Pavone
mesh_terms: D000818:Animals; D001907:Boutonneuse Fever / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies
keywords: Antigenic changes; Childhood; Clinical and laboratory features; Epidemiological analyses; Mediterranean spotted fever