title: Mediterranean spotted fever-like illness in Sardinia, Italy: a clinical and microbiological study.
abstract: BACKGROUND
  Rickettsioses represent a group of emerging infectious diseases in Europe. Climate changes and the anthropization of rural environment have favored vectors' biological cycle and geographic spread. In Sardinia, Mediterranean spotted fever (MSF) is endemic and represents an important public health problem.
  
  
  OBJECTIVE
  We investigated the etiology and the clinical presentation of MSF-like illness in northern Sardinia by enrolling patients admitted to the Infectious Disease Unit of the University of Sassari.
  
  
  RESULTS
  Diagnostic tests included ELISA, Indirect immunofluorescence (IFI), DNA isolation from blood and from eschar samples with real-time PCR and genotyping. Eighty-seven patients with a mean age of 53 ± 14 years, of whom 65 (75 %) males, were included in the study. The most common diagnosis was MSF (79 %), followed by Q fever (8 %), and anaplasmosis (2 %). A tache noire was found in 58 % of rickettioses and 28 % of Coxiella burnetii infections. MSF was confirmed in 47 % of the cases by IFI and 43 % by ELISA antibody tests. The isolation of rickettsial DNA from the eschar was positive in 10/13 (77 %) of the cases due to Rickettsia conorii. Using this method, we identified the first case of R. monacensis infection in Italy.
  
  
  CONCLUSIONS
  In conclusion, antibody-based tests confirmed the diagnosis in less than 50 % of the cases, whereas DNA isolation confirmed the diagnosis in 77 % of tested cases and allowed the identification of a new pathogenic species in Italy. Therefore, DNA isolation should be implemented to better identify the etiology of MSF-like illnesses and help the clinician in the management of patients.
authors.affiliation: Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 8, 07100, Sassari, Italy. giordano@uniss.it.
authors.forename: Giordano
authors.initials: G
authors.lastname: Madeddu
authors.affiliation: Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 8, 07100, Sassari, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Fiore
authors.affiliation: Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Fabiola
authors.initials: F
authors.lastname: Mancini
authors.affiliation: Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 8, 07100, Sassari, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: Caddeo
authors.affiliation: Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Ciervo
authors.affiliation: Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 8, 07100, Sassari, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Babudieri
authors.affiliation: Department of Animal Health, Experimental Zooprophilactic Institute of Sardinia, Sassari, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Masala
authors.affiliation: Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 8, 07100, Sassari, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Bagella
authors.affiliation: Division of Infectious Diseases, Department of Clinical and Molecular Biomedicine, Garibaldi Nesima Hospital, University of Catania, Catania, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nunnari
authors.affiliation: Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Rezza
authors.affiliation: Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 8, 07100, Sassari, Italy.
authors.forename: Maria Stella
authors.initials: MS
authors.lastname: Mura
mesh_terms: D000328:Adult; D000368:Aged; D001907:Boutonneuse Fever / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology* / Q000503:physiopathology; D004269:DNA, Bacterial / Q000235:genetics; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D020114:Rickettsia conorii / Q000235:genetics*
chemical_list: D004269:DNA, Bacterial
keywords: DNA isolation; Italy; Mediterranean spotted fever; Rickettsiosis; Sardinia