Israeli Spotted Fever in Sicily. Description of two cases and minireview

•R. conorii subsp. israelensis is the agent of Israeli spotted fever.•In the last few decades newly recognized tick-borne rickettsioses have been shown to be present in Europe.•We describe here two severe cases of ISF which occurred in Italian adults.

Mediterranean spotted fever (MSF) is endemic in Italy, where Rickettsia conorii subsp. conorii was thought to be the only pathogenic rickettsia and Rhipicephalus sanguineus the vector and main reservoir. R. conorii subsp. israelensis, which belongs to the R. conorii complex, is the agent of Israeli spotted fever (ISF); apart from Israel, it has also been found in Italy (Sicily and Sardinia) and in different regions of Portugal. We describe here two severe cases of ISF which occurred in otherwise healthy Italian adults. Their characteristics are analyzed and discussed in the light of other 91 cases found through a systematic review of international literature.