Rickettsia conorii Indian Tick Typhus Strain and R. slovaca in Humans, Sicily

humans. Additionally, Mycobacteria spp. can occasionally cause disease in humans through contact with fi sh (M. marinum), and pedicure treatments have previously been associated with M. fortuitum infections (10). Recently, the risks associated with exposure to G. rufa fi sh were reported to be low (1). To date, there are only a limited number of reports of patients who might have been infected by this exposure route (1). However, our study raises some concerns over the extent that these fi sh, or their transport water, might harbor potential zoonotic disease pathogens of clinical relevance. In particular, patients with underlying conditions (such as diabetes mellitus or immunosuppression) should be discouraged from undertaking such treatments, especially if they have obvious breaks in the skin or abrasions. This risk can probably be reduced by use of certifi ed diseasefree fi sh reared in controlled facilities under high standards of husbandry and welfare.