The Italy captain, Marco Bortolami, has been ruled out of Saturday's crucial Pool C match with Scotland in St Etienne because of injury.
Bortolami, who plays lock for Gloucester, has not trained this week because of hamstring and neck problems, and he has failed to recover in time to make coach Pierre Berbizier's line-up. He is replaced by the fit-again Santiago Dellape in one of seven changes from the side that struggled to see off Portugal 31-5 last week.
There are three other changes in the pack, with prop Salvatore Perugini, hooker Carlo Festuccia and flanker Josh Sole recalled. Andrea Lo Cicero, Leonardo Ghiraldini and Manoa Vosawai are the players to miss out. Sergio Parisse reverts to his usual position of No8, with Sole coming in on the openside flank.
In the backs, Ramiro Pez ousts Roland de Marigny at fly-half, while there are returns for winger Kaine Robertson and centre Mirco Bergamasco. Bergamasco partners Gonzalo Canale in midfield, with Andrea Masi moving to the wing as a replacement for Matteo Pratichetti. Veteran scrum-half Alessandro Troncon is named as captain in the absence of Bortolami.
Italy have been poor so far in the World Cup, failing to pick up bonus points in their scrappy wins over group minnows Romania and Portugal. The were thrashed 76-14 by New Zealand in their opener. Whoever wins at the Stade Geoffroy-Guichard on Saturday will probably take on Argentina in Paris in the quarter-finals.
Italy's team in full: D Bortolussi; K Robertson, G Canale, Mirco Bergamasco, A Masi; R Pez, A Troncon (capt); S Perugini, C Festuccia, M Castrogiovanni, S Dellape, C Del Fava, J Sole, Mauro Bergamasco, S Parisse.
Replacements: F Ongaro, A Lo Cicero, V Bernabo, L Ghiraldini, P Griffen, R de Marigny, E Galon.