The reigning World Cup champions have one final match to try to avoid an embarrassing early exit.
A victory will be enough to send Italy through to the knockout phase when it takes on last-place Slovakia in the Group F finale for both teams Thursday at Johannesburg.
Italy's stunning 1-1 draw with New Zealand on Sunday has left qualification in doubt for the Azzurri. Paraguay claimed the group lead with a 2-0 win over Slovakia the same day.
Paraguay has four points, Italy and New Zealand two and Slovakia one. Paraguay and New Zealand will play simultaneously Thursday in Polokwane.
While it's possible that Italy could advance with a draw, a win over Slovakia will be enough for the Azzurri to avoid exiting the World Cup at the group stage for the first time since 1974.
"Either we're in or we're out," right back Gianluca Zambrotta said. "It's not the first time we've faced a game like this and we know how to get the best out of ourselves."
Vincenzo Iaquinta is the only forward to score for Italy, with Alberto Gilardino and Antonio Di Natale struggling. Coach Marcello Lippi has been widely criticized for never even considering talented but temperamental strikers Antonio Cassano and Mario Balotelli.
Italy has been forced to rally in both matches after conceding early goals, but its attack has been far from potent despite some promising work from midfielder Riccardo Montolivo.
"I think we're trying too hard," Lippi said. "We were all sure of what we needed to do, but maybe allowing early goals in both games has changed our approach in some manner. We've got to take responsibility, because nobody is happy."
Gilardino and midfielder Claudio Marchisio could be dropped from the lineup in favor of Giampaolo Pazzini and Argentine-born Mauro Camoranesi, respectively.
Star midfielder Andrea Pirlo returned to training Monday and his status is unclear. Pirlo has been out since injuring his left calf in a friendly with Mexico on June 3.
If there's one positive for Italy, it's that Slovakia has fared even worse to this point. The Slovaks have just three shots on target through two matches and had none until second-half stoppage time in the loss to Paraguay.
Captain Marek Hamsik is familiar to Italian fans after scoring a team-high 12 goals to help Napoli finish sixth in Serie A this past season. Hamsik, though, has been invisible during the World Cup.
"I really don't know what our problem is," midfielder Miroslav Stoch said. "We are making a lot of mistakes, especially at the back."
Slovakia can advance with a victory and a loss or draw by New Zealand.
"We're going to give our all and hopefully we'll have a bit more luck," Zambrotta said. "Slovakia has everything on the line, too, so it should be a different game from our first two."
Italy won 3-0 in 1998 in the lone previous meeting.
