Nine-man USA held Italy to a 1-1 draw in Kaiserslautern to keep alive their hopes of reaching the knock-out stages.

Italy midfielder Daniele De Rossi was dismissed in the first half, but when Pablo Mastroeni and Eddie Pope were sent off either side of half-time the writing looked to be on the wall for the USA.

Three points would have confirmed the Azzurri's qualification for the last 16, but after failing to break down their tenacious opposition in a frustrating second half, Group E is officially wide open.

Heading into the final round of matches any of the four teams could now reach the knock-out stages despite Italy heading the table with four points.

It had looked good for an Italian victory halfway through the first period when Alberto Gilardino broke the deadlock after 22 minutes.

Andrea Pirlo delivered a perfect free-kick from the right which the unmarked AC Milan striker powered into the back of the net with a diving header.

But the USA - needing to pick up at least one point to stand a realistic chance of qualifying - shrugged off the early blow and responded five minutes later.

Reading winger Bobby Convey swung over a deep free-kick which Cristian Zaccardo sliced into his own in comical fashion.

The game then took a sinister turn as Italy were first reduced to 10 men when Roma midfielder De Rossi was dismissed for aiming a elbow into the face of Brian McBride.

Francesco Totti was sacrificed by coach Marcello Lippi in favour of Gennaro Gattuso, but 15 minutes later Mastroeni restored parity when he was dismissed for a reckless lunge on Pirlo.

Immediately after the break USA coach Bruce Arena watched on in disbelief as defender Pope was dismissed after picking up a second caution for a foul on Luca Toni.

But rather than push on with their one man advantage, Italy laboured and when they did find their feet in front of goal they were foiled by veteran keeper Kasey Keller.

Substitute DaMarcus Beasley could have produced a shock when his low drive found the back of the net only for the strike to be ruled out for offside against the loitering McBride.

At the other end Alessandro Del Piero could have won it for Italy and sealed their passage into the knock-out stages but his 73rd minute volley from Pirlo's flick was instinctively clawed away by the impressive Keller.