Epidemiology of Rickettsiosis in Children of Almarj in East of Libya -Feb 2022

Abstract

Background: The most important tick-borne infectious disease in North Africa is Mediterranean spotted fever, which is endemic in Libya's green mountain region, with dogs serving as the main domestic reservoir. Aim of this study is to identify the epidemiological, clinical, and laboratory profile of spotted fever in children in the Almarj region, as well as the treatment response. Materials and Methods: A cohort study with prospective data collection of 60 patients visiting Almarj teaching hospital as outpatients or admitted from January 1ST 2018 to December 31ST 2019. Results: The median age of the 60 children was 3.3 years. The 55% were males. A tick-bite history were given in three cases. Majority of the cases had direct contact with domestic animals, all had a high-grade fever and rash (purpuric in 29% and 71% maculopapular). Arthralgia, myalgia affect the joints and muscles of the lower limbs in the majority of cases. One case with Hepatomegaly. In our sample, white blood cell count 56% was normal and thrombocytopenia in 37% of the patients. A mild hyponatremia was the most common electrolyte disturbance 56.9%. High liver enzymes in three cases. The antibiotics used in treatment were well tolerated and there were no deaths. Conclusions and Recommendations: Spotted fever group Rickettsiosis (most likely type is Medritanian spotted fever) is common in Almarj area, and it is curable. Rickettsia should be considered as a possible diagnosis of any febrile disease in summer or spring even before the rash appearance, or when there is no rash at all, particularly in those living in rural areas. The oral antibiotics (doxycycline and azithromycin) had a great response.