title: Epidemiological evaluation of Mediterranean spotted fever in children of the Karak province in south Jordan.
abstract: BACKGROUND
  The aim of this study was to describe the epidemiological patterns of Mediterranean spotted fever (MSF) as well as its treatment and outcomes in children in south Jordan.
  
  
  METHODS
  A retrospective observational study was conducted from June 2013 to December 2015. Data regarding demographics, clinical presentation, laboratory findings, treatment, and outcomes were collected.
  
  
  RESULTS
  In total, 35 male and 20 female patients (mean age: 6 years ± 3.6) were included. The incidence of MSF was 7.9 cases/100,000 inhabitants/year; MSF affected 89% of individuals in the summer, 74.5% of those living in a rural area with tent housing, and 100% of those who had contact with animals. All cases presented with fever, and 94.5% had a skin rash. Serological tests were positive in 87.2% of cases, and Rickettsia conorii (the Moroccan strain) was present in all positive cases. All cases had thrombocytopenia, but none had leukocytosis. Hyponatremia was present in 71% of cases, and 49%, 61.8%, and 72.7% had increased urea, alanine transaminase, and aspartate aminotransferase levels, respectively. Doxycycline was administered to all patients, with a cure rate of 96.4% and mortality rate of 3.6%.
  
  
  CONCLUSIONS
  MSF caused by R. conorii (the Moroccan strain) is prevalent in Jordan, and contact with animals is the route of transmission. The patients' responses to doxycycline were excellent. A high index of suspicion, early diagnosis, and specific treatment considerably decrease mortality. MSF should be considered as a possible cause of febrile disease in those with a rash and in those living in rural areas.
authors.affiliation: Faculty of Medicine, Mutah University, Karak, Jordan. onafi2000@yahoo.com.
authors.forename: Omar
authors.initials: O
authors.lastname: Nafi
authors.forename: Yasseen
authors.initials: Y
authors.lastname: Tarawnah
authors.forename: Amjad
authors.initials: A
authors.lastname: Tarawnah
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001907:Boutonneuse Fever / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D004318:Doxycycline / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007597:Jordan / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D020114:Rickettsia conorii / Q000302:isolation & purification*; D012698:Serologic Tests; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004318:Doxycycline