The carpet viper (Echis romani, recently separated from E. ocellatus) accounts for at least 66
Caterpillar envenomation is an underrecognized problem with a broad spectrum of clinical manifestations. This review summarizes current knowledge on medically important caterpillars, emphasizing their geographic distribution, mechanisms of injury, major clinical syndromes, treatment, and challenges for healthcare professionals. Of nearly 165,000 lepidopteran species, at least 576 species across 14 Lepidoptera families are known to possess urticating or venomous capacity and have been reported worldwide. Injury may result from direct contact with venomous spines or setae, or indirectly through exposure to detachable urticating hairs. Clinical manifestations include erucism, lepidopterism, ophthalmia nodosa, dendrolimiasis, pararamosis, and lonomism, ranging from localized dermatitis to severe hemorrhagic complications and acute kidney injury. Recent studies have expanded our understanding of venom composition and mechanisms of action. Environmental and climatic factors may influence geographic distribution, seasonality, population abundance, and human exposure patterns. Treatment is mainly supportive, although specific antivenom is available for lonomism in some endemic areas. Limited epidemiological surveillance, difficulty identifying species, limited clinical awareness, and restricted access to specific treatment remain major challenges. Healthcare professionals need greater awareness for early recognition and appropriate management of caterpillar-related injuries. A One Health approach integrating clinical, entomological, ecological, and public health perspectives may strengthen surveillance, prevention, and locally adapted management strategies.
Rickettsial diseases represent a major cause of arthropod-borne febrile illness in the Mediterranean basin, where climatic conditions, vector ecology, and close human–animal interactions promote the circulation of a wide diversity of Rickettsia species. In recent years, advances in microbial genomics and molecular diagnostics have substantially refined rickettsial taxonomy, clarified phylogenetic relationships across the Spotted Fever, Typhus, and Transitional Groups, and enhanced recognition of emerging pathogens. This narrative review provides an updated synthesis of rickettsial infections in the Mediterranean region, integrating microbiological, genomic, epidemiological, clinical, diagnostic, and therapeutic evidence. Mediterranean rickettsioses comprise a heterogeneous group of tick- and flea-borne infections caused by both well-established pathogens, such as Rickettsia conorii, and increasingly recognized species including R. aeschlimannii, R. massiliae, R. monacensis, and R. felis. Genomic and phylogenetic studies have identified distinct clades and key virulence determinants involved in host-cell entry, intracellular survival, endothelial damage, and vector adaptation. Rickettsial diseases in the Mediterranean basin are evolving in response to climate-driven vector expansion, increasing pathogen diversity, and improved molecular detection methods. Clinically, disease manifestations range from the classical fever–rash–eschar presentation to severe forms with neurological, renal, cardiac, pulmonary, and ocular involvement, as well as hyperinflammatory syndromes such as hemophagocytic lymphohistiocytosis. Molecular assays performed on eschar or skin samples provide the highest diagnostic yield during the acute phase, whereas serological testing is limited by delayed antibody responses and cross-reactivity. Early treatment with doxycycline remains the most effective therapeutic strategy, while evidence supporting alternative agents and management in special populations, including children and pregnant women, remains limited. Nonetheless, important gaps persist in diagnostic accessibility, epidemiological surveillance, and data from vulnerable populations. Integrating advances in microbiology, molecular epidemiology, and a One Health framework is essential to improve diagnosis, inform clinical decision-making, and reduce the burden of rickettsioses in the Mediterranean region.
Leishmaniasis is a significant neglected tropical disease (NTD) with profound public health and socioeconomic impacts across North Africa. This review provides an emphasis on the epidemiology, transmission dynamics, and diagnostic evolution of the disease. Ecological diversity, rapid urbanization, climate change, and population displacement have reshaped transmission cycles. Cutaneous Leishmaniasis (CL) remains hyper-endemic in North Africa, while Visceral Leishmaniasis (VL) continues to cause high mortality in East Africa. Emerging molecular tools are being evaluated against current diagnostic gold standards, highlighting systemic gaps in surveillance and treatment accessibility. This work provides essential insights on epidemiology, transmission, and diagnosis of Leishmaniasis in Egypt and other North African countries highlighting the impact of ecological and demographic factors on disease dynamics and identifying gaps in surveillance and treatment.
