A are younger than the boys (Fig. 1).

A total of 34 patients were
diagnosed with R. conorii infec- tion
during the study period. Children represent 13% of total population (children
and adults). The median age was

        
years ± (range: 15 days–14 years). The sex ratio
in the children was 0.76. The median age in boys was 5.6 ± 1.7
years old and in girl was 3.3 ± 1.2 years old with a significant difference (P = 0.01): the girls are younger than
the boys (Fig. 1).

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A history of a tick-bite was given
in 13 (38%) cases. Direct contact with dogs was reported in 29 (85.3%) cases.
Patients were seen to hospital after a median of 6 days (range 3–10) of fever. Table 1 shows the
main clinical characteristics of the 34 cases.

The exanthema was observed in 33
(97%) patients and was typical as Fig. 3 (maculopapular,
palm and soles) in 32 (94%) of the cases and atypical in two cases (5.8%).
Among atypical exanthema, petechial rash was observed in one case (2.9%).In all, tache noire was observed
in  31 
(91%)  patients  (Fig. 2);
it was in cephalic region, a solitary lesion in 24 patients, while three
patients presented two lesions. Local lym- phoadenopathy was observed in 14 cases (41%).

Arthralgia and myalgia (38.2%) of
the lower limbs and only in two
(5.7%) cases restricted children’s mobility. Two patients
developed  meningitis,  splenomegaly 
(19%),  vomits   (10%),

diarrhea (12%), hepatomegaly (9%), headache (29.4%),
con-

vulsions (5%) and
cought (6%) (Table 1).

In haematological parameters,
leucopenia (? 5000 per mm3) was found in nine (26.4%)
patients, leucocytosis (? 10 000 per mm3)
in five (14.7%), thrombocytopenia (< 150 000 per mm3) in four (11.7%) cases and anaemia in 61%. AST and/or ALT level were abnormal (> 50 IU/ml) in 8 (23.5%) cases.

Indirect immunofluorescence to R. conorii was
performed in

30
(88%) cases. Serological confirmation of infection was obtained for 21 (70%) patients.

With regard to therapy,
chloramphenicol was used from the beginning in 9 children (intravenously); 21
children were given Josamycine,
four Doxycycline and two Erythromycin. All drugs were well tolerated.