Seroprevalence study of Toscana virus in Yafran area, Libya.

BACKGROUND & OBJECTIVES: In Mediterranean countries, infection of Toscana virus is a public health problem during the summer season, related to sandflies activity; it may cause aseptic meningitis and mild meningoencephalitis. We investigated the presence of antibodies (IgG) against the Toscana virus in the sera of individuals living in the area of Yafran, Libya. METHODS: During the period from December 2013 to February 2014, a total of 232 sera samples were collected from Yefran hospital. Demographic information of participants collected in a questionnaire; samples were analyzed by the serological method of enzyme-linked immunoassays specific for Toscana IgG antibodies. RESULTS: Seroprevalence of IgG antibodies among samples was 25% (n = 232). Seroprevalence varied among genders, age groups. The differences were not statically significant. INTERPRETATION & CONCLUSION: Our findings indicate and confirm local circulation of the Toscana virus. It also indicates that TOSV infection is neglected, and needs to be considered as one of the causes of meningitis or meningoencephalitis.

Diversity of Sequence Types and Impact of Fitness Cost among Carbapenem-Resistant Acinetobacter baumannii Isolates from Tripoli, Libya.

We investigated the molecular epidemiology of 21 carbapenem-resistant Acinetobacter baumannii isolates from Libya and assessed their relative fitness. Core genome multilocus sequence typing (MLST) revealed five interhospital transmission clusters. Three clusters were associated with the international clones (IC) IC1, IC2, and IC7. Carbapenem-resistance was associated with blaOXA-23, blaGES-11, or blaNDM-1. Compared to that of A. baumannii DSM 30008, the doubling time was similar over 10 h, but after 16 h, half the isolates grew to higher densities, suggesting a fitness advantage.

Prevalence of dental caries and associated factors among school-aged children in Tripoli, Libya: a cross-sectional study.

BACKGROUND: In many developing countries, the prevalence of dental caries has increased due to lifestyle changes, lack of preventive services, and inadequate access to dental care. In Arab countries, the increased prevalence of caries has correlated with economic growth over the past decades, resulting in greater access to unhealthy foods and higher consumption of sugar, particularly among children. However, few studies have assessed caries prevalence among pediatric populations in Arab countries. The objective of this study was to assess the prevalence of dental caries and factors associated with caries among children in Tripoli, Libya. METHODS: This cross-sectional study included a convenience sample of 1934 children in first grade (age 6-7 years, n = 1000) and seventh grade (age 11-12 years, n = 934). Four health centers in Tripoli were selected for screening based on location and participation in school-entry health examinations. Data were collected through self-administered parent surveys and visual dental screenings by trained examiners from September 24 to October 15, 2019. The survey comprised questions about socioeconomic characteristics and oral health behaviors, including toothbrushing, sugar consumption, and dental care history. During screenings, untreated decay, missing teeth, and filled teeth (DMFT or dmft) were recorded. Prevalence of tooth decay was calculated as the proportion of children with high DMFT/dmft scores. Binary logistic and negative binomial regression analyses (with significance at p ≤ 0.05) were used to assess factors associated with caries. RESULTS: Among 1000 first-grade children, 78.0% had decay in their primary teeth, with a mean dmft of 3.7. Among 934 seventh-grade children, 48.2% had caries in their permanent teeth, with a mean DMFT of 1.7. The most significant factors associated with caries prevalence were socioeconomic, such as screening site (first grade, p = 0.02; seventh grade, p < 0.001) and maternal employment (seventh grade, p = 0.02), and behavioral, such as toothbrushing duration (seventh grade, p = 0.01), past dental treatment (both grades, p < 0.001), and past emergency visit (both grades, p < 0.001). CONCLUSIONS: Caries prevalence was associated with several behavioral and socioeconomic factors, including screening site, maternal employment, toothbrushing duration, past dental treatment, and past emergency visit. Efforts should be made to address these factors to minimize barriers and improve oral health behavior and care utilization. These findings can be used to evaluate current public health initiatives and inform future planning.

Nasal colonization with methicillin-resistant Staphylococcus aureus at admission among high-risk Turkish and international patients.

OBJECTIVE: The aim of this study was to detect the frequency of methicillin-resistant Staphylococcus aureus (MRSA) colonization at admission in a group of presumably high-risk international or Turkish patients referred to our center for elective operations, some of whom were from countries with an unknown prevalence of MRSA infection or colonization. METHODS: The results of nasal swab screening for MRSA colonization performed using a specific algorithm between 2011 and 2018 in a private medical center were retrospectively reviewed. Presence of MRSA was ascertained using culture and/or real-time polymerase chain reaction (real-time PCR). RESULTS: A total of 3,795 patients were included in the study. More than half of the patients were ≤19 years of age (2,094, 55.2%), and MRSA positivity was more common among these patients. Turkish patients constituted 24.5% of the study population. International patients were most frequently referred from Iraq (55.92%), Libya (11.44%), Romania (2.69%), and Bulgaria (1.98%). MRSA positivity was significantly more common among patients referred from other countries when compared to Turkish nationals (11.5% vs. 4.4%, P = 0.00001). Countries with the highest prevalence rates of MRSA colonization were as follows with decreasing order: United Arab Emirates, 25.0%; Georgia, 23.1%; Russia, 22.7%; Iraq, 13.0%, Romania, 12.7%. Other countries with high number of admitted patients (>70 patients) had the following MRSA rates: Turkey, 4.4%; Libya, 6.0%; Bulgaria, 5.3%. CONCLUSIONS: Although MRSA has a low prevalence in our center, a variation in the rate of MRSA positivity was observed across patients from different countries. Absence hospital acquired contamination or outbreaks in our institution may be attributed to the screening algorithm used and underscores the importance of risk analysis for patients referred from geographical locations with unknown MRSA frequency, to reduce the risk of transmission.

Prevalence and factors associated with traumatic dental injuries among schoolchildren in war-torn Libya.

BACKGROUND/AIMS: No previous epidemiological study has investigated the prevalence and associated factors of traumatic dental injuries (TDIs) among Libyan children. Such information is required for the planning and evaluation of health services. The aim of this study was to assess the prevalence of TDIs and associated factors among 12-year-old schoolchildren in Benghazi, Libya. METHODS: Data for this study were collected as part of a comprehensive, cross-sectional survey investigating oral health status and treatment needs of 12-year-old schoolchildren in Benghazi, Libya, between December 2016 and May 2017. Sociodemographic information was collected through a dental health questionnaire. The children were assessed for oral health status, including TDIs according to modified World Health Organization (WHO) classification criteria, in their classroom by trained and calibrated examiners. Anthropometric measures, lip competence and overjet were all assessed and reported. History of TDIs was sought among those affected. Logistic regression models were applied for TDIs as an outcome variable. The statistical significance for all tests was ≤0.05. RESULTS: Data from 1134 participants were included in this study. TDIs were observed in 10.3% of the sample. Most of these TDIs were enamel fractures only (55.6%) and enamel and dentine fractures (35.9%). "Falling" was the most common cause of TDIs, accounting for 51% of cases. While increased overjet appeared to be associated with higher risk of TDIs (OR: 1.92; 95% CI: 1.29-2.86), being female (OR: 0.34; 95% CI: 0.22-0.53) and overweight (OR: 0.33; 95% CI: 0.13-0.83) were also associated with lower risk of having TDIs. CONCLUSIONS: This survey showed that a considerable proportion (10.3%) of 12-year-old Libyan children had TDIs, with relatively high unmet treatment needs. More efforts are required to develop effective prevention programmes and to enhance the provision of dental treatment of TDIs for Libyan children.

Spatiotemporal analysis and epidemiological characterization of the human immunodeficiency virus (HIV) in Libya within a twenty five year period: 1993-2017.

BACKGROUND: Infection with the human immunodeficiency virus (HIV) is an alarming problem in North African countries, but few studies have analyzed the geographical distribution of the epidemic. Libya, the second largest country in Africa and with the longest coast on the Mediterranean basin facing Europe, has experienced major outbreaks of HIV infection. Since then, no studies have followed up on the burden of HIV infections. To plan interventions and allocate resources, spatial analysis of HIV/AIDS clusters are required in order to identify epidemic foci and trends in the country. The objective of this study was to assess HIV infection clustering and trends in Libya. METHODS: Information on all recorded HIV/AIDS cases during 1993-2017 were extracted from the National Reporting System. A total of 8015 newly diagnosed HIV cases with address information were included. Spatial autocorrelation and spatial-temporal analysis were used to identify HIV clusters. Spatial correlations between cases and socio-demographic factors were determined using spatial regression. RESULTS: HIV cases steadily increased within the Libyan population, particularly among those aged < 27 years. Spatiotemporal analysis showed marked geographic and temporal variation of HIV infection, particularly during 2005-2012. The risk factors varied from one region to another, and the contribution of injection drug use to infection increased with time. Four clusters in three time periods were identified, three on the Mediterranean coast and one in the south. CONCLUSION: HIV is an emerging problem in Libya, particularly among young adults. The infection rate varies greatly among the regions and districts, particularly within certain definable geographical areas. Effective intervention strategies are needed to contain HIV infections, especially within the endemic areas.

A cross-sectional study to estimate the point prevalence of painful diabetic neuropathy in Eastern Libya.

BACKGROUND: Painful Diabetic Neuropathy (PDN) is a complication that affects up to one third of people living with diabetes. There is limited data on the prevalence of PDN from countries in the Middle East and North Africa. The aim of this study was to estimate the point prevalence of PDN in adults in Eastern Libya using the self-report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) pain scale. METHODS: We invited patients attending the Benghazi Diabetes Centre who had diabetes for ≥ 5 years to take part in the study. Patients provided consent and completed the Arabic S-LANSS. Anthropometrics, marital status, socioeconomic and education information was recoded and fasting plasma glucose concentration determined. RESULTS: Four hundred and fifty participants completed the study (age = 19 to 87 years, BMI = 17.6 to 44.2 kg/m2, 224 women). One hundred and ninety five participants (43.3%) reported pain in their lower limbs in the previous 6 months and 190/195 participants (97.4%) reported a S-LANSS score of ≥ 12 suggesting they had neuropathic pain characteristics. Thus, 42.2% (190/450) of participants with diabetes were categorised as experiencing pain with neuropathic characteristics. Mean ± SD duration of diabetes for participants with PDN (20.4 ± 6.5 years) was significantly higher compared with those without PDN (11.1 ± 4.6 years). Participants with PDN smoked tobacco for more years than those without pain (7.9 ± 12.3 years versus 1.1 ± 3.9 years respectively); had significantly higher fasting plasma glucose concentration (143.6 ± 29.3 mg/dl versus 120.0 ± 17.3 mg/dl) and had a significantly higher levels of education and employment status. The most significant predictors of PDN were duration of diabetes (OR = 25.85, 95% CI = 13.56-49.31), followed by smoking for men (OR = 8.28, 95% CI = 3.53-9.42), obesity (OR = 3.96, 95% CI = 2.25-6.96) and high fasting plasma glucose concentration (OR = 3.51, 95% CI = 1.99-6.21). CONCLUSION: The prevalence of PDN in people with diabetes in Eastern Libya was 42.2%. Risk factors for developing PDN were high fasting plasma glucose concentration, long duration of diabetes, and higher level of educational and employment status.

The geographic variation and spatiotemporal distribution of hepatitis C virus infection in Libya: 2007-2016.

BACKGROUND: Hepatitis C Virus infection has been considered an important hidden pandemic in developing countries, particularly in Africa. It varies greatly from one region to another and even within districts of the same region. Macroscopic geospatial analysis has become an important scientific tool for identifying the density and clustering of HCV infection and provides epidemiological information for planning interventions and control strategies. The application of these parameters provides a better knowledge of the hepatitis C virus infection prevalence at the national level and can help to implement pertinent strategies to address the HCV-related burdens. This study aims to determine the geographical variability of HCV infection in Libya and to identify the hot spots within regions and districts of the country, and to analyze the population-based demographic determinants involved and outline the intervention programs needed. METHODS: Disease mapping and spatial analysis were conducted using geographic information data available on all documented cases of HCV infections in Libya between 2007 and 2016. Spatial autocorrelation was tested using Moran's Index, which determines and measures the degree of clustering and dispersion of HCV infection in a country. RESULTS: A total 114,928 HCV infection cases during a ten-year period with accurate geographic information were studied. Ages ranged between 16 and 50 years and the male to female ratio was 2:1. HCV infection was unevenly distributed in Libya, and its incidence increased steadily over the study period. Several hot spots and cold spots were found mainly in the southern and eastern regions of the country. CONCLUSION: HCV infection in Libya was geographically variable, with several hot spots particularly in eastern and southern Libya associated with different demographic determinants. Future intervention planning should consider the geospatial variability and risk factors involved.

Investigating the awareness, behavior, and attitude toward epilepsy among university students in Benghazi, Libya.

OBJECTIVE: The aim of this study was to explore the level of knowledge regarding epilepsy and attitudes prevalent toward people with epilepsy (PWE) among Libyan university students in comparison with international data. METHODS: A self-administrated questionnaire on awareness regarding epilepsy and behaviors toward PWE was distributed among undergraduate students enrolled in the University of Benghazi. The collected data were analyzed against responses from an Italian survey that utilized a similar questionnaire to explore epilepsy-related knowledge and attitudes among Italian university students in Rome (Mecarelli et al., 2007). RESULTS: Out of the 500 interviewed students, 96% successfully completed the survey. Further, 96.6% asserted that they possessed some knowledge regarding epilepsy, gained mainly from their families (76.6%). A total of 57.5% considered epilepsy to be a psychiatric disorder while 11.6% recommended psychological tests for the diagnosis of epilepsy. Moreover, 37.5% believed in ancient superstitions, such as possession by evil forces, as the underlying cause of the condition, and 31.8% recommended traditional remedies to cure it. Further, 66.6% deemed epilepsy as a barrier for career prospects, 41% indicated that it presents an impediment in participation in sports, and 35% considered it as an obstacle in marriage. Additionally, epilepsy was perceived as a severe illness by 53.3% of the respondents and considered to be a moderately severe condition by 43.7%. The responses were found to be statistically significant (P<0.05) against the responses from the Italian study. CONCLUSION: There is a reasonable level of awareness regarding epilepsy among Libyan students, though a lack of accuracy in the acquired knowledge exists. The ancient misconceptions regarding the nature of epilepsy and negative attitudes toward PWE appear to be rather common among the Libyan students. Consequently, the discrepancies in the views between the two surveys concerning the ways in which epilepsy is perceived and PWE are treated were extremely evident, thus reflecting the already established view that epilepsy faces greater stigma as a health condition in developing countries in comparison with Western nations.

Understanding the risk and protective factors associated with obesity amongst Libyan adults - a qualitative study.

BACKGROUND: There are a range of multifaceted behavioural and societal factors that combine to contribute to the causes of obesity. However, it is not yet known how particularly countries' cultural norms are contributing to the global obesity epidemic. Despite obesity reaching epidemic proportions in Libya, since the discovery of oil in 1959, there is a lack of information about obesity in Libyan adults. This study sought to explore the views of key informants about the risk and protective factors associated with obesity among Libyan men and women. METHODS: A series of qualitative semi-structured interviews were conducted with Libyan healthcare professionals and community leaders. RESULTS: Eleven main themes (risk and protective factors) were identified, specifically: socio-demographic and biological factors, socioeconomic status, unhealthy eating behaviours, knowledge about obesity, social-cultural influences, Libya's healthcare facilities, physical activity and the effect of the neighbourhood environment, sedentary behaviour, Libyan food-subsidy policy, and suggestions for preventing and controlling obesity. CONCLUSIONS: Key recommendations are that an electronic health information system needs to be implemented and awareness about obesity and its causes and consequences needs to be raised among the public in order to dispel the many myths and misconceptions held by Libyans about obesity. The current political instability within Libya is contributing to a less-active lifestyle for the population due to security concerns and the impact of curfews. Our findings have implications for Libyan health policy and highlight the urgent need for action towards mitigating against the obesity epidemic in Libya.

Prevalence of smoking in the Maghreb: a systematic review and meta-analysis.

INTRODUCTION: Tobacco is the leading preventable cause of death in the world and kills up to seven million people each year. Monitoring its prevalence is important for prevention programs. The aim of this work was to summarize the literature on the prevalence of smoking in the Maghreb countries during the past two decades. METHODS: The research was conducted on Medline via Pubmed based on the Mesh terms: «Tobacco Use¼, «Smoking¼ and «Africa, Northern¼. Were included articles reporting the prevalence of current smoking in the general population or a subgroup of the population in one or more Maghreb countries. The extracted data was related to current smoking, its definition, total prevalence and prevalence by sex. RESULTS: About 50 articles were included, the data was mainly from Morocco, Algeria and Tunisia. Two studies reported prevalence among college students in Libya. The highest prevalences in the general population were noted in Tunisia with an overall prevalence, during the period studied, of 25% (95% CI [21% -29%]). This prevalence was 16% (95% CI [14% -18%]) in Morocco and 14% (95% CI [8% -22%]) in Algeria. CONCLUSION: The prevalence reported was generally high, especially in Tunisia, although lower than in developed countries, hence the importance of setting up and strengthening prevention and control measures, mainly among young people.

Epidemiology of viral hepatitis in the Maghreb.

INTRODUCTION: Viral hepatitis represents a serious public health problem in the world especially in the Maghreb where the prevalence of the 5 viruses A, B, C, D, and E remains high and varies from one Maghreb country to another, there is few published studies on these infections in our Maghreb countries. METHOD OF STUDY: Our work is a review of the literature about prevalence, the most common mode of transmission, and the most exposed population for these viruses in the Maghreb countries through published studies between 2011 and 2017. RESULT: It has been found that the Maghreb countries are endemic for the five viruses with variable prevalence from one country to another, with sometimes heterogeneous data in the same country. For hepatitis B, Mauritania is the Maghreb country most affected by this infection unlike the rest of the Maghreb countries which are moderately endemic for this virus, the lowest prevalence of VHB was noted in Morocco, the genotype the most common is the D for the majority of Maghreb countries, and the precore mutant profile is also the most common. For hepatitis C the prevalence of infection does not vary much from one Maghreb country to another, but it remains slightly higher in Mauritania. The population most exposed to the virus C in the five countries is hemodialysis patients. The most common genotype in all Maghreb countries is genotype 1 except for Libya, where genotype 4 remains the most common probably related to its borders with Egypt. For hepatitis D, Mauritania is the only Maghreb country with a high endemicity for the virus. Tunisia has the lowest prevalence for hepatitis A and E compared to the rest of the Maghreb countries, all of which are endemic for these two viruses with fecal-oral transmission. CONCLUSION: The management of these viral hepatitis is costly for the health economy and to reduce their prevalence, prevention measures must be followed like vaccination and improving hygiene conditions.

Magnitude of prematurity in the countries of the Great Maghreb.

BACKGROUND: Prematurity is the leading cause of death in neonates, accounting for 75% of neonatal mortality, and the second leading cause of death among children under 5 years of age. OBJECTIVE: To study the extent of prematurity in the Great Maghreb, concerning its various aspects: frequency, risk factors and complications. METHOD: We conducted a systematic review of the literature by searching for all data from the Greater Maghreb related to prematurity published between 2000 and 2018. The search strategy relied on the Medline and Google Scholar databases. Prematurity is defined as any birth occurring at a gestational age less than 37 weeks of amenorrhea. RESULTS: In the Maghreb, the prevalence of prematurity ranged from 6.7% to 15.4%. The main risk factors were infections and chronic maternal conditions, extreme maternal ages and adverse socio-economic conditions. The mortality rate among premature infants ranged from 28% to 45%. Short-term complications were dominated by respiratory and metabolic disorders and infections. CONCLUSION: In view of the serious complications and high mortality caused by prematurity, prevention strategies must be put in place. These should be based on the development of pregnancy surveillance programs, the fight against precariousness and the upgrading of neonatal care structures.

A novel use of social media to evaluate the occurrence of skin lesions affecting wild dusky grouper, Epinephelus marginatus (Lowe, 1834), in Libyan coastal waters.

The social media network Facebook™ was used to gather information on the occurrence and geographical distribution of dusky grouper dermatitis, a skin lesion affecting the dusky grouper, Epinephelus marginatus. Dusky grouper are common targets for spear fishermen in the Mediterranean and by monitoring spearfishing activity in Libyan waters, it was possible to document skin lesions from their entries on Facebook. Thirty-two Facebook accounts and 8 Facebook groups posting from 23 Libyan coastal cities provided a retrospective observational data set comprising a total of 382 images of dusky grouper caught by spearfishing between December 2011 and December 2015. Skin lesions were observable on 57/362 fish, for which images were of sufficient quality for analysis, giving a minimal prevalence for lesions of 15.75%. Only dusky grouper exceeding an estimated 40 cm total length exhibited lesions. The ability to collect useful data about the occurrence and geographical distribution of pathological conditions affecting wild fish using social media networks demonstrates their potential utility as a tool to support epidemiological studies and monitor the health of populations of aquatic animals. To our knowledge, this represents the first time that such an approach has been applied for assessing health in a wild population of fish.

Prevalence of IgG antibodies for the West Nile virus in human population in Tripoli, Libya.

BACKGROUND & OBJECTIVES: West Nile fever (WNF) is a mosquito-borne viral infection, circulated in natural cycles between birds and mosquitoes, particularly Culex species. It is transmitted to humans through mosquito bites, and causes a variety of clinical outcomes, ranging from asymptomatic or mild febrile illness to severe men in go encepha- litis with some fatalities observed in older or immunocompromised patients. West Nile virus (WNV) transmission is considerably influenced by environmental conditions; and abundance of avifauna and mosquitoes.There are very few reports on WNV exposure in individuals from Tripoli City in Libya. The main objective was to provide basic epidemiological information about the WNV seroprevalence in the human population of Tripoli. METHODS: A total of 400 serum samples were collected from persons (123 females, 277 males; age range: 15-78 yr) approaching the Tripoli Reference Laboratory for the purpose of obtaining health certificate; during the period from August to October 2013. The presence of WNV IgG antibodies was evaluated by a commercial kit based on WNV immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA). RESULTS: It was observed that 2.75% (11/400) samples were found reactive in the WNV ELISA assay. This result suggests that WNV has a low prevalence in the study area. INTERPRETATION & CONCLUSION: Seropositivity rates of WNV in Tripoli region of Libya were low. However, continu- ous monitoring of population is important to keep track of the disease prevalence, risk factors, reservoir hosts and vectors for better understaning of the disease epidemiology and designing appropriate control strategies.

The epidemiology of chronic pain in Libya: a cross-sectional telephone survey.

BACKGROUND: Chronic pain is a public health problem although there is a paucity of prevalence data from countries in the Middle East and North Africa. The aim of this study was to estimate the prevalence of chronic pain and neuropathic pain in a sample of the general adult population in Libya. METHODS: A cross-sectional telephone survey was conducted before the onset of the Libyan Civil War (February 2011) on a sample of self-declared Libyans who had a landline telephone and were at least 18 years of age. Random sampling of household telephone number dialling was undertaken in three major cities and interviews conducted using an Arabic version of the Structured Telephone Interviews Questionnaire on Chronic Pain previously used to collect data in Europe. In addition, an Arabic version of S-LANSS was used. 1212 individuals were interviewed (response rate = 95.1 %, mean age = 37.8 ± 13.9 years, female = 54.6 %). RESULTS: The prevalence of chronic pain ≥ 3 months was 19.6 % (95 % CI 14.6 % to 24.6 %) with a mean ± SD duration of pain of 6 · 5 ± 5 · 7 years and a higher prevalence for women. The prevalence of neuropathic pain in the respondents reporting chronic pain was 19 · 7 % (95 % CI 14 · 6-24 · 7), equivalent to 3 · 9 % (95 % CI 2 · 8 to 5 · 0 %) of the general adult population. Only, 71 (29 · 8 %) of respondents reported that their pain was being adequately controlled. CONCLUSIONS: The prevalence of chronic pain in the general adult population of Libya was approximately 20 % and comparable with Europe and North America. This suggests that chronic pain is a public health problem in Libya. Risk factors are being a woman, advanced age and unemployment. There is a need for improved health policies in Libya to ensure that patients with chronic pain receive effective management.

Ulcerative dermatitis in wild dusky grouper Epinephelus marginatus (Lowe) from Libyan waters.

In the period 2013-2015, wild dusky grouper, Epinephelus marginatus (Lowe), caught in Libyan coastal waters and ranging in size from 42 to 92 cm in total length, were observed to have distinctive skin lesions of unknown aetiology. Histopathologically, the lesions comprised a multifocal, unilateral or bilateral dermatitis, involving the epidermis, superficial dermis and scale pockets, and sometimes, in severe cases, the hypodermis. Severe lesions had marked epidermal spongiosis progressing to ulceration. Healing was observed in some fish. Bacteria and fungi could be isolated from severe lesions, although they were not seen histopathologically in early-stage lesions. By contrast, metazoan parasite eggs were observed in the dermis and epidermis of some fish with mild and moderate dermatitis. Unidentified gravid digenean trematode parasites carrying similar eggs were also seen within the blood vessels of the deep and superficial dermis. The cause of this distinctive condition, termed dusky grouper dermatitis (DGD), and its potential impact upon already threatened Mediterranean wild dusky grouper populations and upon cultured grouper more widely have yet to be established.