A COVID-19 case in Libya acquired in Saudi Arabia.

Correspondence

In December 2019, a novel coronavirus was recognized as the cause of severe pneumonia cases in Wuhan, China, which prompted an unprecedented international reaction [1]. The WHO named the disease coronavirus disease 2019 (COVID-19) in February 2020 [2]. Preliminary findings of eight suspected corona virus cases were reported in Libya on March 20, 2020, however they were not confirmed officially [3]. Throughout this paper, we describe the clinical course and laboratory features of the first confirmed case of COVID- 19 in Libya.

A 73-year old Libyan male visited Saudi Arabia, in February 2020. There, he encountered other people during a religious gathering. He returned to Tripoli, Libya, on March 5, 2020. His medical history included hypertension and type-2 diabetes mellitus. Although his symptoms started with fever, cough, and generalized fatigue on March 18, he visited the Tripoli Central Hospital on March 22, where he was admitted with progressive dyspnea, tachypnea, and continued fever. On examination, his temperature was 39 °C, heart rate 75 beats/min, blood pressure 110/60 mm Hg, and oxygen saturation 95% on room air. On auscultation, decreased air entry bilaterally in the lower zone was noted. A high-resolution computed tomography (HRCT) showed multi-lobar and bilateral ground-glass opacities in both lungs, mostly in the mid to lower lungs, with peripheral subpleural distribution (appendix). Complete blood count results included: 0.70 × 109/L lymphocyte count (reference range, 1.0–4.0 × 109/L), 8.8 × 10⁹/L white blood cell count, 168 × 10⁹ platelet count (reference range, 150–400 × 109/L), and 11.9 g/dL hemoglobin concentration. C-reactive protein concentration peaked on admission day at 168.4 mg/L (reference range, <5mg/L). Lactate dehydrogenase test abnormalities peaked on admission day at 411 U/L (reference range, 120–300 U/L); glucose 278 mg/dL (reference range, 70–120 mg/dL); ferritin 1088.2 ng/L (reference range, 30–400 ng/L). However, liver function tests were in the normal range on the first day of admission. Nasopharyngeal swabs and sputum collected on the first and second day after admission were negative on real-time RT-PCR assay for COVID-19. On the third day (March 24), new samples tested positive.

Twenty-six of his family members were isolated until the RT-PCR assay tested negative on March 26. According to his family, the patient stayed for five days without appropriate care and neglected in the hospital, after which he was transferred to Alhadba Alkhadra Hospital on March 29. He was isolated and appropriately treated with cefixime 400 mg (tablet) every 24 h and azithromycin (500 mg on day one, followed by 250 mg per day). As of April 4, the patient's condition had steadily improved. On examination, his temperature was 37 °C; heart rate 89 beats/min, blood pressure 140/70 mm Hg, and oxygen saturation 98% on room air. In addition, the patient was tested negative on April 4, 2020. Consequently, he will be discharged and followed up accordingly.

We present the first official confirmed case of COVID-19 in Libya. However, the fragile healthcare infrastructure in Libya poses a severe threat, with a potential outbreak from neighbouring countries given the current situation of civil war [4]. Therefore, all returning travellers must be screened to detect asymptomatic infected individuals.

Funding sources

This study did not receive any grant or funding from any department or institute.

CRediT authorship contribution statement

Muhammed Elhadi: Conceptualization, Data curation, Formal analysis, Investigation, Writing - original draft, Writing - review & editing. Ahmed Abdulhakim Momen: Conceptualization, Data curation, Investigation, Writing - review & editing. Osama Mohamed Ali Senussi Abdulhadi: Conceptualization, Data curation, Investigation, Writing - review & editing.

Declaration of competing interest

The authors declare that they have no competing interests and no relationship with the industry or organizations.