title: Pediatric invasive disease due to Haemophilus influenzae serogroup A in Riyadh, Saudi Arabia: case series.
abstract: We describe the first two cases of invasive disease caused by Haemophilus influenzae serotype A in Saudi Arabia. This is the first known reported invasive Haemophilus influenzae serotype A from Saudi Arabia.
  
  
  METHODS
  A ten-month-old and three-month-old male not known to have any past history of any medical illness and who had received H. influenzae type b (Hib) vaccine presented to our hospital mainly with fever of few days' duration. A provisional diagnosis of meningitis with sepsis was made and laboratory tests were requested. The chest radiograph was normal. The laboratory results revealed leukocytosis, but leukopenia was noticed in the younger infant. Blood culture and cerebrospinal fluid specimens yielded a pure culture of Haemophilus influenzae and serotyping showed the isolates to be serogroup A. Both patients were started on vancomycin and third-generation cephalosporin. On receiving the blood culture result, vancomycin was stopped. Fever subsided after 48 hours, while in the second case, it continued for 12 days from the admission date. The repeat blood cultures were negative. Antibiotic therapy was given for 10 days for the first case with an unremarkable hospital course, while the second case was complicated by seizure and received a longer duration of antibiotics. Both infants were discharged home in good condition.
  
  
  CONCLUSIONS
  Invasive non-typeable H. influenzae strains are emerging and there is a need for surveillance of this disease. This has implications in future vaccine development.
authors.affiliation: King Fahad Medical City, Riyadh, Saudi Arabia. roaaf@hotmail.com.
authors.forename: Zailaie
authors.initials: Z
authors.lastname: Roaa
authors.forename: Alawfi
authors.initials: A
authors.lastname: Abdulsalam
authors.forename: Ghazi
authors.initials: G
authors.lastname: Shahid
authors.forename: Baba
authors.initials: B
authors.lastname: Kamaldeen
authors.forename: Al Fawaz
authors.initials: AF
authors.lastname: Tariq
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016667:Bacterial Capsules; D001431:Bacteriological Techniques; D002511:Cephalosporins / Q000627:therapeutic use; D002555:Cerebrospinal Fluid / Q000382:microbiology; D018073:Haemophilus Vaccines / Q000008:administration & dosage; D006193:Haemophilus influenzae / Q000145:classification* / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D008297:Male; D008583:Meningitis, Haemophilus / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology; D012529:Saudi Arabia / Q000453:epidemiology; D018805:Sepsis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology; D065288:Serogroup; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D018073:Haemophilus Vaccines; C044237:Haemophilus influenzae type b polysaccharide vaccine; D014640:Vancomycin