Dominance of the ON1 Genotype of RSV-A and BA9 Genotype of RSV-B in Respiratory Cases from Jeddah, Saudi Arabia.

Human respiratory syncytial virus (HRSV) is a main cause of hospital admission for lower respiratory tract infection. In previous studies from Saudi Arabia, higher prevalence of the NA1 genotype in group A was observed from Riyadh and Taif. This study recruited respiratory cases from Jeddah during January to December, 2017. RSV represented 13.4% in the recruited cases with 64% of them belonging to group A and 36% to group B. All group A cases in this study were ON1 type characterized by duplication of 72 nucleotides, 24 amino acids in the C-terminal in the second hypervariable region of the G gene. In addition, for group B all of the cases were clustered under BA9, which had uniquely characterized as duplication of 60 nucleotides in the G protein. Our sequences showed similarity with earlier sequences from Saudi Arabia, Kuwait, Thailand, South Africa, Spain, the USA and Cyprus. Some amino acid substitutions in the investigated sequences would cause a change in potential O-glycosylation and N-glycosylation profiles from prototype ON1. The predominance of the ON1 and BA9 genotype of RSV-A in Jeddah compared to previous Saudi studies showing predominance of the NA1 genotype for group A. This difference in genotype prevalence could be due to fast spread of the ON1 genotype worldwide or due to the flux of travelers through Jeddah during hajj/umrah compared to Riyadh and Taif. This shift in genotype distribution requires continuous surveillance for genetic characterization of circulating respiratory infections including RSV. These findings may contribute to the understanding of RSV evolution and to the potential development of a vaccine against RSV.

Clinical profile of admitted children with febrile seizures.

OBJECTIVE: The objectives of this study were to evaluate the clinical profile, investigations, treatments and outcome of hospitalized children with febrile seizures. METHODS: A series of 69 consecutive children with febrile seizures was identified by chart review from 1st January 1997 to 1st January 2002 at King Abdul-Aziz University Hospital in Jeddah, Kingdom of Saudi Arabia. Clinical, laboratory, EEG, and neuroimaging data were evaluated by one investigator using a structured data collection form. RESULTS: The children`s ages ranged between 7-70 months (mean 20, SD 14), and 59.5% were males. The source of the febrile illness was evident in 65%, however, most admitted children (60 out of 69) had atypical seizures (55%), were ill looking (24.5%), had febrile status (17.5%), or positive meningeal irritation signs (4%). Electrolyte abnormalities were uncommon (10%), however, complete blood count was abnormal in 45%, which increased the likelihood of receiving intravenous antibiotics (p=0.01). Lumbar puncture was performed on 75%, particularly those with a first seizure (odds ratio [OR] 3.8, 95% confidence interval [CI] 0.9-15) or younger than 2 years of age (OR 3.4, 95% CI 0.7-17). Brain CT was performed in 13% and EEG in 33%. Obtaining an EEG was less likely if the seizures were typical (13% versus 50% in atypical, p=0.002). Duration of hospitalization ranged between 1-14 days (mean 4.7, SD 3.2), and only one child had meningitis, which was predicted clinically. CONCLUSION: Pediatricians are selective in admitting and investigating children with febrile seizures. The children frequently had atypical seizures, status epilepticus, or were ill looking. The yield of investigations remains low and does not justify extensive work-up or prolonged hospitalization.