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A higher risk of human papillomavirus (HPV)-related cervical intra-epithelial neoplasia (CIN) is suspected among females with cystic fibrosis (CF).We conducted a single center prospective cohort study among females attending the Lyon adult CF center. We performed a cervical cytology (Hologic Thinprep®) and HPV testing with genotyping (Clinical Arrays Papillomavirus; Genomica, enabling 35 genotype detection, 20 of which are high-risk (HR-HPV)) at inclusion. We followed all females with positive HPV tests at 6, 12 and 24 months to evaluate HPV persistence, and performed a colposcopy in cases of abnormal cytology.We included eighty-five participants, 18 (21%) of whom were lung-transplanted. The mean age at inclusion was 31.9 (range 18-59) years. The prevalence of HPV (all types) was 31.8%. HR-HPV was found in 25.9% of the whole cohort, 44.4% of transplanted patients, and 20.1% of nontransplanted patients. Genotype-specific HR-HPV persistence at 12 months was 43.5% among transplanted and 34.6% among nontransplanted patients. Overall, 17.6% (15/85) of females had an abnormal cytology: 44.4% (8/18) among transplanted and 10.4% (7/67) among nontransplanted patients. CIN was identified in 12 (14.1%) patients (6 low-grade, 6 high-grade). High-grade CIN developed in 4 nontransplanted patients.Transplanted females had high HR-HPV, abnormal cervical cytology and CIN prevalence rates compared to large published cohorts in the general non-CF population. Although HR-HPV prevalence and persistence were globally not significantly different in nontransplanted females compared to the general population, we reported high frequencies of abnormal cytology and CIN. Cervical cancer screening and prevention should be promoted among females with CF.

Acute Parvovirus B19 (PVB19) infection is responsible for erythema infectiosum in children and non-specific polyarthralgias in immunocompetent adults associated with skin lesions and rarer manifestations (hepatic, neurological, cardiac or nephrological). In immunocompromised patients, cytopenias are more frequent and in some cases, viremia persists and is responsible for PVB19 chronic infection. PVB19 is responsible for pure red cell aplasia during chronic hemolytic diseases. Acute PVB19 infection is a differential diagnosis of some autoimmune diseases and has been suspected to be a trigger for some autoimmune diseases because of its ability to promote the emergence of autoimmune markers. Mechanisms of molecular mimicry, induction of apoptosis and activation of enzymes have been demonstrated, explaining in part the production of autoantibodies during infection. However, the demonstration of a causal relationship in the triggering of autoimmune disease remains to be done. This review provides a synthesis of the PVB19 infection clinical data in adults with a particular focus on these links with autoimmunity.

Background: The surgical removal of the gallbladder, or cholecystectomy, is one of the more commonly performed procedures by general surgeons. Cholecystectomy represents the most common biliary tract procedure and the second most common surgical procedure overall. Aim of Study: To evaluate the role of Harmonic scalpel in laparoscopic cholecystectomy in closure of cystic duct and artery and its complications. Patients and Methods: This prospective randomized study was conducted at El-Zahra University Hospital, Cairo, Egypt, on 100 consecutive patients between March 2017 and October 2019 with chronic calcular cholecystitis. Patient selection for the study was based on clinical diagnosis, ultrasonographic examination findings, laboratory investigations. All patients of the study were subjected to laparoscopic cholecystectomy using the harmonic scalpel for hemostasis and for sealing of the cystic duct without using any ligatures or clips. Results: The operative time in patients of the study ranged between 40-105min with a mean operative time of 55.4±15.6 min. In our patients post-operative bleeding occur in two cases (2%) which was minimal and stopped spontaneously, wound infection in 3 patients (3%), bile leak was present in one case (1%), which stop spontaneously after 5 days. Conclusion: The use of ultrasonic technology in the closure of the cystic duct has proven to be as safe and effective as the commonly used simple metal clips. Neither minor nor major bile leaks attributed to the use of ultrasonic technology were encountered throughout the study period.

International audience; OBJECTIVES: Group A rotavirus is a major cause of acute gastroenteritis in young children worldwide. A prospective surveillance network has been set up in France to investigate rotavirus infections and to detect the emergence of potentially epidemic strains.METHODS: From 2014 to 2017, rotavirus-positive stool samples were collected from 2394 children under 5 years old attending the paediatric emergency units of 13 large hospitals. Rotaviruses were genotyped by RT-PCR with regard to their outer capsid proteins VP4 and VP7.RESULTS: Genotyping of 2421 rotaviruses showed that after a marked increase in G9P[8] (32.1%) during the 2014-2015 season, G9P[8] became the predominant genotype during the 2015-2016 and 2016-2017 seasons with detection rates of 64.1% and 77.3%, respectively, whilst G1P[8] were detected at low rates of 16.8% and 6.6%, respectively. Phylogenetic analysis of the partial rotavirus VP7 and VP4 coding genes revealed that all these G9P[8] strains belonged to the lineage III and the P[8]-3 lineage, respectively, and shared the same genetic background (G9-P[8]-I1-R1-C1-M1-A1-N1-T1-E1-H1) as did most of previously detected G9P[8] strains and particularly the emerging G9P[8] strains from the 2004-2005 season in France.CONCLUSIONS: G9P[8] rotaviruses have become the predominant circulating genotype for the first time since their emergence a decade ago. In the absence of rotavirus immunisation programmes in France, our data give an insight into the natural fluctuation of rotavirus genotypes in a non-vaccinated population and provide a base line for a better interpretation of data in European countries with routine rotavirus vaccination.

International audience; A pregnant woman did not show any problem during the first trimester, but ultrasound exam, confirmed by RMI, showed a large intra-abdominal hyper-echogenic cystic image at 24 weeks of gestation. Meconial peritonitis was suspected, complicated by stable splenomegaly. No neurological signs, variation of the amniotic fluid volume, cardiologic dysfunction or thrombocytemia was observed. Serological assays done before and during pregnancy showed constant low IgM and high IgG anti-CMV levels. Amniocentesis showed a high viral load in amniotic fluid. Fetal and maternal bleed were positive. The pregnancy was interrupted at 31 weeks without post-mortem fetal examination. Placenta revealed hydrophic villi with cytomegalic anti-CMV positive inclusions. This case of CMV recurrence leads to severe complications of the fetal development in a pregnant woman. The isolated abdominal abnormalities were an atypical presentation of fetal CMV, causing inappropriate decisions. Multiplex examinations on amniotic fluid would be keys during the pregnancy examination to prevent fatal outcomes.

Resume Propos Le parvovirus B19 est responsable du megalerytheme epidemique chez l’enfant, de crise d’erythroblastopenie aigue chez le sujet porteur d’une hemoglobinopathie, d’anemie aregenerative chronique chez l’immunodeprime et d’anasarque fœtale pendant la grossesse. Chez l’adulte immunocompetent, le spectre des manifestations cliniques et biologiques ne cesse de s’elargir. Methodes Nous rapportons une serie de 26 observations de primo-infection a parvovirus B19 chez l’adulte immunocompetent. Il s’agit d’une etude retrospective sur la periode 2000 a 2010 realisee dans deux services de medecine interne. Le diagnostic etait clinique, serologique ou moleculaire. Resultats Il existait une predominance feminine (sex-ratio 3,33/1). L’âge moyen au diagnostic etait de 38,8 ans (extremes : 18–68). Les principales manifestations cliniques etaient la fievre (65 %), des polyarthralgies peripheriques et symetriques (62 %) et un exantheme (58 %). Deux patients ont presente une atteinte neurologique (paralysie du VI, paresthesies des extremites) et un patient une myocardite. Les anomalies biologiques observees etaient moderees et transitoires avec un syndrome inflammatoire (73 %), une thrombopenie (43 %), une lymphopenie (38 %) et une cytolyse hepatique (37 %). Une production d’anticorps anti-nucleaires (19 %), d’anticorps anti-ADN natifs (28 %), d’anticorps anti-phospholipides (14 %) associee a une hypocomplementemie (32 %) ont ete observees. Des fausses reactions positives d’IgM anti-CMV et anti-EBV etaient presentes dans 27 % des cas. Deux patients ont presente une infection a parvovirus B19 persistante. Conclusion La diversite des presentations peut etre a l’origine de tableaux trompeurs pour le clinicien. Le diagnostic doit etre evoque chez l’adulte immunocompetent en raison du risque de transmission a des patients susceptibles de developper une infection severe comme la femme enceinte ou les patients immunodeprimes.

Le cancer du col est une maladie maligne liee a l’infection par le papillomavirus humain et qui se developpe sur plusieurs annees. L’objectif du depistage est de detecter tres precocement les lesions a forte probabilite d’evoluer en un cancer. Les tests de biologie moleculaire constituent le gold standard pour le diagnostic des infections a HPV. L’etude de la charge virale, de l’integration du genome et des transcrits E6/E7 sont des biomarqueurs prometteurs pour l’etude de la progression des lesions cervicales. Cette revue de litterature relate les specificites des differentes techniques moleculaires et des principaux kits de diagnostic des infections a HPV responsables du cancer du col.

International audience; Group A rotavirus (RVA) is the leading cause of acute gastroenteritis in young children worldwide. A prospective surveillance network has been set up to investigate the virological and clinical features of RVA infections and to detect the emergence of potentially epidemic strains in France. From 2009 to 2014, RVA-positive stool samples were collected from 4800 children

The unwarranted persistence of the immunoinflammatory process turns this critical component of the body’s natural defenses into a destructive mechanism, which is involved in a wide range of diseases, including chronic rejection. Performing a comprehensive analysis of human kidney grafts explanted because of terminal chronic rejection, we observed that the inflammatory infiltrate becomes organized into an ectopic lymphoid tissue, which harbors the maturation of a local humoral immune response. Interestingly, intragraft humoral immune response appeared uncoupled from the systemic response because the repertoires of locally produced and circulating alloantibodies only minimally overlapped. The organization of the immune effectors within adult human inflamed tissues recapitulates the biological program recently identified in murine embryos during the ontogeny of secondary lymphoid organs. When this recapitulation was incomplete, intragraft B cell maturation was impeded, limiting the aggressiveness of the local humoral response. Identification of the molecular checkpoints critical for completion of the lymphoid neogenesis program should help develop innovative therapeutic strategies to fight chronic inflammation.

Humoral rejection and its relationship with anti HLA antibodies have been extensively studied in organ transplantation with the exception of liver transplantation (LT). Recently, association between donor specific anti HLA antibodies (DSA) and increased risk of rejection and graft loss has been suggested in LT. When such antibodies appear, adequate treatment and monitoring are needed to avoid or delay allograft loss. We report here three cases of probable antibody-mediated rejection developed after pregnancy in liver transplanted women. Sera at the time of rejection and during follow-up have been retrospectively tested for the ability of DSA to bind complement components. These cases display different outcomes depending on the complement binding DSA capacity and titers after treatment of the rejection episodes. Thus, they highlight the potential interest of complement binding Luminex Single Antigen assays to monitor the efficiency of anti-rejection therapy.

The tumor suppressor gene p16ink4a is homozygously deleted in numerous T as well as in some B lineage acute lymphoblastic leukemia (ALL). We therefore analyzed the clinical and biological implications of this feature by studying p16ink4a expression in 58 cases of childhood ALL. mRNA and protein were significantly correlated and both appeared more highly expressed in B than in T lineage ALLs: 13 out of the 15 T cell ALLs did not show any p16ink4a expression. The main result of this study is the strong prognostic value of p16ink4a expression. When stratifying the patients in three groups according to p16ink4a expression, we observed in univariate analysis: (1) the shortest disease-free survival for patients presenting a high p16ink4a level; (2) contrasting with the good prognosis in the group of patients expressing p16ink4a at low level; (3) while cases without any expression of the inhibitor were associated with a medium course of the disease (P=0.0165). This prognostic value was confirmed by the multivariate analysis showing therapeutic regimen and p16ink4a protein expression as the only variables retained in the model. A specific metabolic profile related to cellular survival and proliferation was observed in each of the three p16ink4a expression groups. Among the cell cycle-related proteins we analyzed, only p21waf1 bcl-2 and CDK4 were significantly and positively correlated to p16ink4a. Furthermore, CDK6 was also strongly expressed in the group of cases with high p16ink4a level. An enhancement of p16ink4a, p21waf1 and bcl-2 was previously described in prolonged cellular survival, while aging cells showed a decrease in CDK4 expression. The concomitant high expression of the oncogenic protein CDK4 (and of CDK6), we observed, may amplify the leukemic advantage of prolonged lifespan blast cells by favoring cell progression through G1 phase. These data suggest that at least two mechanisms may be associated in the oncogenesis of very aggressive ALLs, ie deregulation of cell multiplication and prolonged blast lifespan.

223 Infertility among women with cystic fibrosis: prevalence and risk factors M. Shteinberg, A. Ben Lulu, Z. Blumenfeld, M. Gur, L. Bentur, H. Mussaffi, H. Blau, I. Sarouk, O. Efrati, M. Cohen-Cymberknoh, E. Kerem, M. Aviram, E. Pickard, G. Livnat. Carmel Medical Center, Pulmonology and CF Center, Haifa, Israel; Technion-Israel Institute of Technology, The B. Rappaport Faculty of Medicine, Haifa, Israel; Rambam Health Care Campus, Obstetrics & Gynecology, Haifa, Israel; Rambam Health Care Campus, Ruth Rappaport Children’s Hospital, Haifa, Israel; Schneider Children’s Medical Center, Kathy and Lee Graub Cystic Fibrosis Center, Petach Tikva, Israel; Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel; Sheba Medical Center, Cystic Fibrosis Center, Tel Aviv, Israel; Hadassah-Hebrew University Medical Center, Cystic Fibrosis Center, Jerusalem, Israel; Soroka Medical Center, Cystic Fibrosis Center, Beer Sheva, Israel; Shaare Zedek Medical Center, Cystic Fibrosis Center, Jerusalem, Israel; Carmel Medical Center, CF Center, Haifa, Israel Objectives: Women with cystic fibrosis frequently encounter difficulty conceiving; however, the incidence of subfertility among CF women has not been established. It is unknown whether CF severity is associated with subfertility. We aimed to determine the rate of subfertility in women with CF, and to explore risk factors for female subfertility. Methods: A retrospective study of all CF centers in Israel including women with CF aged 18 and older. Women were divided into four fertility categories: 1. Normal fertility (spontaneous pregnancy). 2. Subfertility (having required assisted reproduction after 1 year of infertility). 3. Infertile (remained infertile despite treatments). 4. Not attempted childbearing. Clinical characteristics were compared between the fertility groups. Chi or T-test were employed where appropriate. Results: 130 women were included. 32 women had normal fertility, 17 subfertility, 4 infertility, and 77 never attempted childbearing. For further analysis, groups 2 and 3 were combined. The following variables were associated with decreased fertility: presence of two class I–III mutations, 52% (groups 2&3) vs. 40% in group 1; Pancreatic insufficiency, 61% vs. 44% (p =0.196); and BMI, 22.2±3kg/m2 vs. 23.2±3kg/m2, respectively. Differences did not reach statistical significance. There were no differences in lung function, rate of exacerbations, or colonization with Pseudomonas between fertility groups. Conclusion: The rate of subfertility among CF women was 39.6%, much higher than in the general population (10–15%). No clear risk factors for infertility were identified, although a trend for pancreatic sufficiency was associated with less infertility.

Parvovirus B19 causes erythema infectiosum in children, transient aplastic anemia in patients with hemoglobinopathies, pur red cell aplasia in immunocompromised persons and hydrops fetalis in pregnancy. The spectrum of clinical and biological manifestations in immunocompetent adult continues to grow up.We report on a case series of 26 patients with primary parvovirus B19 infection in immunocompetent adults. This is a retrospective study over the period 2000 to 2010 in two departments of internal medecine. The diagnostic was clinical, serological or molecular.There was a female predominance (sex-ratio 3.33/1). Median patient age at diagnostic was 38.8 years (range: 18-68). The predominant symptoms were fever (65%), peripheral and symmetrical polyarthralgia (62%) and skin rash (58%). Two patients had neurological manifestations (sixth cranial nerve palsy, distal paresthesia) and one patient had myocarditis. Abnormal laboratory values included increased acute phase reactants (73%), thrombocytopenia (43%), lymphopenia (38%) and elevated liver enzymes (37%). Antinuclear (19%), anti-DNA (28%) and anti-phospholipids antibodies (14%), and hypocomplementemia (32%) were observed. False reaction with anti-CMV and anti-EBV IgM positivity was documented in 27% of cases. Two patients had persistent parvovirus B19 infection.The diversity of the clinical manifestations of parvovirus B19 infection may be misleading for the clinician. However, the diagnosis should be suspected in immunocompetent adults to limit the risk of transmission to the patients who could develop a severe infection such as pregnant women or immunocompromised patients.

Resume Notre etude porte sur 29 485 tests de depistage biochimique de la trisomie 21, base sur le dosage de l'hCG et de l'alphfoetoproteine (AFP). Une elevation de l'AFP serique maternelle (AFPsm) a ete observee chez 416 patientes qui ont fait l'objet d'une enquete, permettant un recueil des donnees sur le deroulement et l'issue de la grossesse, dans 347 cas. L'analyse des donnees a montre que dans 66 % des cas, l'elevation de l'AFPsm a correspondu a une grossesse normale. Pour les 118 cas de grossesse anormale (34 %), il faut retenir 14 cas de defaut de fermeture du tube neural et 4 cas de laparoschisis. Les saignements fœtoplacentaires presents chez 12,9 % des patientes permettent d'expliquer l'elevation de l'AFPsm; il faut savoir qu'ils s'observent dans 44 % des cas a l'occasion de grossesses anormales. Un suivi attentif de la grossesse comportant une echographie de reference apparait necessaire en cas d'elevation de l'AFPsm.

A. Brodin-Sartorius, Y. Mekki, M. Pastural, G. Billaud, S. Daoud, C. Chauvet, J.-L. Touraine, B. Lina, E. Morelon, O. Thaunat. Severe transfusion-transmitted parvovirus B19 infection in a naive immunocompromised patient. Transpl Infect Dis 2011: 13: 97–98. All rights reserved.

The objective of this article is to determine the safety and effectiveness of transvaginal sacrospinous ligament fixation as part of the management of pelvic support defects in a residency program.A retrospective chart review of patients undergoing sacrospinous ligament fixation at the Division of Gynecology, Jackson Memorial Hospital, University of Miami School of Medicine, between July 1990 and December 1995, was performed. Patients with vaginal vault prolapse and uterine prolapse with documented preoperative evaluation were included in this study. Data were obtained using a detailed predetermined flow sheet.A total of 160 patients was included in the study. All patients underwent right sacrospinous ligament fixation, anterior and posterior colporrhaphy, and perineorrhaphy. In addition, 31 (19%) underwent enterocele repair, 5 (3%) underwent trachelectomy, and 9 (6%) underwent Burch procedure. Complications included fever 13 (8.1%), urinary tract infection 16 (10%), blood loss requiring transfusion 7 (4.3%), sciatic neuralgia 2 (1.2%), and rectovaginal fistula 2 (1.2%). The mean follow-up was 40 months (range 18 to 78 months). The success of the operation was gauged by recurrence. Ninety-four percent of the patients had no evidence of vaginal vault prolapse on follow-up, and 85% had no recurrence of any pelvic support defect. Eleven of the 24 patients with recurrence underwent repeat surgery, whereas 13 opted for conservative management with pessaries.Transvaginal unilateral sacrospinous ligament fixation is a safe and successful operation for the treatment of pelvic support defect and should be an essential component in the training of gynecologic residents.

Introduction et objectifs Le virus de la rougeole est responsable chez l’enfant d’un tableau d’eruption febrile le plus souvent benin. Introduite dans le calendrier vaccinal francais en 1983, la vaccination a permis une baisse considerable de son incidence. Mais depuis plusieurs annees, il apparait que le virus circule toujours activement dans une population insuffisamment vaccinee. L’objectif de cette etude a ete a partir des donnees du laboratoire d’evaluer la seroprevalence des patients et du personnel soignant pour la rougeole. Materiels et methodes Entre le 01/01/2005 et le 01/01/2009 1 524 analyses de serologie rougeole IgG ont ete realisees au sein de notre laboratoire. Une analyse retrospective de ces donnees a ete conduite pour evaluer la seroprevalence de ces anticorps. La population etudiee a une moyenne d’âge de 21 ans et est constituee a 58 % de femmes. Resultats La seroprevalence moyenne est de 77.2 % (75 %, 79,4 % IC 95 %) ce qui est coherent avec les estimations actuelles. Cette seroprevalence varie en fonction de l’âge. Pour les patients elle est la plus faible pour les moins de 5 ans 59.2 % (53,1 % 65,2 % IC 95 %), ce qui peut s’expliquer par le recrutement de l’hopital, pour les plus de 10 ans et moins de 20 ans elle est estimee a 64.8 % (58,7 et 70,5 % IC 95 %), entre 5 et 10 ans a 71.2 % (65,3 % 76,7 % IC 95 %), entre 20 et 30 ans a 90,5 % (85,5 et 94,2 % IC 95 %) et maximale pour les plus de 30 ans 94,9 % (92,2 %, 96,8 % IC 95 %). La seroprevalence pour le personnel de sante est de 90,8 % (85,8 %, 94,4 % IC 95 %). Conclusion A l’hopital les patients âges de 10 a 20 ans sont donc les plus exposes au risque de rougeole par leur faible seroprevalence. Les enfants de moins 5 ans pourraient constituer le foyer initial d’une epidemie nosocomiale potentiellement dissemine par le personnel soignant non protege.

Introduction et objectifs Le Parvovirus B19 est principalement responsable de manifestations cutanees benignes. Il peut entrainer des infections gravissimes, notamment des infections maternofoetales, des myocardites, des anemies severes. Le but de notre etude est d’evaluer les contextes dans lesquels ce virus est recherche : contexte clinique, facteurs de risques lies au patient ou a l’environnement. Materiels et methodes Nous avons fait l’analyse retrospective des demandes concernant ce virus sur la periode 2004-2008, soit 5 045 serologies et 1 324 analyses de biologie moleculaire par Polymerase Chain Reaction (PCR). Resultats Le virus a ete mis en evidence par PCR dans 222 prelevements (16.8 %) de nature diverse (sang, liquide amniotique, biopsies, necropsies) et issus de 134 patients. La serologie a montre 201 resultats compatibles avec une infection en cours (4 %). Les prelevements positifs proviennent majoritairement des services d’hematologie, suivis par l’obstetrique et la pediatrie, avec predominance des enfants de moins de 10 ans et des adultes jeunes (26 a 45 ans). On releve egalement une plus grande frequence en ete et en hiver. Enfin, la gravite potentielle de l’infection a Parvovirus B19 a ete confirmee par sa mise en evidence dans les necropsies de 2 foetus, 1 nouveau-ne et un adulte. Conclusion L’analyse retrospective de 4 ans de recherche d’infections a Parvovirus B19 montre le caractere epidemique saisonnier de ces infections, amenant a une vigilance particuliere en periode epidemique notamment chez les patients pour lesquels l’infection peut etre gravissime (femme enceinte, patient hospitalise en service de cardiologie). La collaboration entre les laboratoires et les services les plus concernes permet d’ameliorer le diagnostic de ces infections et de mettre en place une surveillance etroite des patients, seule alternative en l’absence actuelle de traitement.

Introduction et objectifs La mort fœtale in utero (MFIU) est plus frequente (15 %) si l’infection a lieu avant 20 semaines d’amenorrhees (SA), ce risque devient plus faible (2 %) au dela de 20 SA, les manifestations cliniques peuvent apparaitre jusqu’a 12 semaines apres la maladie maternelle. Si l’atteinte fœtale est en general regressive en quelques semaines, elle peut dans certains cas persister jusqu’a la naissance. Les manifestations echographiques frequentes sont : anasarque (risque de 3,9 %) avec 6,3 % de deces ; atteinte cardiaque ; myocardite ; intestin hyperechogene ; retard de croissance intra uterin ; hepato-splenomegalie ; hydramnios. Materiels et methodes Le diagnostic chez la femme enceinte se base sur le depistage des IgG et IgM anti-Parvovirurs B19 dans le sang maternel par le test ELISA « BIOTRIN-DIASORIN », confirme par la PCR positive ; le diagnostic prenatal affirme l’infection par la detection de l’ADN du Parvovirus B19 dans le liquide amniotique (LA). Entre 2005 et 2009, le laboratoire de virologie des HCL a diagnostique de nombreuses infections maternofœtales a Parvovirus B19 dans la region lyonnaise, 15 cas en 2005, 10 en 2007, 11 en 2008 et 3 le premier trimestre 2009. Resultats Notre laboratoire a enregistre les cas suivants : 2005 : 7/15 cas d’atteintes fœtales a Parvovirus B19 dont 5 exsanguino-transfusions (EST) avec guerison et 1 MFIU ; 2007 : 5/10 atteintes fœtales dont myocardites, ascites, retard de croissance, une MFIU et une EST avec guerison ; 2008 : 4/11 atteintes fœtales, 2 MFIU, une anemie, une EST ; 2009 : 3/3, 2 MFIU, et une anemie severe, le fœtus a eu une EST et qui est sous surveillance echographique hebdomadaire. Une etroite collaboration entre les services de maternite des HCL, les centres de pathologie et notre laboratoire nous a permis l’etude fœtopathologique de 3 fœtus et le virus a ete detecte dans les differentes necropsies, au niveau du cœur, du foie, des reins et aussi dans le cerveau. Conclusion Ceci nous pose la question suivante : est ce que le Parvovirus B19 peut provoquer des atteintes neurosensorielles ?

En 2005 et 2007, la region lyonnaise a connu deux cycles epidemiques d’infection materno-fœtale a Parvovirus B19, 7 cas en 2005 et 5 en 2007, le risque d’atteinte fœtale est surtout marque si l’infection a lieu avant 20 semaines d’amenorrhees, les manifestations cliniques peuvent apparaitre jusqu’a 12 semaines apres la maladie maternelle. Si l’atteinte fœtale est en general regressive en quelques semaines, elle peut dans certains cas persister jusqu’a la naissance. Les manifestations echographiques frequentes sont : – anasarque (risque de 3,9 %) avec 6,3 % de deces ; – anemie et atteinte cardiaque ; – myocardite ; – intestin hyperechogene ; – retard de croissance Intra uterin ; – hepato-splenomegalie ; – gros placenta ; – hydramnios ; – atteintes neurologiques (recente publication 2007). Les signes d’anemie sont recherches par la mesure de la velocimetrie maximale systolique (VSM) de l’artere cerebrale moyenne par echo-Doppler. Le diagnostic virologique se base essentiellement sur les IgG, IgM et PCR positives dans le sang maternel, le diagnostic d’infection in utero est confirme par la detection de l’ADN du Parvovirus B19 par PCR dans le liquide amniotique et tout autre prelevement fœtal (liquide d’ascite, pericardique, pleural et sang fœtal). L’experience de notre laboratoire concernant les 7 et 5 cas se resume comme suivant : – Annee 2005 : • 2 hydrops, guerison spontanee (16 et 18 semaines) ; • 5 hydrops severes (22 a 24 semaines), 5 ExSanguino-Transfusions In Utero (ESTIU), 4 guerisons et un deces. – Annee 2007 : • 2 myocardites et ascite avec regression et guerison en cours ; • 1 retard de croissance severe sous surveillance echographique hebdomadaire ; • 2 hydrops, 1 Mort Fœtale In Utero (MFIU) avec une interruption medicale de grossesse et 1 ESTIU sous surveillance echographique hebdomadaire. L’ADN du Parvovirus B19 detecte par PCR dans le liquide amniotique, les necropsies fœtales (foie, cœur, cerveau) apres l’IMG et le placenta confirme l’infection in utero. La presence du Parvovirus dans le cerveau suggere son role neuropathologique, ceci necessite une etude plus approfondie et un suivi de cas plus importants de nouveau-nes infectes in utero par le Parvovirus B19 sur une periode de developpement jusqu’a l’âge de 8 a 10 ans. Conclusion Notre experience au laboratoire de virologie Est a Lyon nous permet de degager les points originaux suivants : – la duree entre deux cycles epidemique a Parvovirus B19 peut etre raccourcie de 4ans a 2 ans ; – la recherche de l’ADN du Parvovirus B19 par PCR dans le liquide amniotique et le sang maternel constitue l’element fondamental du diagnostic de l’infection materno-fœtale (le profil serologique IgG+, IgM- n’excluant pas une infection en cours) ; – le Parvovirus B19 peut etre responsable d’atteintes neurologique et urogenitale chez le fœtus ; – l’exsanguino-transfusion necessite un sang selectionne et qualifie Parvovirus B19 negatif.

In 2010 and 2011, the city of Lyon, located in the Rhone-Alpes region (France), has experienced one of the highest incidences of measles in Europe. We describe a measles outbreak in the Lyon area, where cases were diagnosed at Lyon University hospitals (LUH) between 2010 and mid-2011. Data were collected from the mandatory notification system of the regional public health agency, and from the virology department of the LUH. All patients and healthcare workers who had contracted measles were included. Overall, 407 cases were diagnosed, with children of less than one year of age accounting for the highest proportion (n=129, 32%), followed by individuals between 17 and 29 years-old (n=126, 31%). Of the total cases, 72 (18%) had complications. The proportions of patients and healthcare workers who were not immune to measles were higher among those aged up to 30 years. Consequently, women of childbearing age constituted a specific population at high risk to contract measles and during this outbreak, 13 cases of measles, seven under 30 years-old, were identified among pregnant women. This study highlights the importance of being vaccinated with two doses of measles vaccine, the only measure which could prevent and allow elimination of the disease.