La mort in utero : prise en charge obstétricale

La mort in utero (MIU) complique 1,5% des grossesses à partir de 20 semaines d'aménorrhée. Les couples frappés par la MIU sont déconcertés par ce diagnostic et souvent restent sidérés par cette annonce. Il est alors important que l'équipe soignante, médecins, sages-femmes et travailleurs sociaux, unissent leurs efforts pour une prise en charge attentive de ces couples. Souvent, l'accouchement est déclenché artificiellement, mais il est également possible d'opter pour une attitude expectative. Un bilan étiologique doit être proposé dans tous les cas et les parents doivent être renseignés quant aux démarches administratives et aux formalités à accomplir. Les parents devraient pouvoir décider du moment de l'hospitalisation, faire part de leurs désirs face au corps de leur enfant, le voir, le toucher, accepter ou refuser l'autopsie. Finalement, le bilan étiologique sera discuté avec le couple 4-6 semaines plus tard afin d'éclaircir cet épisode douloureux et d'envisager leur avenir obstétrical

Whole-genome sequencing for rapid, reliable and routine investigation of Mycobacterium tuberculosis transmission in local communities.

Contact investigations following the diagnosis of active tuberculosis (TB) are paramount for the control of the disease. Epidemiological data are very powerful for contact tracing but might be delayed and/or difficult to integrate, especially in the setting of multiple contact-tracing investigations. The aim of this study was to address the added-value of whole-genome sequencing (WGS) to routine local TB surveillance systems. From November 2016 to July 2017, the local TB surveillance system identified three clusters that could constitute a unique larger outbreak. Epidemiological and clinical information were integrated with WGS genotyping data of Mycobacterium tuberculosis strains obtained using a simple DNA extraction method coupled with sequencing using an Illumina MiSeq platform and an in-house bioinformatics pipeline for single nucleotide polymorphism (SNP) analysis. Epidemiological investigations identified three putative TB clusters potentially interrelated including eight patients with active TB. Seven M. tuberculosis isolates were available and analysed by WGS. Using a 5-SNP threshold to define recent transmission, WGS-based genotyping supported the occurrence of the three clusters as well as a link between clusters 1 and 2 (SNP ≤1), constituting a larger outbreak. This outbreak was clearly delineated by refuting a potential link with the third cluster (SNP >500). Genotyping data did not support the belonging of patient 7 to any studied cluster. This study illustrates the usefulness of WGS genotyping for routine TB surveillance systems in local communities to rapidly confirm or disprove epidemiological hypotheses and delineate TB clusters, especially in the context of multiple contact-tracing investigations