Shotgun metagenomic screening to improve the retrospective diagnosis of undocumented intrauterine infections on embedded placenta samples: Lessons from a brucellosis case.

BACKGROUND: Microbiological diagnosis of intrauterine infections (IIU) still relies on bacteriological cultures or targeted DNA amplification lacking in sensitivity. Shotgun metagenomics (SMg) is an emerging unbiased molecular approach that makes it possible to sequence all the nucleic acids from any sample. It had never previously been used for IIU. METHODS: We here report the case of a patient with an unexplained IIU and fetal loss that could be documented by a combined SMg/microbiological approach, leading to the diagnosis of maternal brucellosis. RESULTS: A 31-year-old woman presented with an undocumented IIU with fetal loss at 24 weeks of gestation. Culture-based work-up failed to identify the pathogen involved. Paraffin-embedded placenta sample was retrospectively analyzed by SMg. Brucella spp nucleic acids were detected, and subacute maternal brucellosis was confirmed by targeted PCR and serological testing. CONCLUSION: This case provides grounds for further utilization of SMg for the microbiological diagnosis of unexplained obstetrical infections.

Modulation of the functional interfaces between retroviral intasomes and the human nucleosome.

Infection by retroviruses as HIV-1 requires the stable integration of their genome into the host cells. This process needs the formation of integrase (IN)-viral DNA complexes, called intasomes, and their interaction with the target DNA wrapped around nucleosomes within cell chromatin. To provide new tools to analyze this association and select drugs, we applied the AlphaLISA technology to the complex formed between the prototype foamy virus (PFV) intasome and nucleosome reconstituted on 601 Widom sequence. This system allowed us to monitor the association between both partners and select small molecules that could modulate the intasome/nucleosome association. Using this approach, drugs acting either on the DNA topology within the nucleosome or on the IN/histone tail interactions have been selected. Within these compounds, doxorubicin and histone binders calixarenes were characterized using biochemical, in silico molecular simulations and cellular approaches. These drugs were shown to inhibit both PFV and HIV-1 integration in vitro. Treatment of HIV-1-infected PBMCs with the selected molecules induces a decrease in viral infectivity and blocks the integration process. Thus, in addition to providing new information about intasome-nucleosome interaction determinants, our work also paves the way for further unedited antiviral strategies that target the final step of intasome/chromatin anchoring. IMPORTANCE In this work, we report the first monitoring of retroviral intasome/nucleosome interaction by AlphaLISA. This is the first description of the AlphaLISA application for large nucleoprotein complexes (>200 kDa) proving that this technology is suitable for molecular characterization and bimolecular inhibitor screening assays using such large complexes. Using this system, we have identified new drugs disrupting or preventing the intasome/nucleosome complex and inhibiting HIV-1 integration both in vitro and in infected cells. This first monitoring of the retroviral/intasome complex should allow the development of multiple applications including the analyses of the influence of cellular partners, the study of additional retroviral intasomes, and the determination of specific interfaces. Our work also provides the technical bases for the screening of larger libraries of drugs targeting specifically these functional nucleoprotein complexes, or additional nucleosome-partner complexes, as well as for their characterization.

Synthetic Cathinones in Belgium: Two Case Reports with Different Outcomes Observed in the Emergency Room.

We herein report two cases of cathinone intoxication. The first case is about a drug addict who was admitted to the emergency room after the injection of an unknown compound. He presented with tachycardia, palpitations, mydriasis, dyspnea, dizziness, headache and nausea. After leaving the hospital against medical advice, he returned the next day with police escort, presenting aggressiveness and agitation signs. One month later, he returned one more time for sleeping disorders, hallucinations and anxiety. He was finally transferred for his 21st detoxification treatment. The second case concerns a man who was wandering the streets and tried to escape when police officers called him. He confessed to snorting of N-ethylpentedrone and was admitted with severe agitation including delusion of persecution, tachycardia, mydriasis and fever. Because of renal failure, rhabdomyolysis and metabolic acidosis, he was transferred to the intensive care unit where he manifested worsening of the symptoms, turning into coma. He was intubated for 3 days before a complete resolution of the symptoms. A screening was performed by high-resolution mass spectrometry followed by quantifications made by high-performance liquid chromatography coupled with a diode array detector. In the first case, alpha-pyrrolidinohexiophenone was identified only during the first two admissions. However, as plenty of other psychotropic substances were also found, the cathinone alone could not be held directly responsible for the symptoms. In the second case, more than 2,000 ng/mL of N-ethylpentedrone was found without any decrease in the next 17 h, underlining the long half-life of this compound. Unlike the first case, symptoms could be clearly attributed to the cathinone. In conclusion, cathinones can be found on the Belgian illicit drug market, with various routes of administration and clinical consequences. In these two case reports, some common points were observed initially. However, one patient was finally able to leave the hospital without any treatment, whereas the other would most likely have died without intensive care.

[Sepsis during pregnancy: Key points in 2022]. / Sepsis et grossesse.

Sepsis is a severe affection, that requires an urgent and specific treatment sequence. Physiological changes occurring during pregnancy make the diagnosis of sepsis more challenging in this setting, with possible delay in treatment initiation, that in turn is responsible for poorer maternal and fetal outcome. This review aims to summarize current knowledge on the diagnosis and treatment of maternal sepsis, as well as persistent knowledge gaps in the field.

Myostatin mutation causing double muscling could affect increased psoroptic mange sensitivity in dual purpose Belgian Blue cattle.

Belgian Blue cattle are known for their high degree of muscling and good carcass qualities. This high degree of muscling is mainly caused by a mutation in the myostatin gene (MSTN). Although the MSTN mutation is considered as fixed in the Belgian Blue breed, segregation is occurring in a sub-population bred for dual purpose. In the latter population, we observed an association between the mutation in MSTN and susceptibility to psoroptic mange, a skin disease caused by Psoroptes ovis mites that heavily plagues Belgian Blue cattle. In total, 291 animals were sampled and screened for their susceptibility for mange lesions and their MSTN genotype. Via linear mixed modelling, we observed that homozygous mutant animals had a significant increase in the size of mange lesions (+2.51% lesion extent) compared to homozygous wild type. These findings were confirmed with zero-inflated modelling, an animal model and odds analysis. Risk ratios for developing severe mange lesions were 5.9 times as high for homozygous mutant animals. All analyses confirmed an association between the MSTN genotype and psoroptic mange lesion size.

High male specific contribution of the X-chromosome to individual global recombination rate in dairy cattle.

BACKGROUND: Meiotic recombination plays an important role in reproduction and evolution. The individual global recombination rate (GRR), measured as the number of crossovers (CO) per gametes, is a complex trait that has been shown to be heritable. The sex chromosomes play an important role in reproduction and fertility related traits. Therefore, variants present on the X-chromosome might have a high contribution to the genetic variation of GRR that is related to meiosis and to reproduction. RESULTS: We herein used genotyping data from 58,474 New Zealand dairy cattle to estimate the contribution of the X-chromosome to male and female GRR levels. Based on the pedigree-based relationships, we first estimated that the X-chromosome accounted for 30% of the total additive genetic variance for male GRR. This percentage was equal to 19.9% when the estimation relied on a SNP-BLUP approach assuming each SNP has a small contribution. We then carried out a haplotype-based association study to map X-linked QTL, and subsequently fine-mapped the identified QTL with imputed sequence variants. With this approach we identified three QTL with large effect accounting for 7.7% of the additive genetic variance of male GRR. The associated effects were equal to + 0.79, - 1.16 and + 1.18 CO for the alternate alleles. In females, the estimated contribution of the X-chromosome to GRR was null and no significant association with X-linked loci was found. Interestingly, two of the male GRR QTL were associated with candidate genes preferentially expressed in testis, in agreement with a male-specific effect. Finally, the most significant QTL was associated with PPP4R3C, further supporting the important role of protein phosphatase in double-strand break repair by homologous recombination. CONCLUSIONS: Our study illustrates the important role the X-chromosome can have on traits such as individual recombination rate, associated with testis in males. We also show that contribution of the X-chromosome to such a trait might be sex dependent.

Management of lactating breast abscesses by ultrasound-guided needle aspiration and continuation of breastfeeding: A pilot study.

INTRODUCTION: Needle aspiration of breast abscesses during lactation are currently recommended as an alternative to surgery only for moderate forms. In case of breast abscess, many patients stop breastfeeding on the advice of a health professional. We reviewed our experience of treatment of lactating breast abscesses by ultrasound-guided aspiration and suggest an algorithm of their management. We also analyzed the continuation of breastfeeding of these patients after advices from trained teams. MATERIEL AND METHODS: We conducted a retrospective study from April 2016 to April 2017, including 28 patients referred for a breast abscess during lactation at the Duroc Breast Imaging Center. A management by ultrasound-guided aspiration was proposed to each patient. We collected data about the breastfeeding between October 2018 and January 2019. RESULTS: A single aspiration was sufficient in 64.3% of cases. The delay between the occurrence of the abscess and the indication for drainage was significantly higher for patients who have needed finally surgical drainage (p = 0,0031). There were no difference of size of abscesses between patients receiving needle aspiration alone and those who have undergone surgery (p = 0,97). All patients who had been managed by needle aspiration continued breastfeeding after the treatment and 40% of the patients were still breastfeeding at 6 months. CONCLUSION: The management of lactating breast abscess by ultrasound-guided needle aspiration is an effective alternative to surgery. It appears to be effective regardless of the size of the abscess and is compatible with the continuation of breastfeeding. Our study has indeed shown that if they are well advised, the majority of patients continue breastfeeding so that it is essential that health professionals be better trained regarding the management of breastfeeding complications.

[Chronic paracetamol intoxication : under-diagnosed iatrogenic cause of metabolic acidosis with increased anion gap]. / L'intoxication chronique au paracétamol : cause iatrogène sous-diagnostiquée d'acidose métabolique à trou anionique augmenté.

The occurrence of metabolic acidosis with increased anion gap in the context of chronic paracetamol intoxication is an easily treatable clinical situation. Its rapid recognition is essential given its complete reversibility in the event of adequate management by eviction of the toxic agent, in this case paracetamol. It has an unknown cause and therefore potentially under-diagnosed, to be considered in the same way as the other more frequent etiologies. Because of this lack of knowledge, its frequency is probably underestimated considering the widespread consumption of paracetamol in the population.

La survenue d'une acidose métabolique à trou anionique augmenté dans le cadre d'une intoxication chronique au paracétamol est une situation clinique facile à traiter. Sa reconnaissance rapide est essentielle compte tenu de son entière réversibilité en cas de prise en charge adéquate par éviction de l'agent toxique, en l'occurrence le paracétamol. C'est une cause méconnue et de ce fait potentiellement sous-diagnostiquée, à envisager au même titre que les autres étiologies plus fréquentes. Du fait de cette méconnaissance, sa fréquence est probablement sous-estimée au vu de la consommation répandue de paracétamol au sein de la population.

[Type 2 diabetes and endocrine disrupting environmental chemical pollutants]. / Le diabète de type 2 et les polluants chimiques de l'environnement à effet perturbateur endocrinien.

Endocrine disruptors are chemicals or natural molecules able to interfere with the hormonal system of living organisms. These pollutants can promote the emergence of diseases of the endocrine system in humans or animals. In this publication, we will focus on certain families of endocrine disrupting chemicals that may contribute to the development of type 2 diabetes, a disease whose prevalence is increasing strongly in the world.

Les perturbateurs endocriniens sont des produits chimiques ou molécules naturelles capables d'interférer avec le système hormonal des organismes vivants. Ces polluants peuvent entraîner l'apparition de pathologies endocriniennes chez l'Homme ou chez l'animal. Dans cette publication, nous envisagerons le rôle possible de certaines familles de produits chimiques perturbateurs endocriniens sur l'apparition du diabète de type 2, pathologie dont la prévalence est en forte augmentation au niveau mondial.

A Periodic Hexagon Tiling Model and Non-Hermitian Orthogonal Polynomials.

We study a one-parameter family of probability measures on lozenge tilings of large regular hexagons that interpolates between the uniform measure on all possible tilings and a particular fully frozen tiling. The description of the asymptotic behavior can be separated into two regimes: the low and the high temperature regime. Our main results are the computations of the disordered regions in both regimes and the limiting densities of the different lozenges there. For low temperatures, the disordered region consists of two disjoint ellipses. In the high temperature regime the two ellipses merge into a single simply connected region. At the transition from the low to the high temperature a tacnode appears. The key to our asymptotic study is a recent approach introduced by Duits and Kuijlaars providing a double integral representation for the correlation kernel. One of the factors in the integrand is the Christoffel-Darboux kernel associated to polynomials that satisfy non-Hermitian orthogonality relations with respect to a complex-valued weight on a contour in the complex plane. We compute the asymptotic behavior of these orthogonal polynomials and the Christoffel-Darboux kernel by means of a Riemann-Hilbert analysis. After substituting the resulting asymptotic formulas into the double integral we prove our main results by classical steepest descent arguments.

Colour-sidedness in Gloucester cattle is associated with a complex structural variant impacting regulatory elements downstream of KIT.

Colour-sidedness is a striking coat colour pattern found in a number of cattle breeds, typically characterised by a white stripe that extends along the back, head and belly of the animal. This dominant phenotype is caused by two related translocations (Cs6 and Cs29 ) that alter a region downstream of the KIT gene. Gloucester cattle are native to the UK and are known for an unusual colour-sided pattern that does not extend to the head. We carried out whole-genome sequencing of two Gloucester bulls as well as colour-sided Irish Moiled, British White and Pustertaler Sprinzen for comparison. We found that the Gloucester cattle also have a complex structural variant downstream of KIT, which overlaps the regions involved in Cs6 and Cs29 . All three alleles potentially disrupt a number of putative regulatory elements downstream of KIT. These results complement and expand on the recently published work focused on the Pinzgauer breed from Austria, a carrier of the same colour-sided pattern as seen in Gloucester cattle.

[Association between exposure to persistent organic pollutants during pregnancy and thyroid function during childhood : a pilot longitudinal study and literature review]. / Associations entre exposition aux polluants organiques persistants durant la grossesse et fonction thyroïdienne durant la petite enfance : étude longitudinale pilote et revue de la littérature.

OBJECTIVE: Perfluoroalkyl substances (PFAS) are chemicals widely employed in the industry. Long term consequences of the newborns' contamination by PFAS on thyroid function are of concern. The aim of this study is to assess the potential associations between PFAS contamination measured at birth and thyroid function assessed few months later. PFAS levels were previously determined in cord blood from a cohort of newborns recruited in Liege. METHOD: Parents of the children belonging to the first and the fifth quintiles of exposure to PFAS were contacted in order to measure the thyroid stimulating hormone (TSH) levels in their child few months after birth. Twenty-eight children participated in the study. Moreover, we performed a literature review about associations between pre- or perinatal exposure to persistent organic pollutants and thyroid function during early childhood. RESULT: No significant difference was highlighted between both groups of contamination (Mann-Whitney, p-value = 0.91). Literature review highlighted the critical need of new longitudinal data about this problematic. CONCLUSION: Our results suggest that the PFAS levels at birth are not associated with TSH levels later in life. Large scale studies are required to confirm our results.

Objectif : Notre but est d'étudier les associations potentielles entre contamination par les composés perfluorés (PFC) mesurée à la naissance et fonction thyroïdienne évaluée quelques mois plus tard. Les niveaux de PFC ont été déterminés précédemment dans le sang de cordon de nouveau-nés recrutés à Liège. Méthode : Les parents des enfants appartenant au premier et cinquième quintiles d'exposition aux PFC ont été contactés pour mesurer les niveaux de thyréostimuline (TSH) chez leurs enfants quelques mois après la naissance. Vingt-huit enfants ont été recrutés. De plus, nous avons réalisé une revue de littérature concernant les associations entre exposition pré- ou périnatale aux polluants organiques persistants (POP) et fonction thyroïdienne pendant la petite enfance. Résultat : Aucune différence significative n'a été mise en évidence entre les deux groupes de contamination (Mann-Whitney, p = 0,91). Selon, la revue de la littérature, il est indispensable de disposer de nouvelles données longitudinales relatives à la relation entre contamination par les POP et fonction thyroïdienne. Conclusion : Nos résultats suggèrent que les concentrations de PFC à la naissance ne sont pas associées aux niveaux de TSH au cours de la vie. Des études basées sur de plus grandes cohortes sont requises pour confirmer nos résultats.

Congenital syphilis: A prospective study of 22 cases diagnosed by PCR.

Congenital syphilis (CS) is caused by Treponema pallidum infection in utero. There is a need to develop new tools to diagnose CS: the diagnostic value of PCR is difficult to assess. The aim of this study was to describe the clinical and laboratory characteristics of mothers and infants with CS as diagnosed by PCR tests on various maternal and neonatal samples. PATIENTS AND METHODS: We included all infants epidemiologically linked to a mother diagnosed with syphilis whose samples were referred to the Syphilis Reference Center, and for whom at least one positive PCR result was obtained. RESULTS: Twenty-two mother-infant pairs (8.3%) with assay performed on samples from one to four different anatomic sites were included between February 2011 and April 2018. Seven mothers (31.8%) were born abroad, fifteen (68.2%) presented psychological and/or social problems, eight (36.4%) had not been screened for syphilis prior to delivery, and eleven (50%) were referred from French overseas departments or territories, or from the Paris region. Six infants (27.3%) were stillborn and six were born preterm, while fifteen infants (68.2%) presented clinical features of CS. All infants born preterm were symptomatic. Infant VDRL/RPR titer was no greater than four times that in the mother's serum, except in two cases. DISCUSSION: Lack of antenatal care, social disadvantage and psychological issues were common. There is a need for enhanced surveillance both in the French overseas departments/territories and in the Paris region. A larger study is required to assess the sensitivity and specificity of PCR. The best site for sampling has yet to be established. We recommend the collection of as many samples as possible to avoid underdiagnosis of CS.

[Biological markers of alcohol consumption]. / Les marqueurs biologiques de la consommation d'alcool.

To recognize an alcoholic subject is a frequent request, in a medical or forensic setting. The reasons to determine the alcoholic status of an individual are many and various. Amongst the most frequent are : to decide on the origin of liver or neurological disease, put and maintain a liver transplantation candidate on a waiting list, identify the alcoholic worker to prevent work-related accidents, or evaluate the possible risk an alcoholic individual represents, for road safety or for parental custody. The specific alcohol consumption biological markers combined with clinical and psychological examinations are the best tools to identify the individuals with a problematic consumption. The use of markers belongs to the recommended actions to support patients undergoing treatment for alcoholism. It is mandatory in various situations to distinguish between the teetotaler, the moderate or problematic drinkers. Different biomarkers are described here to allow practitioners to adapt their prescriptions.

Reconnaître un sujet alcoolique est une requête fréquente, que ce soit dans un cadre médical ou médico-légal. Les besoins de connaître le statut alcoolique d'un individu sont multiples et variés. Parmi les plus fréquents, on peut citer : se prononcer sur l'origine d'une pathologie hépatique ou neurologique, inscrire et maintenir un candidat à une greffe hépatique sur une liste d'attente, identifier le travailleur alcoolique afin de prévenir les accidents de travail, ou encore apprécier le risque éventuel qu'un individu alcoolique représente, que ce soit derrière son volant ou dans le contexte d'une garde parentale. Les marqueurs biologiques spécifiques de la consommation d'alcool, combinés aux examens cliniques et psychologiques, constituent à ce jour les meilleurs outils pour identifier les individus à consommation problématique. L'utilisation de ces indicateurs fait également partie des mesures prônées pour l'accompagnement des sujets en cure de désintoxication. Distinguer le sujet abstinent, consommateur social (dit modéré) ou problématique peut, dès lors, s'avérer essentiel dans diverses situations. Les différents biomarqueurs disponibles à ce jour sont discutés dans cet article afin de permettre aux cliniciens une prescription adaptée aux investigations à mener.

[Preterm premature rupture of membranes: CNGOF Guidelines for clinical practice - Short version]. / Rupture prématurée des membranes avant terme : recommandations pour la pratique clinique du CNGOF ­ Texte court.

OBJECTIVE: To determine management of women with preterm premature rupture of membranes (PPROM). METHODS: Bibliographic search from the Medline and Cochrane Library databases and review of international clinical practice guidelines. RESULTS: In France, PPROM rate is 2 to 3% before 37 weeks of gestation (level of evidence [LE] 2) and less than 1% before 34 weeks of gestation (LE2). Prematurity and intra-uterine infection are the two major complications of PPROM (LE2). Compared to other causes of prematurity, PPROM is not associated with an increased risk of neonatal mortality and morbidity, except in case of intra-uterine infection, which is associated with an augmentation of early-onset neonatal sepsis (LE2) and of necrotizing enterocolitis (LE2). PPROM diagnosis is mainly clinical (professional consensus). In doubtful cases, detection of IGFBP-1 or PAMG-1 is recommended (professional consensus). Hospitalization of women with PPROM is recommended (professional consensus). There is no sufficient evidence to recommend or not recommend tocolysis (grade C). If a tocolysis should be prescribed, it should not last more than 48hours (grade C). Antenatal corticosteroids before 34 weeks of gestation (grade A) and magnesium sulfate before 32 weeks of gestation (grade A) are recommended. Antibiotic prophylaxis is recommended (grade A) because it is associated with a reduction of neonatal mortality and morbidity (LE1). Amoxicillin, 3rd generation cephalosporins, and erythromycin in monotherapy or the association erythromycin-amoxicillin can be used (professional consensus), for 7 days (grade C). However, in case of negative vaginal culture, early cessation of antibiotic prophylaxis might be acceptable (professional consensus). Co-amoxiclav, aminosides, glycopetides, first and second generation cephalosporins, clindamycin, and metronidazole are not recommended for antibiotic prophylaxis (professional consensus). Outpatient management of women with clinically stable PPROM after 48hours of hospitalization is a possible (professional consensus). During monitoring, it is recommended to identify the clinical and biological elements suggesting intra-uterine infection (professional consensus). However, it not possible to make recommendation regarding the frequency of this monitoring. In case of isolated elevated C-reactive protein, leukocytosis, or positive vaginal culture in an asymptomatic patient, it is not recommended to systematically prescribe antibiotics (professional consensus). In case of intra-uterine infection, it is recommended to immediately administer an antibiotic therapy associating beta-lactamine and aminoside (grade B), intravenously (grade B), and to deliver the baby (grade A). Cesarean delivery should be performed according to the usual obstetrical indications (professional consensus). Expectative management is recommended before 37 weeks of gestation in case of uncomplicated PPROM (grade A), even in case of positive vaginal culture for B Streptococcus, provided that an antibiotic prophylaxis has been prescribed (professional consensus). Oxytocin and prostaglandins are two possible options to induce labor in case of PPROM (professional consensus). CONCLUSION: Expectative management is recommended before 37 weeks of gestation in case of uncomplicated PPROM (grade A).

[Antibiotic prophylaxis in preterm premature rupture of membranes: CNGOF preterm premature rupture of membranes guidelines]. / Choix et durée de l'antibioprophylaxie en cas de rupture prématurée des membranes avant terme. RPC rupture prématurée des membranes avant terme CNGOF.

OBJECTIVE: To analyse benefits and risks of antibiotic prophylaxis in the management of preterm premature rupture of membranes. METHODS: PubMed and Cochrane Central databases search. RESULTS: Streptoccoccus agalactiae (group B streptococcus) and Escherichia coli are the two main bacteria identified in early neonatal sepsis (EL3). Antibiotic prophylaxis at admission is associated with significant prolongation of pregnancy (EL2), reduction in neonatal morbidity (EL1) without impact on neonatal mortality (EL2). Co-amoxiclav could be associated with an increased risk for neonatal necrotising enterocolitis (EL2). Antibiotic prophylaxis at admission in women with preterm premature rupture of the membranes is recommended (Grade A). Monotherapy with amoxicillin, third generation cephalosporin and erythromycin can be used as well as combination of erythromycin and amoxicillin (Professional consensus) for 7 days (GradeC). Shorter treatment is possible when initial vaginal culture is negative (Professional consensus). Co-amxiclav, aminoglycosides, glycopeptides, first and second generation cephalosporin, clindamycin and metronidazole are not recommended (Professional consensus). CONCLUSIONS: Antibiotic prophylaxis against Streptoccoccus agalactiae (group B streptococcus) and E. coli is recommended in women with preterm premature of the membranes (Grade A). Monotherapy with amoxicillin, third generation cephalosporin or erythromycin, as well as combination of erythromycin and amoxicillin are recommended (Professional consensus).

[Diagnosis and management of intra-uterine infection: CNGOF Preterm Premature Rupture of Membranes Guidelines]. / Infection intra-utérine : diagnostic et traitement. RPC rupture prématurée des membranes avant terme CNGOF.

OBJECTIVE: To determine the diagnosis criteria and management of intra-uterine inflammation or infection (Triple I, III). METHODS: PubMed and Cochrane Central databases search. RESULTS: III is defined as an infection of the fetal membranes, and/or other components like the decidua, fetus, amniotic fluid or placenta. This word should be preferred to the word chorioamnionitis that is less precise (Professional consensus). III clinical signs exhibit poor limited sensibility and specificity (EL3). The diagnosis of III is retained in case of maternal fever (defined by a body temperature≥38°C) with no alternative cause identified and at least 2 signs among the following: fetal tachycardia>160 bpm for 10min or longer, uterine pain of labor, purulent fluid from the cervical canal (Professional consensus). Maternal hyperleukocytosis>20 giga/L in the absence of corticosteroids treatment or increased plasmatic C-reactive protein also argue for III, despite their limited sensibility and specificity (EL3). III requires prompt delivery (Grade A). III is not by itself an indication for cesarean delivery (Professional consensus). Antibiotic treatment should cover Streptococcus agalactiae and Escherichia coli. Antibiotics should be started immediately and maintained all over delivery, to reduce neonatal and maternal morbidity (Grade B). Treatment should rely on a combination of betalactamin and aminoglycoside (Grade B). After vaginal delivery, one single dose of antibiotic is required. Antibiotic duration should be longer in case of bacteremia. Longer duration could be considered in case of persistent fever or of cesarean delivery (Professional consensus).

Listeria monocytogenes-associated respiratory infections: a study of 38 consecutive cases.

OBJECTIVES: Listeria monocytogenes (Lm) is a foodborne human pathogen responsible for severe infections, including septicaemia, neurolisteriosis, and maternal-foetal and focal infections. Little is known about Lm-associated respiratory tract or lung infections. METHODS: We conducted a retrospective study of culture-proven cases of Lm pleural infections and pneumonia reported to the French National Reference Centre for Listeria from January 1993 to August 2016. RESULTS: Thirty-eight consecutive patients with pleural infection (n = 32), pneumonia (n = 5), or both (n = 1) were studied; 71% of these were men. Median age was 72 (range 29-90). Two patients presented with concomitant neurolisteriosis. All patients but one reported at least one immunosuppressive condition (97%), with a median number of 2 (range 0-5), including 29% (8/28) with current exposure to immunosuppressive therapy and 50% (17/34) with ongoing neoplasia; 75% (21/28) reported previous pleural or pulmonary disease. Antibiotic therapy mostly consisted in amoxicillin (72%) associated with aminoglycoside in 32%. Chest-tube drainage was performed in 7/19 patients with empyema (37%); 25% of the patients (7/30) required intensive care management. In-hospital mortality reached 35% and occurred after a median time interval of 4 days (range 1-33 days). Three patients had recurrence of empyema (time interval of 1 week to 4 months after treatment completion). Altogether, only 13/31 patients (42%) diagnosed with Lm respiratory infection experienced an uneventful outcome at 2-year follow-up. CONCLUSION: Lm is a rare but severe cause of pneumonia and pleural infection in older immunocompromised patients, requiring prompt diagnosis and adequate management and follow-up.