M. Boukerrou

Low clinical burden of 2009 pandemic influenza A (H1N1) infection during pregnancy on the Island of La Réunion.

Background Pregnant women have been identified as a group at risk, both for respiratory complications than for the admissions to the Intensive Care Unit (ICU) during the 2009 H1N1 influenza pandemic (pdm). The purpose of this prospective register-based cohort-study was to characterize the clinical virulence of the pdm (H1N1/09)v during pregnancy in La Réunion. Methods/Principal Findings Over a twelve-week pdm wave (13 July to 3 October 2009), 294 pregnant women presented with an influenza-like illness (ILI) to one of the three maternity departments of the South Reunion area, Indian Ocean. Out of these, 278 were checked by RT-PCR for influenza viruses (157 positive and 121 negative, of whom, 141 with pdm flu and 132 with ILIs of non pdm origin, 5 untyped). The median body temperature was higher in women experiencing pdm flu than in those with non pdm ILI (38.9°C versus 38.3°C, P<0.0001), without evidence linked to circulating viremia. Oseltamivir was given for 86% of pdm flu cases in a median time inferior than 48 hrs (range 0–7 days). The hospitalization rate for pdm flu was of 60% and not associated with underlying conditions. Six viral pneumonia and fourteen asthma attacks were observed among 84 hospitalized pdm flu cases, of whom, only one led to the ICU for an acute lung injury. No maternal death occurred during the pdm wave. None adverse pregnancy outcome was associated with pdm flu. No congenital birth defect, nor early-onset neonatal influenza infection was attributable to pdm flu exposure. Conclusions/Significance This report mitigates substantially the presumed severity of pandemic H1N1/09 influenza infection during pregnancy. The reasons for which the clinical burden of H1N1/09 influenza virus may differ worldwide raise questions about a differential local viral-strain effect and public health preparedness, notably in timely access to special care and antiviral treatments.

A case of postoperative breast infection by Mycobacterium fortuitum associated with the hospital water supply

This report describes the first known laboratory-confirmed case of Mycobacterium fortuitum breast infection related to the hospital water supply. The source of the M fortuitum infection was identified by repetitive extragenic palindromic sequence-based polymerase chain reaction genotyping. In addition, we discuss appropriate infection control measures to minimize patient exposure to waterborne pathogens, in particular, in the context of nontuberculous mycobacteria, which is difficult to eradicate from the water supply network.

L’hyperémèse gravidique : quelles conséquences sur la grossesse ?

OBJECTIVES The aim of this study was to determine the impact of hyperemesis gravidarum (HG) on pregnancy. METHODS For this purpose, we conducted a retrospective cohort study between January 1st, 2006 and July 31st, 2009 in the level-3 maternity of the South Reunion teaching hospital, Saint-Pierre. Perinatal outcomes (gestational diabetes mellitus, hypertensive disorders of pregnancy, caesarean section, IUGR<10th percentile, low birth weight<2500 g, preterm birth<37 weeks, perinatal death) were compared among the women hospitalized for HG (exposed group) and a non-exposed group randomly selected from the South Reunion birth register. Finally, we also investigated the interactions between HG and maternal weight gain to assess whether HG might change perinatal outcomes according to weight gain. RESULTS During the study period, 215 women hospitalized for HG delivered (cumulative incidence rate of HG 14.1‰ among total deliveries), of which 197 were included in the exposed group. The low gestational weight gain (<7 kg), used as a criterion to define severe HG, was significantly more likely in the exposed group (30.5% versus 16.1%, P<0.0001). There was no significant association between HG and the various perinatal outcomes tested. The risk of delivering a low birth weight neonate was twofold (adjusted RR: 2.0, 95%CI: 1.0-3.1), that for a small-for-gestational age infant was more likely (adjusted RR: 1.7, 95% CI: 1.1-2.4), both only in case of severe HG. CONCLUSION Severe HG, defined for women with a gestational weight gain of less than 7 kg, is a poor prognostic factor for fetal growth.

P417 - L’obésité : un nouveau facteur de risque d’infection néonatale précoce à streptocoque B ?

Objectif Preciser le lien entre l’indice de masse corporelle (IMC) et la transmission verticale du streptocoque B (SGB). Sujets/Materiels et Methodes Etude cas - temoin sur toutes les grossesses singletons accouchees a partir de 24 SA dans le sud de la Reunion pour lesquelles un depistage du SGB a ete realise. Analyse par regression logistique des donnees 2004-2007 du registre perinatal Sud-Reunion. Resultats principaux Parmi les 17430 femmes depistees, accouchees entre le 1er janvier 2004 et le 31 decembre 2007, 2909 etaient colonisees a SGB (16,7 %). Dans un modele a interactions ajuste sur une variable composite confirmant le role protecteur de la cesarienne et de l’antibioprophylaxie, ainsi que le lien significatif avec les liquides teintes et la tachycardie.

Elevated human chorionic gonadotrophin without pregnancy: A case of gallbladder carcinoma

We report a rare case of primary gallbladder adenocarcinoma producing human chorionic gonadotropin (HCG) in a 31-year-old woman. The patient was first misdiagnosed and monitored for an extra-uterine pregnancy. The most frequent cause of elevated serum HCG is pregnancy but elevated HCG can also be a marker of others pathologies like tumors. It is of utmost importance to keep in mind all the possible causes of elevated serum HCG. Once pregnancy has been ruled out, complementary exams should be performed to seek a tumor, especially since tumors producing HCG can be particularly aggressive.

Impact of management on mortality in patients with invasive cervical cancer in Reunion Island

OBJECTIVE In Reunion Island, the standardized mortality rate for cervical cancer is 4.8/100,000 women, twice higher than in Metropolitan France. For locally advanced disease, the standard of care includes a treatment by brachytherapy. Nevertheless, brachytherapy was not available on the Island before 2016. The objective of this study was to assess the impact of the management of patients with invasive cervical cancer on mortality in Reunion. METHODS We have identified all the women hospitalized in one of the health care centers of the Island diagnosed with invasive cervical cancer between 01/01/2010 and 31/12/2015. The guidelines of the French Society of Gynecological Oncology (FSGO) were considered as the reference to evaluate professional practices. The characteristics that had an influence on global survival after log-rank test were included in a multivariate analysis according to the Cox Model. RESULTS Retrospective analysis identified 303 women meeting inclusion criteria. The assessment of professional practices showed that the decisions on 11.6% of the patients discussed during multidisciplinary meetings, were not applied, consequentially leading to a decrease in survival (p=0.001). A total of 156 patients (51.5%) were administered a treatment in accordance with the guidelines of the FSGO and had a better survival, even after multivariate analysis (HR 2.53 [CI 95% 1.55-4.14], p<10-3). Nonconformity was associated with the lack of access to brachytherapy on the Island. Women on the Island presented low rates of screening tests (cover rates 53.2%). CONCLUSION The absence of treatment in accordance with the guidelines and decisions taken during multidisciplinary meetings and the absence of brachytherapy were associated to a higher mortality among patients with invasive cervical cancer in Reunion Island. We hope that the implementation of brachytherapy in Reunion will address these deficiencies.