OBJECTIVE: To assess the extent of nosocomial transmission of tuberculosis among infants, family members, and healthcare workers (HCWs) who were exposed to a 29-week-old premature infant with congenital tuberculosis, diagnosed at 102 days of age.DESIGN: A prospective exposure investigation using tuberculin skin test (TST) conversion was conducted. Contacts underwent two skin tests 10 to 12 weeks apart. Clinical examination and chest radiographs were performed to rule out disease. Isoniazid prophylaxis was administered to exposed infants at higher risk.SETTING: A neonatal intensive care unit in an urban hospital in Brussels, Belgium.PARTICIPANTS: Ninety-seven infants, 139 HCWs, and 180 visitors.RESULTS: Newly positive TST results occurred in HCWs who had been in close contact with the infant. Six (19%) of 32 primary care nurses and physicians had TST conversions and received treatment. Among the 97 exposed infants, 85 were screened and 34 were identified as at higher risk of infection. Of these, 27 received preventive isoniazid. None of the infants and none of the 93 other infants' family members evaluated were infected.CONCLUSIONS: Congenital tuberculosis in an infant poses a risk for nosocomial transmission to HCWs. Delayed diagnosis of this rare disease and close proximity are the most important factors related to transmission.

En vue d’évaluer l’intérêt d’un nouveau marqueur de l’infection bactérienne dans le cadre de l’infection fœtomaternelle, nous avons dosé la procalcitonine (PCT) par une méthode immunoluminométrique ultrasensible (PCT ProCa-S, Brahms) chez 202 femmes, âgées de 20 à 40 ans. Les femmes non infectées (n = 178) incluses dans cette étude ont été réparties en deux groupes : groupe I : femmes enceintes (n = 97) avec un âge gestationnel entre 20 et 36 semaines d’aménorrhée ; groupe II : femmes non enceintes (n = 81). Les femmes ayant une valeur de CRP > 1 mg/dl ont été exclues (n = 24). La PCT est significativement plus élevée (test t de Student, p < 0,001) chez les femmes enceintes par rapport au groupe contrôle (moyenne pour le groupe I : 26,75 pg/ml, pour le groupe II : 14,15 pg/ml). Cette augmentation physiologique, mise en évidence par cette méthode ultrasensible nécessiterait des études supplémentaires pour bien comprendre sa physiopathologie.

The haemoglobin disorders are frequent genetic diseases in tropical regions and in the mediterranean basin. They include thalassaemia and sickle cell disease. Because of important migrations of populations after the Second World War many big cities are confronted with the disease in West Europe nowadays. In Brussels where a neonatal screening has been organised in the majority of the maternity's, 45% of newborns have at least one parent originating from a region at risk for an haemoglobin disorder. One neonate among 2.000 is diagnosed with a major haemoglobinopathy at the screening. This rate is important and it appeared essential to evaluate the knowledge and need for complementary information among the doctors confronted with the disease. A survey was done in January 1999 and a questionnaire was sent to all gynaecologists, paediatricians and general practitioners in Brussels. The main results were a general self-evaluation of poor knowledge and a great need for complementary information. This survey was important to obtain adequate support of official health authorities in term of screening, prevention and financial aid to information campaigns. A consensus is needed among the different doctors for the best care possible of sick patients.

Haemoglobinopathies are the most frequent genetic diseases in the world. The estimated frequency of carriers in the world is of 200 millions while there is about 300.000 births per year of major forms of haemoglobinopathies. The neonatal screening of haemoglobinopathies performed at the Hospital Erasme on around 80% of births in Brussels since 1994 has demonstrated that the frequency of carriers of an abnormal haemoglobin is around 1.5% while more than 1/2.000 newborns has a major haemoglobinopathy. A strategy must be adopted to manage the haemoglobinopathies in Brussels.

During universal hemoglobinopathq screening performed in our laboratory (l) , a new hemoglobin (Hb) variant was found in a newborn of Congolese origin and in his mother. The pregnancy was normal and delivery occurred at 38 weeks gestation. The newborn had a low birth weight (2.440 Kg) but was otherwise healthy. The mother had no peculiar medical history and her blood count, obtained 7 months after delivery, was normal (Table I). Separation of Hb fractions in the cord blood by an isoelectrofocusing (IEF) technique (Fig. 1) revealed the presence of several fast-moving abnormal fractions. As seen in the hemolysate of the mother. the variant migrated almost at the position of Hb Fa, in IEF. Electrophoretic migration of the variant Hb under various experimental conditions (2,3) are given in Table 11. The different behavior of the globin chains at pH 9.0 and 6.0 suggested that a histidine residue was involved. The variant did not separate by capillary zone electro-

We describe a case of spontaneously reversible refractory anaemia, a subtype of myelodysplastic syndrome (MDS), with monosomy 7 secondary to chronic treatment with azathioprine (AZA) in a young renal transplant recipient. AZA was stopped after that conventional cytogenetics and fluorescence in situ hybridization (FISH) had demonstrated the existence of a monosomy 7 clone, 4 months later, haematological values had considerably improved and the karyotypic examination as well as the FISH analysis were normal. The spontaneous remission of this MDS with monosomy 7, which is usually associated with a particularly poor prognosis, could be due to the recovery of a better immunosurveillance following the withdrawal of AZA.