{"id":4007,"date":"2025-01-12T21:33:58","date_gmt":"2025-01-12T21:33:58","guid":{"rendered":"https:\/\/echonews.fr\/?page_id=4007"},"modified":"2025-03-19T09:42:05","modified_gmt":"2025-03-19T09:42:05","slug":"joseph-bonan-copy","status":"publish","type":"page","link":"https:\/\/echonews.fr\/?page_id=4007","title":{"rendered":"Cours-cytomegalovirus"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"4007\" class=\"elementor elementor-4007\" data-elementor-settings=\"{&quot;ha_cmc_init_switcher&quot;:&quot;no&quot;}\">\n\t\t\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-a664abd elementor-section-full_width elementor-section-stretched elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"a664abd\" data-element_type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-4e5d8aa\" data-id=\"4e5d8aa\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8e2bac8 elementor-hidden-mobile elementor-widget elementor-widget-image\" data-id=\"8e2bac8\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"2560\" height=\"1106\" src=\"https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/Bandeau-accueil-learning-V4-BIS.jpg\" class=\"attachment-full size-full wp-image-3915\" alt=\"\" srcset=\"https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/Bandeau-accueil-learning-V4-BIS.jpg 2560w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/Bandeau-accueil-learning-V4-BIS-300x130.jpg 300w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/Bandeau-accueil-learning-V4-BIS-1024x442.jpg 1024w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/Bandeau-accueil-learning-V4-BIS-768x332.jpg 768w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/Bandeau-accueil-learning-V4-BIS-1536x664.jpg 1536w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/Bandeau-accueil-learning-V4-BIS-2048x885.jpg 2048w\" sizes=\"(max-width: 2560px) 100vw, 2560px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-e83836e elementor-section-full_width elementor-section-stretched elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"e83836e\" data-element_type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-3a73111\" data-id=\"3a73111\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8facf2b elementor-hidden-desktop elementor-hidden-tablet elementor-widget elementor-widget-image\" data-id=\"8facf2b\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"1475\" height=\"1106\" src=\"https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/Bandeau-accueil-learning-V4-BIS-SMART.jpg\" class=\"attachment-full size-full wp-image-4003\" alt=\"\" srcset=\"https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/Bandeau-accueil-learning-V4-BIS-SMART.jpg 1475w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/Bandeau-accueil-learning-V4-BIS-SMART-300x225.jpg 300w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/Bandeau-accueil-learning-V4-BIS-SMART-1024x768.jpg 1024w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/Bandeau-accueil-learning-V4-BIS-SMART-768x576.jpg 768w\" sizes=\"(max-width: 1475px) 100vw, 1475px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-4fa78e7 elementor-section-content-middle elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"4fa78e7\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-45f264d\" data-id=\"45f264d\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-b87e716 elementor-view-default elementor-widget elementor-widget-icon\" data-id=\"b87e716\" data-element_type=\"widget\" data-widget_type=\"icon.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-wrapper\">\n\t\t\t<a class=\"elementor-icon\" href=\"https:\/\/echonews.fr\/?page_id=4577\">\n\t\t\t<i aria-hidden=\"true\" class=\"hm hm-home\"><\/i>\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-84761cf\" data-id=\"84761cf\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d109f5d wpr-main-menu-align-right wpr-main-menu-align--mobileright elementor-widget__width-initial wpr-main-menu-align--tabletleft wpr-pointer-underline wpr-pointer-line-fx wpr-pointer-fx-fade wpr-sub-icon-caret-down wpr-sub-menu-fx-fade wpr-nav-menu-bp-mobile wpr-mobile-menu-full-width wpr-mobile-menu-item-align-center wpr-mobile-toggle-v1 wpr-sub-divider-yes elementor-widget elementor-widget-wpr-nav-menu\" data-id=\"d109f5d\" data-element_type=\"widget\" data-settings=\"{&quot;menu_layout&quot;:&quot;horizontal&quot;}\" data-widget_type=\"wpr-nav-menu.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<nav class=\"wpr-nav-menu-container wpr-nav-menu-horizontal\" data-trigger=\"hover\"><ul id=\"menu-1-d109f5d\" class=\"wpr-nav-menu\"><li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4170\"><a href=\"https:\/\/echonews.fr\/?page_id=4007\" class=\"wpr-menu-item wpr-pointer-item menu-link\">M\u00e9decine<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4169\"><a href=\"https:\/\/echonews.fr\/?page_id=4081\" class=\"wpr-menu-item wpr-pointer-item menu-link\">Droit Constitutionnel<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4289\"><a href=\"https:\/\/echonews.fr\/?page_id=4189\" class=\"wpr-menu-item wpr-pointer-item menu-link\">Psychologie<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4725\"><a href=\"https:\/\/echonews.fr\/?page_id=4647\" class=\"wpr-menu-item wpr-pointer-item menu-link\">Geopolitique<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4348\"><a href=\"https:\/\/echonews.fr\/?page_id=4300\" class=\"wpr-menu-item wpr-pointer-item menu-link\">Traitement des Iconographies<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4533\"><a href=\"https:\/\/echonews.fr\/?page_id=4359\" class=\"wpr-menu-item wpr-pointer-item menu-link\">Publications<\/a><\/li>\n<\/ul><\/nav><nav class=\"wpr-mobile-nav-menu-container\"><div class=\"wpr-mobile-toggle-wrap\"><div class=\"wpr-mobile-toggle\"><span class=\"wpr-mobile-toggle-line\"><\/span><span class=\"wpr-mobile-toggle-line\"><\/span><span class=\"wpr-mobile-toggle-line\"><\/span><\/div><\/div><ul id=\"mobile-menu-2-d109f5d\" class=\"wpr-mobile-nav-menu\"><li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4170\"><a href=\"https:\/\/echonews.fr\/?page_id=4007\" class=\"wpr-mobile-menu-item menu-link\">M\u00e9decine<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4169\"><a href=\"https:\/\/echonews.fr\/?page_id=4081\" class=\"wpr-mobile-menu-item menu-link\">Droit Constitutionnel<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4289\"><a href=\"https:\/\/echonews.fr\/?page_id=4189\" class=\"wpr-mobile-menu-item menu-link\">Psychologie<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4725\"><a href=\"https:\/\/echonews.fr\/?page_id=4647\" class=\"wpr-mobile-menu-item menu-link\">Geopolitique<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4348\"><a href=\"https:\/\/echonews.fr\/?page_id=4300\" class=\"wpr-mobile-menu-item menu-link\">Traitement des Iconographies<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4533\"><a href=\"https:\/\/echonews.fr\/?page_id=4359\" class=\"wpr-mobile-menu-item menu-link\">Publications<\/a><\/li>\n<\/ul><\/nav>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-6b83863 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"6b83863\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-ef411df\" data-id=\"ef411df\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8d1de42 elementor-widget elementor-widget-text-editor\" data-id=\"8d1de42\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: center;\"><span style=\"color: #2f7ba5;\"><strong><span style=\"color: #000000;\">Production de RESSOURCES P\u00e9dagogiques <\/span><br \/><span style=\"color: #000000;\">assist\u00e9e par I.A.<\/span>\u00a0<\/strong><\/span><strong>\u00a0<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-a5003fb elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"a5003fb\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-6569a93\" data-id=\"6569a93\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-b93442f elementor-widget elementor-widget-text-editor\" data-id=\"b93442f\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: center;\">Joseph Bonan<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-b8983ce elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"b8983ce\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-7cf5bfa\" data-id=\"7cf5bfa\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-c484220\" data-id=\"c484220\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-9075a85 elementor-view-default elementor-widget elementor-widget-icon\" data-id=\"9075a85\" data-element_type=\"widget\" data-widget_type=\"icon.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-wrapper\">\n\t\t\t<a class=\"elementor-icon\" href=\"mailto:joseph.bonan@gmail.com\">\n\t\t\t<i aria-hidden=\"true\" class=\"hm hm-mail-open\"><\/i>\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-3eddbcd\" data-id=\"3eddbcd\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-e450769 elementor-view-default elementor-widget elementor-widget-icon\" data-id=\"e450769\" data-element_type=\"widget\" data-widget_type=\"icon.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-wrapper\">\n\t\t\t<a class=\"elementor-icon\" href=\"https:\/\/x.com\/Jkbjkb1\">\n\t\t\t<i aria-hidden=\"true\" class=\"fab fa-x-twitter\"><\/i>\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-28a34fe\" data-id=\"28a34fe\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-537b06c elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"537b06c\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-69c2e76f\" data-id=\"69c2e76f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-324c8218 elementor-widget-mobile__width-initial elementor-widget elementor-widget-text-editor\" data-id=\"324c8218\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>D\u00e9mo<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-30776014\" data-id=\"30776014\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2ca49d0f elementor-widget-mobile__width-initial elementor-widget elementor-widget-image\" data-id=\"2ca49d0f\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"1024\" height=\"596\" src=\"https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/logodef00_2@3x-1024x596.png\" class=\"attachment-large size-large wp-image-3862\" alt=\"\" srcset=\"https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/logodef00_2@3x-1024x596.png 1024w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/logodef00_2@3x-300x175.png 300w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/logodef00_2@3x-768x447.png 768w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/logodef00_2@3x.png 1485w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-65f81c59\" data-id=\"65f81c59\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-592a43ad elementor-widget elementor-widget-text-editor\" data-id=\"592a43ad\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>D\u00e9mo<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-c80a116 elementor-section-height-min-height elementor-section-boxed elementor-section-height-default elementor-section-items-middle wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"c80a116\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-958db6c\" data-id=\"958db6c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-1d53588 elementor-widget elementor-widget-text-editor\" data-id=\"1d53588\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: justify;\">Ci-dessous, \u00e0 titre d\u00e9monstration, <strong>un cours m\u00e9dical tr\u00e8s complet r\u00e9alis\u00e9 en utilisant notre m\u00e9thodologie d&#8217;assistance p\u00e9dagogique par I.A.. <\/strong><\/p><p>On y trouvera :<\/p><ul><li>Un plan du cours,<\/li><li>Un d\u00e9veloppement de chacun des chapitres composant ce cours,<\/li><li>Une s\u00e9rie de 12 FAQ,<\/li><li>Une s\u00e9rie de 40 QCM,<\/li><li>Un Quizz permettant \u00e0 l&#8217;\u00e9tudiant de s&#8217;auto-\u00e9valuer par le score obtenu,<\/li><li>12 Questions d&#8217;examen \u00e0 r\u00e9ponses courtes,<\/li><li>12 cas cliniques fictifs,<\/li><li>19 diapositives Powerpoint \u00e0 destination de l&#8217;enseignant pour son cours,<\/li><li>5 illustrations originales libres de droits.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-e116145 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"e116145\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-a67ffcc\" data-id=\"a67ffcc\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c9ca831 elementor-widget elementor-widget-text-editor\" data-id=\"c9ca831\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: center;\"><strong>Infections cong\u00e9nitales \u00e0 cytom\u00e9galovirus : <br \/>de la pr\u00e9vention \u00e0 la prise en charge postnatale<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-94e614c elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"94e614c\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-9f4ec05\" data-id=\"9f4ec05\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-f9e76be elementor-widget elementor-widget-image\" data-id=\"f9e76be\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"1024\" src=\"https:\/\/echonews.fr\/wp-content\/uploads\/2025\/03\/enseignant1-def-1024x1024.png\" class=\"attachment-large size-large wp-image-5212\" alt=\"\" srcset=\"https:\/\/echonews.fr\/wp-content\/uploads\/2025\/03\/enseignant1-def-1024x1024.png 1024w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/03\/enseignant1-def-300x300.png 300w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/03\/enseignant1-def-150x150.png 150w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/03\/enseignant1-def-768x768.png 768w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/03\/enseignant1-def-1536x1536.png 1536w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/03\/enseignant1-def.png 2048w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b3a2c5a elementor-widget elementor-widget-text-editor\" data-id=\"b3a2c5a\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Dr Pierre Dupont<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5f7e642 elementor-shape-rounded elementor-grid-0 e-grid-align-center elementor-widget elementor-widget-social-icons\" data-id=\"5f7e642\" data-element_type=\"widget\" data-widget_type=\"social-icons.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-social-icons-wrapper elementor-grid\">\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-hm-envelop elementor-repeater-item-8ef4679\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">Hm-envelop<\/span>\n\t\t\t\t\t\t<i class=\"hm hm-envelop\"><\/i>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-linkedin elementor-repeater-item-22d535c\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">Linkedin<\/span>\n\t\t\t\t\t\t<i class=\"fab fa-linkedin\"><\/i>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-x-twitter elementor-repeater-item-e1d7e7f\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">X-twitter<\/span>\n\t\t\t\t\t\t<i class=\"fab fa-x-twitter\"><\/i>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-62ec171\" data-id=\"62ec171\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8b5f796 elementor-widget elementor-widget-image\" data-id=\"8b5f796\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"1024\" src=\"https:\/\/echonews.fr\/wp-content\/uploads\/2025\/03\/enseignant4-def-1024x1024.jpg\" class=\"attachment-large size-large wp-image-5215\" alt=\"\" srcset=\"https:\/\/echonews.fr\/wp-content\/uploads\/2025\/03\/enseignant4-def-1024x1024.jpg 1024w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/03\/enseignant4-def-300x300.jpg 300w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/03\/enseignant4-def-150x150.jpg 150w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/03\/enseignant4-def-768x768.jpg 768w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/03\/enseignant4-def-1536x1536.jpg 1536w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/03\/enseignant4-def.jpg 2048w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-59c6c36 elementor-widget elementor-widget-text-editor\" data-id=\"59c6c36\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Dr Margaret Smith<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-027613a elementor-shape-rounded elementor-grid-0 e-grid-align-center elementor-widget elementor-widget-social-icons\" data-id=\"027613a\" data-element_type=\"widget\" data-widget_type=\"social-icons.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-social-icons-wrapper elementor-grid\">\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-hm-envelop elementor-repeater-item-8ef4679\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">Hm-envelop<\/span>\n\t\t\t\t\t\t<i class=\"hm hm-envelop\"><\/i>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-linkedin elementor-repeater-item-33f156f\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">Linkedin<\/span>\n\t\t\t\t\t\t<i class=\"fab fa-linkedin\"><\/i>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-599fa00\" data-id=\"599fa00\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-68d9666 elementor-widget elementor-widget-image\" data-id=\"68d9666\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"1024\" src=\"https:\/\/echonews.fr\/wp-content\/uploads\/2025\/03\/enseignant002-1024x1024.jpg\" class=\"attachment-large size-large wp-image-5220\" alt=\"\" srcset=\"https:\/\/echonews.fr\/wp-content\/uploads\/2025\/03\/enseignant002-1024x1024.jpg 1024w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/03\/enseignant002-300x300.jpg 300w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/03\/enseignant002-150x150.jpg 150w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/03\/enseignant002-768x768.jpg 768w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/03\/enseignant002.jpg 1070w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c83ce1f elementor-widget elementor-widget-text-editor\" data-id=\"c83ce1f\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Dr Fran\u00e7oise durand<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5fb4b9f elementor-shape-rounded elementor-grid-0 e-grid-align-center elementor-widget elementor-widget-social-icons\" data-id=\"5fb4b9f\" data-element_type=\"widget\" data-widget_type=\"social-icons.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-social-icons-wrapper elementor-grid\">\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-hm-envelop elementor-repeater-item-8ef4679\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">Hm-envelop<\/span>\n\t\t\t\t\t\t<i class=\"hm hm-envelop\"><\/i>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-youtube elementor-repeater-item-c3ba047\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">Youtube<\/span>\n\t\t\t\t\t\t<i class=\"fab fa-youtube\"><\/i>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-linkedin elementor-repeater-item-b144531\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">Linkedin<\/span>\n\t\t\t\t\t\t<i class=\"fab fa-linkedin\"><\/i>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-839d9d3 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"839d9d3\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-715405e\" data-id=\"715405e\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-e7416a2 elementor-widget elementor-widget-text-editor\" data-id=\"e7416a2\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: justify;\">Le cours<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-bb18985 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"bb18985\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-1fc8c9c elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"1fc8c9c\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-29d4c3e\" data-id=\"29d4c3e\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5672b97 elementor-widget elementor-widget-toggle\" data-id=\"5672b97\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-9061\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-9061\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Plan du cours<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-9061\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-9061\"><p><strong>Dur\u00e9e totale : 2 heures<\/strong><\/p><ol><li><strong>Introduction \u00e0 l&#8217;infection cong\u00e9nitale \u00e0 CMV <\/strong>(10 min)<ul><li>D\u00e9finition et importance clinique<\/li><li>\u00c9pid\u00e9miologie et pathophysiologie<\/li><\/ul><\/li><li><strong>Strat\u00e9gies de pr\u00e9vention primaire et secondaire<\/strong> (20 min)<ul><li>Mesures d&#8217;hygi\u00e8ne<\/li><li>R\u00f4le potentiel des vaccins<\/li><li>Utilisation du valaciclovir et des immunoglobulines<\/li><\/ul><\/li><li><strong>D\u00e9pistage et diagnostic pr\u00e9natal<\/strong> (30 min)<ul><li>Algorithmes s\u00e9rologiques (IgG\/IgM, avidit\u00e9)<\/li><li>R\u00f4le de l\u2019amniocent\u00e8se et du PCR<\/li><\/ul><\/li><li><strong>Options th\u00e9rapeutiques pr\u00e9natales et n\u00e9onatales<\/strong> (20 min)<ul><li>Traitements antiviraux : valaciclovir et valganciclovir<\/li><li>Suivi des nouveau-n\u00e9s symptomatiques<\/li><\/ul><\/li><li><strong>Gestion postnatale et suivi \u00e0 long terme<\/strong> (20 min)<ul><li>S\u00e9quelles potentielles (surdit\u00e9, retard neurologique)<\/li><li>Protocoles de suivi jusqu\u2019\u00e0 l\u2019\u00e2ge scolaire<\/li><\/ul><\/li><li><strong>Discussion et \u00e9tudes de cas<\/strong> (20 min)<ul><li>Exemples pratiques bas\u00e9s sur les m\u00e9ta-analyses<\/li><li>Questions ouvertes<\/li><\/ul><\/li><\/ol><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-9062\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-9062\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Chapitre 1 : Introduction au CMV Cong\u00e9nital <\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-9062\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-9062\"><p><strong>1.1. Qu\u2019est-ce que le CMV ?<\/strong><\/p><p><strong>Caract\u00e9ristiques biologiques<\/strong><\/p><ul><li><strong>Famille des herpesvirus :<\/strong><ul><li>Virus ADN double brin.<\/li><li>Propri\u00e9t\u00e9 de latence : persiste dans les cellules h\u00f4tes apr\u00e8s une infection primaire.<\/li><li>Peut se r\u00e9activer en cas d\u2019immunosuppression.<\/li><\/ul><\/li><li><strong>Modes de transmission :<\/strong><ul><li><strong>Contact direct avec les fluides corporels :<\/strong><ul><li>Salive, urine, lait maternel, s\u00e9cr\u00e9tions g\u00e9nitales.<\/li><\/ul><\/li><li><strong>Transmission verticale :<\/strong><ul><li>Pendant la grossesse (placenta), l\u2019accouchement ou l\u2019allaitement.<\/li><\/ul><\/li><\/ul><\/li><li><strong>Pr\u00e9valence :<\/strong><ul><li>Le CMV infecte 50 % \u00e0 90 % de la population adulte mondiale.<\/li><li>L\u2019infection est souvent asymptomatique chez les individus immunocomp\u00e9tents.<\/li><\/ul><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>Le CMV est un virus ubiquitaire, souvent b\u00e9nin, mais ses cons\u00e9quences peuvent \u00eatre graves lorsqu\u2019il est transmis au f\u0153tus. Sa propri\u00e9t\u00e9 de latence et sa capacit\u00e9 de r\u00e9activation compliquent sa gestion.<\/p><p><strong>1.2. \u00c9pid\u00e9miologie mondiale du CMV cong\u00e9nital<\/strong><\/p><p><strong>Pr\u00e9valence de l\u2019infection cong\u00e9nitale<\/strong><\/p><ul><li><strong>Taux global :<\/strong><ul><li>0,64 % \u00e0 2,2 % des naissances dans le monde.<\/li><li>Variation selon les r\u00e9gions :<ul><li>Pr\u00e9valence plus \u00e9lev\u00e9e dans les pays \u00e0 faibles ressources (environ 1 % \u00e0 5 %).<\/li><li>Pr\u00e9valence plus faible dans les pays d\u00e9velopp\u00e9s (environ 0,3 % \u00e0 1 %).<\/li><\/ul><\/li><\/ul><\/li><li><strong>Caract\u00e9ristiques des infections maternelles :<\/strong><ul><li>50 % des cas dus \u00e0 une infection primaire pendant la grossesse.<\/li><li>50 % dus \u00e0 une r\u00e9activation ou \u00e0 une r\u00e9infection (g\u00e9n\u00e9ralement moins graves).<\/li><\/ul><\/li><\/ul><p><strong>Facteurs de risque<\/strong><\/p><ul><li><strong>Exposition aux enfants en bas \u00e2ge :<\/strong><ul><li>Les jeunes enfants excr\u00e8tent le virus dans leur salive et leur urine pendant plusieurs mois apr\u00e8s une infection.<\/li><li>Professionnels de la petite enfance \u00e0 risque \u00e9lev\u00e9.<\/li><\/ul><\/li><li><strong>Statut s\u00e9rologique :<\/strong><ul><li>Femmes s\u00e9ron\u00e9gatives : pas d\u2019immunit\u00e9 contre le CMV.<\/li><li>Risque accru lors d\u2019une grossesse rapproch\u00e9e d\u2019une pr\u00e9c\u00e9dente grossesse.<\/li><\/ul><\/li><\/ul><p><strong>Transmission verticale<\/strong><\/p><ul><li>Risque de transmission verticale en fonction du moment de l\u2019infection maternelle :<ul><li>30 % au premier trimestre.<\/li><li>40 % au deuxi\u00e8me trimestre.<\/li><li>66 % au troisi\u00e8me trimestre.<\/li><\/ul><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>Bien que la transmission soit plus fr\u00e9quente en fin de grossesse, les infections pr\u00e9coces (premier trimestre) sont associ\u00e9es aux s\u00e9quelles les plus graves. Ces diff\u00e9rences doivent \u00eatre clairement expliqu\u00e9es pour guider la pr\u00e9vention et la prise en charge.<\/p><p><strong>1.3. Cons\u00e9quences cliniques du CMV cong\u00e9nital<\/strong><\/p><p><strong>Chez le f\u0153tus<\/strong><\/p><ul><li><strong>Manifestations graves associ\u00e9es aux infections du premier trimestre :<\/strong><ul><li>Microc\u00e9phalie.<\/li><li>Calcifications intracr\u00e2niennes.<\/li><li>Retard de croissance intra-ut\u00e9rin (RCIU).<\/li><li>Hydramnios ou oligohydramnios.<\/li><\/ul><\/li><li><strong>Signes \u00e9chographiques possibles :<\/strong><ul><li>Ascite, h\u00e9patospl\u00e9nom\u00e9galie.<\/li><li>Dilatation ventriculaire c\u00e9r\u00e9brale.<\/li><li>Troubles du d\u00e9veloppement cortical (polymicrogyrie, ag\u00e9n\u00e9sie du corps calleux).<\/li><\/ul><\/li><\/ul><p><strong>\u00c0 la naissance<\/strong><\/p><ul><li><strong>Nouveau-n\u00e9s symptomatiques (10 % des cas) :<\/strong><ul><li>Troubles neurologiques : convulsions, hypotonie, retard mental.<\/li><li>Probl\u00e8mes sensoriels : surdit\u00e9, atteinte visuelle.<\/li><li>Manifestations h\u00e9matologiques : thrombocytop\u00e9nie, an\u00e9mie.<\/li><\/ul><\/li><li><strong>Nouveau-n\u00e9s asymptomatiques (90 % des cas) :<\/strong><ul><li>Risque de s\u00e9quelles tardives, principalement une surdit\u00e9 neurosensorielle progressive (12 %).<\/li><\/ul><\/li><\/ul><p><strong>\u00c0 long terme<\/strong><\/p><ul><li><strong>S\u00e9quelles permanentes :<\/strong><ul><li>Premi\u00e8re cause non g\u00e9n\u00e9tique de surdit\u00e9 neurosensorielle.<\/li><li>Retard mental et cognitif.<\/li><li>Troubles moteurs et \u00e9pilepsie.<\/li><\/ul><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>Les s\u00e9quelles d\u00e9pendent principalement du moment de l\u2019infection pendant la grossesse. Les l\u00e9sions c\u00e9r\u00e9brales pr\u00e9coces sont souvent irr\u00e9versibles et responsables des handicaps les plus graves.<\/p><p><strong>1.4. Physiopathologie de la transmission verticale<\/strong><\/p><p><strong>\u00c9tapes de l\u2019infection materno-f\u0153tale<\/strong><\/p><ol><li><strong>Infection maternelle primaire ou r\u00e9activation :<\/strong><ul><li>Le virus infecte les cellules \u00e9pith\u00e9liales et se propage dans le sang.<\/li><\/ul><\/li><li><strong>Infection du placenta :<\/strong><ul><li>Le CMV traverse la barri\u00e8re placentaire, souvent via les cellules trophoblastiques.<\/li><li>Le placenta agit comme un r\u00e9servoir, favorisant la transmission au f\u0153tus.<\/li><\/ul><\/li><li><strong>Infection f\u0153tale :<\/strong><ul><li>Propagation syst\u00e9mique dans les organes f\u0153taux : cerveau, foie, rein, oreille interne.<\/li><li>Atteinte du syst\u00e8me nerveux central (CNS) : cible principale des l\u00e9sions graves.<\/li><\/ul><\/li><\/ol><p><strong>Facteurs influen\u00e7ant la gravit\u00e9<\/strong><\/p><ul><li><strong>Charge virale maternelle :<\/strong> Plus \u00e9lev\u00e9e en cas d\u2019infection primaire.<\/li><li><strong>Moment de l\u2019infection :<\/strong><ul><li>Premier trimestre : atteinte du CNS et anomalies graves.<\/li><li>Troisi\u00e8me trimestre : atteinte multi-organes, g\u00e9n\u00e9ralement moins s\u00e9v\u00e8re.<\/li><\/ul><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>La physiopathologie explique pourquoi une prise en charge rapide et cibl\u00e9e est essentielle pour r\u00e9duire la transmission et les complications.<\/p><p><strong>1.5. Importance du CMV comme probl\u00e8me de sant\u00e9 publique<\/strong><\/p><p><strong>Impact sur la sant\u00e9 mondiale<\/strong><\/p><ul><li>Premi\u00e8re cause d\u2019infection cong\u00e9nitale dans le monde.<\/li><li>Responsable de 8 000 cas de s\u00e9quelles neurologiques par an aux \u00c9tats-Unis, surpassant les maladies comme la rub\u00e9ole cong\u00e9nitale.<\/li><\/ul><p><strong>Co\u00fbt pour la soci\u00e9t\u00e9<\/strong><\/p><ul><li>Co\u00fbts m\u00e9dicaux directs : hospitalisations, traitements antiviraux, appareillages auditifs.<\/li><li>Co\u00fbts indirects : soutien \u00e9ducatif, prise en charge des handicaps \u00e0 long terme.<\/li><\/ul><p><strong>Absence de vaccination<\/strong><\/p><ul><li>Contrairement \u00e0 d&#8217;autres infections cong\u00e9nitales (ex. : rub\u00e9ole), il n\u2019existe pas encore de vaccin approuv\u00e9 pour le CMV.<\/li><li>Les efforts de pr\u00e9vention reposent actuellement sur des strat\u00e9gies comportementales et m\u00e9dicales.<\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>Le CMV repr\u00e9sente une priorit\u00e9 en sant\u00e9 publique en raison de sa pr\u00e9valence \u00e9lev\u00e9e, de son impact sur les nouveau-n\u00e9s et des d\u00e9fis li\u00e9s \u00e0 sa pr\u00e9vention.<\/p><p><strong>Conclusion du Chapitre 1<\/strong><\/p><p><strong>Synth\u00e8se<\/strong><\/p><ul><li>Le CMV est une infection fr\u00e9quente, b\u00e9nigne chez les adultes, mais pouvant entra\u00eener des s\u00e9quelles graves chez les f\u0153tus infect\u00e9s.<\/li><li>Sa transmission verticale est influenc\u00e9e par le moment de l\u2019infection et le statut immunitaire de la m\u00e8re.<\/li><li>Il constitue un enjeu majeur en sant\u00e9 publique n\u00e9cessitant une pr\u00e9vention efficace.<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-9063\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-9063\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Chapitre 2 : Strat\u00e9gies de Pr\u00e9vention Primaire et Secondaire <\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-9063\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-9063\"><p><strong>Pr\u00e9vention Primaire : \u00c9viter l\u2019infection initiale chez les femmes enceintes<\/strong><\/p><ol><li><strong> Sensibilisation et \u00e9ducation<\/strong><\/li><\/ol><ul><li><strong>Public cible :<\/strong><ul><li>Femmes enceintes s\u00e9ron\u00e9gatives.<\/li><li>Professionnels de sant\u00e9.<\/li><li>Travailleuses dans des cr\u00e8ches ou des \u00e9coles maternelles.<\/li><\/ul><\/li><li><strong>Objectifs :<\/strong><ul><li>Informer sur le risque de transmission.<\/li><li>Promouvoir les mesures d\u2019hygi\u00e8ne adapt\u00e9es.<\/li><\/ul><\/li><li><strong>Moyens :<\/strong><ul><li>Campagnes de sensibilisation via consultations pr\u00e9natales.<\/li><li>Supports \u00e9ducatifs (brochures, vid\u00e9os).<\/li><li>Inclusion du CMV dans les programmes de formation m\u00e9dicale et param\u00e9dicale.<\/li><\/ul><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>Les femmes s\u00e9ron\u00e9gatives ne disposent pas d&#8217;immunit\u00e9 contre le CMV et sont \u00e0 risque \u00e9lev\u00e9 d\u2019infection primaire. Sensibiliser t\u00f4t dans la grossesse ou id\u00e9alement en phase pr\u00e9conceptionnelle permet de r\u00e9duire ce risque.<\/p><ol start=\"2\"><li><strong> Mesures d\u2019hygi\u00e8ne pour r\u00e9duire la transmission<\/strong><\/li><\/ol><ul><li><strong>Recommandations cl\u00e9s :<\/strong><ul><li>Lavage des mains fr\u00e9quent, surtout apr\u00e8s contact avec des enfants.<\/li><li>\u00c9viter de partager :<ul><li>Ustensiles (cuill\u00e8res, fourchettes).<\/li><li>Verres ou bouteilles.<\/li><li>Nourriture.<\/li><\/ul><\/li><li>Ne pas embrasser les jeunes enfants sur la bouche ou les joues.<\/li><li>D\u00e9sinfecter r\u00e9guli\u00e8rement les surfaces touch\u00e9es par les enfants (jouets, chaises hautes).<\/li><\/ul><\/li><li><strong>Efficacit\u00e9 prouv\u00e9e :<\/strong><ul><li>Une \u00e9tude contr\u00f4l\u00e9e (Revello et al.) a montr\u00e9 une r\u00e9duction de 87 % des s\u00e9roconversions gr\u00e2ce \u00e0 ces mesures.<\/li><\/ul><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>Ces mesures sont simples mais n\u00e9cessitent un engagement constant des femmes enceintes et de leur entourage. Les professionnels doivent expliquer que le contact avec les fluides corporels des jeunes enfants est la source principale d&#8217;infection.<\/p><ol start=\"3\"><li><strong> Pr\u00e9vention pr\u00e9conceptionnelle<\/strong><\/li><\/ol><ul><li><strong>D\u00e9pistage s\u00e9rologique avant la grossesse :<\/strong><ul><li>Identifier les femmes s\u00e9ron\u00e9gatives.<\/li><li>Informer ces femmes des risques et des strat\u00e9gies de pr\u00e9vention.<\/li><\/ul><\/li><li><strong>Suivi rapproch\u00e9 pendant les tentatives de conception :<\/strong><ul><li>Contr\u00f4les s\u00e9rologiques r\u00e9guliers pour d\u00e9tecter une infection primaire r\u00e9cente.<\/li><\/ul><\/li><li><strong>Vaccins en d\u00e9veloppement :<\/strong><ul><li>Candidats vaccins en phase I\/II.<\/li><li>Vaccins bas\u00e9s sur la glycoprot\u00e9ine B (gB) et le complexe pentam\u00e9rique.<\/li><\/ul><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>Bien qu&#8217;aucun vaccin ne soit actuellement disponible, les recherches en cours offrent des perspectives prometteuses pour la pr\u00e9vention du CMV.<\/p><p><strong>Pr\u00e9vention Secondaire : R\u00e9duire la transmission verticale apr\u00e8s une infection primaire<\/strong><\/p><ol><li><strong> Hyperimmunoglobulines (HIG)<\/strong><\/li><\/ol><ul><li><strong>M\u00e9canisme d\u2019action :<\/strong><ul><li>Neutralisation directe du virus.<\/li><li>Stimulation des d\u00e9fenses immunitaires maternelles.<\/li><\/ul><\/li><li><strong>Efficacit\u00e9 :<\/strong><ul><li>\u00c9tudes contradictoires :<ul><li>Revello et al. (2014) : Pas de r\u00e9duction significative de la transmission verticale.<\/li><li>Kagan et al. (2021) : Transmission r\u00e9duite de 35 % \u00e0 7,5 % avec des doses plus \u00e9lev\u00e9es et des administrations plus fr\u00e9quentes.<\/li><\/ul><\/li><\/ul><\/li><li><strong>Limites :<\/strong><ul><li>Administration optimale dans les 10 jours suivant l\u2019infection.<\/li><li>Co\u00fbt \u00e9lev\u00e9.<\/li><li>Disponibilit\u00e9 limit\u00e9e.<\/li><li>Effets secondaires possibles : r\u00e9actions allergiques, pr\u00e9maturit\u00e9.<\/li><\/ul><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>Les HIG ne sont pas encore standardis\u00e9es dans les protocoles de pr\u00e9vention, mais elles restent une option dans des contextes sp\u00e9cifiques.<\/p><ol start=\"2\"><li><strong> Antiviraux : Valaciclovir<\/strong><\/li><\/ol><ul><li><strong>M\u00e9canisme d\u2019action :<\/strong><ul><li>Inhibition de la r\u00e9plication virale via l\u2019ADN polym\u00e9rase.<\/li><li>R\u00e9duction de la charge virale maternelle et du risque de transmission placentaire.<\/li><\/ul><\/li><li><strong>Efficacit\u00e9 :<\/strong><ul><li>R\u00e9duction de 70 % du risque de transmission verticale.<\/li><li>R\u00e9sultats plus significatifs lorsque le traitement est administr\u00e9 au premier trimestre.<\/li><\/ul><\/li><li><strong>Dosage et administration :<\/strong><ul><li>Dose recommand\u00e9e : 8 g\/jour (4 prises de 2 g).<\/li><li>Dur\u00e9e : jusqu\u2019\u00e0 l\u2019amniocent\u00e8se ou la fin du premier trimestre.<\/li><\/ul><\/li><li><strong>Effets secondaires et suivi :<\/strong><ul><li>Effets secondaires fr\u00e9quents : maux de t\u00eate, naus\u00e9es, troubles r\u00e9naux.<\/li><li>Surveillance biologique r\u00e9guli\u00e8re (fonction r\u00e9nale, num\u00e9ration globulaire).<\/li><\/ul><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>Le valaciclovir est une option th\u00e9rapeutique efficace, particuli\u00e8rement pour les infections primaires d\u00e9tect\u00e9es t\u00f4t. Cependant, son utilisation n\u00e9cessite une surveillance stricte pour \u00e9viter les complications.<\/p><ol start=\"3\"><li><strong> Surveillance \u00e9chographique rapproch\u00e9e<\/strong><\/li><\/ol><ul><li><strong>Objectifs :<\/strong><ul><li>Identifier les signes pr\u00e9coces d\u2019infection f\u0153tale.<\/li><li>Surveiller l\u2019\u00e9volution des anomalies.<\/li><\/ul><\/li><li><strong>Signes \u00e0 rechercher :<\/strong><ul><li>Microc\u00e9phalie.<\/li><li>Calcifications intracr\u00e2niennes.<\/li><li>RCIU (retard de croissance intra-ut\u00e9rin).<\/li><li>Ascite ou hydramnios.<\/li><\/ul><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>Une surveillance \u00e9chographique r\u00e9guli\u00e8re permet d\u2019adapter les d\u00e9cisions cliniques, y compris la planification de l\u2019amniocent\u00e8se ou le traitement antiviral.<\/p><ol start=\"4\"><li><strong> Amniocent\u00e8se et PCR sur liquide amniotique<\/strong><\/li><\/ol><ul><li><strong>Indications :<\/strong><ul><li>Faible avidit\u00e9 des IgG chez la m\u00e8re.<\/li><li>Signes \u00e9chographiques suspects.<\/li><\/ul><\/li><li><strong>Moment optimal :<\/strong><ul><li>Apr\u00e8s 17 semaines de gestation.<\/li><li>Au moins 6-8 semaines apr\u00e8s l\u2019infection primaire.<\/li><\/ul><\/li><li><strong>R\u00e9sultats :<\/strong><ul><li>PCR positive : confirmation de l\u2019infection f\u0153tale.<\/li><li>PCR n\u00e9gative : faible risque de s\u00e9quelles graves.<\/li><\/ul><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>L\u2019amniocent\u00e8se reste le gold standard pour confirmer l\u2019infection f\u0153tale, mais elle doit \u00eatre utilis\u00e9e de mani\u00e8re judicieuse pour \u00e9viter des interventions inutiles.<\/p><p><strong>Conclusion du chapitre<\/strong><\/p><ol start=\"5\"><li><strong> Points cl\u00e9s<\/strong><\/li><\/ol><ul><li>La pr\u00e9vention primaire repose sur des mesures d\u2019hygi\u00e8ne simples mais efficaces.<\/li><li>La pr\u00e9vention secondaire est possible gr\u00e2ce aux antiviraux (valaciclovir) et, dans certains cas, aux HIG.<\/li><li>La d\u00e9tection pr\u00e9coce de l\u2019infection primaire est essentielle pour maximiser l\u2019efficacit\u00e9 des interventions.<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-9064\" class=\"elementor-tab-title\" data-tab=\"4\" role=\"button\" aria-controls=\"elementor-tab-content-9064\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Chapitre 3 : D\u00e9pistage et Diagnostic <\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-9064\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"4\" role=\"region\" aria-labelledby=\"elementor-tab-title-9064\"><p><strong>3.1. Importance du d\u00e9pistage pr\u00e9natal dans le CMV cong\u00e9nital<\/strong><\/p><p><strong>Objectifs principaux :<\/strong><\/p><ul><li><p>Identifier les femmes \u00e0 risque d\u2019infection primaire au CMV pendant la grossesse.<\/p><\/li><li><p>D\u00e9tecter pr\u00e9cocement les infections maternelles primaires pour pr\u00e9venir la transmission verticale.<\/p><\/li><li><p>\u00c9valuer le risque d\u2019infection f\u0153tale et les complications associ\u00e9es.<\/p><\/li><li><p>Guider les d\u00e9cisions th\u00e9rapeutiques et les options de suivi pr\u00e9natal.<\/p><\/li><\/ul><p>Impact clinique<\/p><ul><li><p>Une d\u00e9tection pr\u00e9coce permet d\u2019initier des interventions pr\u00e9ventives comme le traitement antiviral ou la surveillance \u00e9chographique rapproch\u00e9e.<\/p><\/li><li><p>Elle contribue \u00e9galement \u00e0 rassurer les patientes en absence de risque significatif.<\/p><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>L\u2019objectif est de r\u00e9duire le risque de transmission verticale et d\u2019am\u00e9liorer les r\u00e9sultats pour le f\u0153tus et le nouveau-n\u00e9 gr\u00e2ce \u00e0 une prise en charge adapt\u00e9e.<\/p><p><strong>3.2. Algorithme de d\u00e9pistage pr\u00e9natal<\/strong><\/p><p><strong><em>\u00c9tape 1 : Test s\u00e9rologique initial<\/em><\/strong><\/p><ul><li><p>Tests syst\u00e9matiques au premier trimestre (6-12 semaines).<\/p><\/li><li><p>Analyse des anticorps IgG et IgM :<\/p><ul><li><p><strong>IgG positif, IgM n\u00e9gatif :<\/strong> Immunit\u00e9 ancienne, pas de risque d\u2019infection primaire.<\/p><\/li><li><p><strong>IgG n\u00e9gatif, IgM n\u00e9gatif :<\/strong> Femme s\u00e9ron\u00e9gative, \u00e0 risque d\u2019infection primaire.<\/p><\/li><li><p><strong>IgG et IgM positifs :<\/strong> Infection r\u00e9cente ou r\u00e9activation.<\/p><\/li><\/ul><\/li><\/ul><p><strong><em>\u00c9tape 2 : Analyse de l\u2019avidit\u00e9 des IgG<\/em><\/strong><\/p><ul><li><p><strong>Faible avidit\u00e9 :<\/strong> Infection r\u00e9cente (&lt;3 mois), risque accru de transmission verticale.<\/p><\/li><li><p><strong>Forte avidit\u00e9 :<\/strong> Infection ancienne (&gt;3 mois), pas de risque significatif.<\/p><\/li><li><p><strong>Avidit\u00e9 interm\u00e9diaire :<\/strong> Interpr\u00e9tation prudente, n\u00e9cessite des investigations suppl\u00e9mentaires.<\/p><\/li><\/ul><p><strong><em>\u00c9tape 3 : Surveillance pour les femmes \u00e0 risque<\/em><\/strong><\/p><ul><li><p>Si s\u00e9ron\u00e9gative (IgG\/IgM n\u00e9gatif) :<\/p><ul><li><p>Surveillance mensuelle ou bimensuelle pour d\u00e9tecter une \u00e9ventuelle s\u00e9roconversion.<\/p><\/li><\/ul><\/li><li><p>Si infection r\u00e9cente (IgM positif, faible avidit\u00e9 IgG) :<\/p><ul><li><p>\u00c9valuation clinique, \u00e9chographique, et potentiellement traitement antiviral (valaciclovir).<\/p><\/li><\/ul><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>Un algorithme bien d\u00e9fini permet d\u2019identifier rapidement les cas n\u00e9cessitant une prise en charge sp\u00e9cialis\u00e9e tout en \u00e9vitant les investigations inutiles.<\/p><p><strong>3.3. Diagnostic de l\u2019infection maternelle<\/strong><\/p><p><strong><em>1. Signes cliniques<\/em><\/strong><\/p><ul><li><p>La plupart des infections maternelles primaires sont asymptomatiques.<\/p><\/li><li><p>Signes possibles :<\/p><ul><li><p>Fi\u00e8vre l\u00e9g\u00e8re.<\/p><\/li><li><p>Sympt\u00f4mes pseudo-grippaux.<\/p><\/li><li><p>Ad\u00e9nopathies cervicales.<\/p><\/li><\/ul><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>Les sympt\u00f4mes \u00e9tant souvent banals ou absents, un diagnostic bas\u00e9 uniquement sur la clinique est difficile. La s\u00e9rologie est donc essentielle.<\/p><p><strong><em>2. Outils diagnostiques<\/em><\/strong><\/p><ul><li><p><strong>S\u00e9rologie CMV :<\/strong><\/p><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li><p>Tests de routine pour IgG et IgM.<\/p><\/li><li><p>Confirmation par avidit\u00e9 des IgG si IgM positif.<\/p><\/li><\/ul><\/li><\/ul><ul><li><p><strong>PCR sanguin :<\/strong><\/p><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li><p>Recherche de l\u2019ADN viral dans le sang maternel.<\/p><\/li><li><p>Indiqu\u00e9 dans les cas complexes ou si la s\u00e9rologie est ambigu\u00eb.<\/p><\/li><\/ul><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>La s\u00e9rologie est le pilier du diagnostic maternel, mais la PCR peut \u00eatre utile pour confirmer une infection active, surtout dans les cas difficiles.<\/p><p><strong>3.4. Diagnostic de l\u2019infection f\u0153tale<\/strong><\/p><p><strong><em>1. Amniocent\u00e8se<\/em><\/strong><\/p><ul><li><p><strong>Indications :<\/strong><\/p><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li><p>Faible avidit\u00e9 des IgG chez la m\u00e8re.<\/p><\/li><li><p>Signes \u00e9chographiques \u00e9vocateurs d\u2019une infection f\u0153tale.<\/p><\/li><li><p>PCR sanguine maternelle positive.<\/p><\/li><\/ul><\/li><\/ul><ul><li><p><strong>Moment optimal :<\/strong><\/p><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li><p>Apr\u00e8s 17 semaines de grossesse.<\/p><\/li><li><p>Au moins 6-8 semaines apr\u00e8s l\u2019infection maternelle pr\u00e9sum\u00e9e pour maximiser la sensibilit\u00e9.<\/p><\/li><\/ul><\/li><\/ul><ul><li><p><strong>R\u00e9sultats :<\/strong><\/p><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li><p><strong>PCR positive sur liquide amniotique :<\/strong> Confirmation de l\u2019infection f\u0153tale.<\/p><\/li><li><p><strong>PCR n\u00e9gative :<\/strong> Exclusion probable d\u2019une infection, avec un risque faible de s\u00e9quelles.<\/p><\/li><\/ul><\/li><\/ul><p><strong><em>2. Diagnostic diff\u00e9rentiel<\/em><\/strong><\/p><ul><li><p>Une PCR n\u00e9gative n\u2019exclut pas totalement une infection tardive.<\/p><\/li><li><p>Les infections tardives (apr\u00e8s le troisi\u00e8me trimestre) sont rarement associ\u00e9es \u00e0 des s\u00e9quelles graves.<\/p><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>L\u2019amniocent\u00e8se est une proc\u00e9dure invasive, mais elle reste le gold standard pour diagnostiquer une infection f\u0153tale. Sa r\u00e9alisation doit \u00eatre justifi\u00e9e par des \u00e9l\u00e9ments cliniques et biologiques solides.<\/p><p><strong>3.5. Surveillance \u00e9chographique pr\u00e9natale<\/strong><\/p><p><strong><em>1. R\u00f4le de l\u2019\u00e9chographie dans le d\u00e9pistage des complications<\/em><\/strong><\/p><ul><li><p>D\u00e9tecter les anomalies \u00e9vocatrices d\u2019une infection f\u0153tale :<\/p><ul><li><p><strong>C\u00e9r\u00e9brales :<\/strong> Microc\u00e9phalie, calcifications intracr\u00e2niennes, ventriculom\u00e9galie.<\/p><\/li><li><p><strong>Syst\u00e9miques :<\/strong> H\u00e9patospl\u00e9nom\u00e9galie, ascite, hydramnios.<\/p><\/li><\/ul><\/li><\/ul><p><strong><em>2. Intervalles de suivi \u00e9chographique<\/em><\/strong><\/p><ul><li><p>\u00c9chographies r\u00e9guli\u00e8res tous les 2 \u00e0 4 semaines pour suivre l\u2019\u00e9volution.<\/p><\/li><li><p>IRM f\u0153tale recommand\u00e9e en cas d\u2019anomalies c\u00e9r\u00e9brales \u00e0 l\u2019\u00e9chographie.<\/p><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>L\u2019\u00e9chographie permet d\u2019\u00e9valuer la gravit\u00e9 de l\u2019infection et d\u2019aider \u00e0 la planification des interventions, y compris une \u00e9ventuelle interruption m\u00e9dicale de grossesse.<\/p><p><strong>3.6. Diagnostic n\u00e9onatal<\/strong><\/p><p><strong><em>1. Identification des nouveau-n\u00e9s \u00e0 risque<\/em><\/strong><\/p><ul><li><p>PCR sur les urines ou la salive dans les 3 semaines suivant la naissance.<\/p><\/li><li><p>\u00c9valuation clinique approfondie :<\/p><ul><li><p>Tests auditifs.<\/p><\/li><li><p>Imagerie c\u00e9r\u00e9brale (IRM ou \u00e9chographie transfontanellaire).<\/p><\/li><\/ul><\/li><\/ul><p><strong><em>2. Diff\u00e9renciation entre infection cong\u00e9nitale et postnatale<\/em><\/strong><\/p><ul><li><p>Infection cong\u00e9nitale confirm\u00e9e si PCR positive dans les 3 semaines suivant la naissance.<\/p><\/li><li><p>Une infection diagnostiqu\u00e9e apr\u00e8s cette p\u00e9riode est probablement postnatale.<\/p><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>Un diagnostic pr\u00e9cis est essentiel pour initier un traitement antiviral chez les nouveau-n\u00e9s symptomatiques et planifier un suivi prolong\u00e9.<\/p><p><strong>Conclusion du chapitre<\/strong><\/p><p><strong><em>R\u00e9sum\u00e9 des points cl\u00e9s<\/em><\/strong><\/p><ul><li><p><strong>D\u00e9pistage maternel :<\/strong><\/p><ul><li><p>Test s\u00e9rologique IgG\/IgM, suivi par l\u2019avidit\u00e9 des IgG en cas de positivit\u00e9.<\/p><\/li><\/ul><\/li><li><p><strong>Diagnostic f\u0153tal :<\/strong><\/p><ul><li><p>Amniocent\u00e8se et PCR sur liquide amniotique, combin\u00e9es \u00e0 des examens \u00e9chographiques.<\/p><\/li><\/ul><\/li><li><p><strong>Importance du diagnostic pr\u00e9coce :<\/strong><\/p><ul><li><p>Permet d\u2019initier des interventions th\u00e9rapeutiques et de planifier le suivi pr\u00e9natal et n\u00e9onatal.<\/p><\/li><\/ul><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>Le d\u00e9pistage et le diagnostic pr\u00e9natal sont essentiels pour g\u00e9rer efficacement les infections \u00e0 CMV cong\u00e9nital, r\u00e9duisant ainsi les s\u00e9quelles \u00e0 long terme.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-9ed176a\" data-id=\"9ed176a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-130535d elementor-widget elementor-widget-toggle\" data-id=\"130535d\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1991\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-1991\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Chapitre 4 : Options Th\u00e9rapeutiques Pr\u00e9natales et N\u00e9onatales <\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1991\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-1991\"><p><strong>4.1. Traitement pr\u00e9natal : Pr\u00e9venir la transmission verticale<\/strong><\/p><p><strong>1. Valaciclovir<\/strong><\/p><ul><li><strong>M\u00e9canisme d\u2019action :<\/strong><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>Pro-m\u00e9dicament du valine-acyclovir, qui inhibe la r\u00e9plication de l\u2019ADN viral en bloquant l\u2019ADN polym\u00e9rase du CMV.<\/li><li>R\u00e9duit la charge virale maternelle et limite le passage transplacentaire du virus.<\/li><\/ul><\/li><\/ul><ul><li><strong>Efficacit\u00e9 clinique :<\/strong><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>R\u00e9duction de 70 % des transmissions verticales lorsqu\u2019il est administr\u00e9 dans le premier trimestre.<\/li><li>Effets optimaux observ\u00e9s en cas d\u2019infection primaire r\u00e9cente et d\u00e9but rapide du traitement.<\/li><\/ul><\/li><\/ul><ul><li><strong>Posologie :<\/strong><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>8 g\/jour, administr\u00e9s en 4 prises (2 g toutes les 6 heures).<\/li><\/ul><\/li><\/ul><ul><li><strong>Effets secondaires :<\/strong><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>Effets fr\u00e9quents : naus\u00e9es, c\u00e9phal\u00e9es, troubles digestifs.<\/li><li>Effets rares : insuffisance r\u00e9nale aigu\u00eb, n\u00e9cessitant une surveillance biologique r\u00e9guli\u00e8re (cr\u00e9atinin\u00e9mie).<\/li><\/ul><\/li><\/ul><p><strong>2. Hyperimmunoglobulines (HIG)<\/strong><\/p><ul><li><strong>M\u00e9canisme d\u2019action :<\/strong><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>Neutralisation des particules virales dans le sang maternel et au niveau du placenta.<\/li><li>R\u00e9duction des titres viraux maternels.<\/li><\/ul><\/li><\/ul><ul><li><strong>Efficacit\u00e9 clinique :<\/strong><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>R\u00e9sultats variables :<ul><li>\u00c9tudes italiennes : r\u00e9duction significative de la transmission verticale (jusqu\u2019\u00e0 7,5 %).<\/li><li>\u00c9tudes am\u00e9ricaines (Revello et al.) : absence d\u2019efficacit\u00e9 d\u00e9montr\u00e9e.<\/li><\/ul><\/li><li>L\u2019administration pr\u00e9coce (&lt;10 jours apr\u00e8s l\u2019infection) semble cl\u00e9 pour maximiser l\u2019efficacit\u00e9.<\/li><\/ul><\/li><\/ul><ul><li><strong>Posologie et administration :<\/strong><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>Dose standard : 100-200 UI\/kg toutes les 2-4 semaines jusqu\u2019\u00e0 20-22 semaines de grossesse.<\/li><\/ul><\/li><\/ul><ul><li><strong>Effets secondaires :<\/strong><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>R\u00e9actions allergiques potentielles.<\/li><li>Risque accru de pr\u00e9maturit\u00e9 observ\u00e9 dans certaines \u00e9tudes.<\/li><\/ul><\/li><\/ul><p><strong>3. Surveillance \u00e9chographique et IRM<\/strong><\/p><ul><li><strong>R\u00f4le de l\u2019imagerie :<\/strong><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>Identifier les anomalies li\u00e9es \u00e0 l\u2019infection f\u0153tale.<\/li><li>D\u00e9terminer si le traitement antiviral doit \u00eatre poursuivi ou intensifi\u00e9.<\/li><\/ul><\/li><\/ul><ul><li><strong>Signes \u00e9chographiques \u00e9vocateurs :<\/strong><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>Microc\u00e9phalie, calcifications intracr\u00e2niennes.<\/li><li>H\u00e9patospl\u00e9nom\u00e9galie, ascite, retard de croissance intra-ut\u00e9rin (RCIU).<\/li><\/ul><\/li><\/ul><ul><li><strong>IRM c\u00e9r\u00e9brale :<\/strong><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>R\u00e9alis\u00e9e en compl\u00e9ment pour pr\u00e9ciser les l\u00e9sions c\u00e9r\u00e9brales (polymicrogyrie, atrophie corticale).<\/li><\/ul><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>Le traitement pr\u00e9natal est crucial pour r\u00e9duire la transmission verticale et limiter l\u2019impact de l\u2019infection sur le d\u00e9veloppement f\u0153tal. Les interventions doivent \u00eatre adapt\u00e9es au contexte clinique.<\/p><p><strong>4.2. Prise en charge n\u00e9onatale : Traitement des nouveau-n\u00e9s symptomatiques<\/strong><\/p><p><strong>1. Valganciclovir<\/strong><\/p><ul><li><strong>M\u00e9canisme d\u2019action :<\/strong><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>Inhibe la r\u00e9plication virale en bloquant l\u2019ADN polym\u00e9rase du CMV.<\/li><li>Pr\u00e9vient la progression des l\u00e9sions c\u00e9r\u00e9brales et des atteintes auditives.<\/li><\/ul><\/li><\/ul><ul><li><strong>Indications :<\/strong><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>Nouveau-n\u00e9s symptomatiques \u00e0 la naissance (atteinte neurologique, h\u00e9patospl\u00e9nom\u00e9galie, thrombocytop\u00e9nie).<\/li><li>Enfants \u00e0 risque \u00e9lev\u00e9 de s\u00e9quelles auditives progressives.<\/li><\/ul><\/li><\/ul><ul><li><strong>Posologie :<\/strong><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>Dose orale : 16 mg\/kg, administr\u00e9e deux fois par jour pendant 6 mois.<\/li><\/ul><\/li><\/ul><ul><li><strong>Efficacit\u00e9 clinique :<\/strong><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>R\u00e9duction des s\u00e9quelles auditives et neurologiques \u00e0 12 et 24 mois.<\/li><li>Pr\u00e9vention de la progression des l\u00e9sions c\u00e9r\u00e9brales.<\/li><\/ul><\/li><\/ul><ul><li><strong>Effets secondaires :<\/strong><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>Neutrop\u00e9nie (30-50 % des cas), n\u00e9cessitant une surveillance r\u00e9guli\u00e8re de l\u2019h\u00e9mogramme.<\/li><li>Autres : diarrh\u00e9es, anomalies h\u00e9patiques transitoires.<\/li><\/ul><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>Le valganciclovir est un traitement de r\u00e9f\u00e9rence pour les nouveau-n\u00e9s symptomatiques, mais sa tol\u00e9rance n\u00e9cessite une surveillance \u00e9troite.<\/p><p><strong>2. Suivi des nouveau-n\u00e9s asymptomatiques<\/strong><\/p><ul><li><strong>Crit\u00e8res de suivi :<\/strong><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>Infections confirm\u00e9es par PCR dans les 3 premi\u00e8res semaines de vie.<\/li><li>Enfants sans signes cliniques \u00e0 la naissance mais \u00e0 risque de surdit\u00e9 progressive.<\/li><\/ul><\/li><\/ul><ul><li><strong>Surveillance r\u00e9guli\u00e8re :<\/strong><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>Tests auditifs tous les 6 mois jusqu\u2019\u00e0 5 ans.<\/li><li>IRM c\u00e9r\u00e9brale en cas de suspicion de l\u00e9sions neurologiques tardives.<\/li><\/ul><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>M\u00eame les enfants asymptomatiques \u00e0 la naissance n\u00e9cessitent un suivi prolong\u00e9 pour d\u00e9tecter les complications tardives.<\/p><p><strong>3. Strat\u00e9gies de prise en charge multidisciplinaire<\/strong><\/p><ul><li><strong>\u00c9quipe sp\u00e9cialis\u00e9e :<\/strong><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>P\u00e9diatres infectiologues.<\/li><li>ORL pour la surveillance auditive.<\/li><li>Neurologues et psychologues pour le suivi du d\u00e9veloppement.<\/li><\/ul><\/li><\/ul><ul><li><strong>Objectifs :<\/strong><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>Pr\u00e9venir les complications gr\u00e2ce \u00e0 une intervention pr\u00e9coce.<\/li><li>Assurer une r\u00e9habilitation auditive si n\u00e9cessaire (appareils auditifs, implants cochl\u00e9aires).<\/li><\/ul><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>La collaboration entre sp\u00e9cialistes am\u00e9liore consid\u00e9rablement les r\u00e9sultats fonctionnels des enfants atteints de CMV cong\u00e9nital.<\/p><p><strong>4.3. Limites et d\u00e9fis des traitements actuels<\/strong><\/p><p><strong>1. Contraintes des antiviraux<\/strong><\/p><ul><li>Administration prolong\u00e9e (6 mois) n\u00e9cessaire pour maximiser les b\u00e9n\u00e9fices.<\/li><li>Effets secondaires fr\u00e9quents (h\u00e9matologiques, r\u00e9naux).<\/li><li>Compliance des familles parfois difficile \u00e0 maintenir.<\/li><\/ul><p><strong>2. Acc\u00e8s limit\u00e9 aux HIG<\/strong><\/p><ul><li>Co\u00fbt \u00e9lev\u00e9 des immunoglobulines.<\/li><li>Variabilit\u00e9 des r\u00e9sultats cliniques selon les \u00e9tudes, rendant leur utilisation controvers\u00e9e.<\/li><\/ul><p><strong>3. Absence de vaccination<\/strong><\/p><ul><li>Aucun vaccin approuv\u00e9 \u00e0 ce jour.<\/li><li>Vaccins en phase d\u2019essais cliniques (glycoprot\u00e9ine B, complexes pentam\u00e9riques).<\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>Malgr\u00e9 des progr\u00e8s significatifs, les options th\u00e9rapeutiques actuelles pr\u00e9sentent encore des limites, soulignant le besoin de recherche continue.<\/p><p><strong>4.4. Perspectives futures<\/strong><\/p><p><strong>1. D\u00e9veloppement de nouveaux antiviraux<\/strong><\/p><ul><li>Antiviraux plus cibl\u00e9s et mieux tol\u00e9r\u00e9s.<\/li><li>Formulations adapt\u00e9es pour les femmes enceintes et les nouveau-n\u00e9s.<\/li><\/ul><p><strong>2. Vaccins en d\u00e9veloppement<\/strong><\/p><ul><li>Vaccins contre le CMV bas\u00e9s sur des vecteurs viraux ou de l\u2019ARNm.<\/li><li>Objectif : pr\u00e9venir les infections primaires chez les femmes s\u00e9ron\u00e9gatives.<\/li><\/ul><p><strong>3. Am\u00e9lioration des strat\u00e9gies de suivi<\/strong><\/p><ul><li>Tests audiologiques avanc\u00e9s pour d\u00e9tecter les surdit\u00e9s progressives plus t\u00f4t.<\/li><li>Biomarqueurs pr\u00e9dictifs pour identifier les enfants \u00e0 risque \u00e9lev\u00e9 de complications.<\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>Les recherches en cours offrent des perspectives prometteuses pour am\u00e9liorer la pr\u00e9vention et le traitement des infections \u00e0 CMV cong\u00e9nital.<\/p><p><strong>Conclusion du Chapitre<\/strong><\/p><p><strong>R\u00e9sum\u00e9 des points cl\u00e9s<\/strong><\/p><ul><li>Les antiviraux (valaciclovir, valganciclovir) sont les traitements de r\u00e9f\u00e9rence pour pr\u00e9venir la transmission verticale et r\u00e9duire les s\u00e9quelles chez les nouveau-n\u00e9s symptomatiques.<\/li><li>Les HIG peuvent \u00eatre utiles dans des contextes sp\u00e9cifiques, mais leur efficacit\u00e9 reste controvers\u00e9e.<\/li><li>Une prise en charge multidisciplinaire et un suivi prolong\u00e9 sont essentiels pour am\u00e9liorer les r\u00e9sultats \u00e0 long terme.<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1992\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-1992\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Chapitre 5 : Gestion Postnatale et Suivi \u00e0 Long Terme <\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1992\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-1992\"><p><strong>5.1. Objectifs de la gestion postnatale<\/strong><\/p><p><strong>1. \u00c9valuer la gravit\u00e9 de l\u2019infection \u00e0 la naissance<\/strong><\/p><ul><li>Identifier les nouveau-n\u00e9s symptomatiques n\u00e9cessitant une prise en charge urgente.<\/li><li>\u00c9valuer les atteintes multisyst\u00e9miques, en particulier neurologiques, auditives et h\u00e9patiques.<\/li><\/ul><p><strong>2. Initier un traitement si n\u00e9cessaire<\/strong><\/p><ul><li><p>Prot\u00e9ger contre les complications imm\u00e9diates et pr\u00e9venir les s\u00e9quelles \u00e0 long terme.<\/p><\/li><\/ul><p><strong>3. Planifier un suivi \u00e0 long terme<\/strong><\/p><ul><li><p>Identifier les s\u00e9quelles tardives comme la surdit\u00e9 progressive ou les troubles neurod\u00e9veloppementaux.<\/p><\/li><li><p>Fournir un soutien \u00e9ducatif et m\u00e9dical adapt\u00e9 \u00e0 l\u2019enfant et \u00e0 sa famille.<\/p><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>La gestion postnatale est essentielle pour am\u00e9liorer les r\u00e9sultats \u00e0 long terme chez les enfants infect\u00e9s par le CMV. Elle n\u00e9cessite une approche multidisciplinaire et un suivi prolong\u00e9.<\/p><p><strong>5.2. Diagnostic postnatal<\/strong><\/p><p><strong>1. Confirmation de l\u2019infection cong\u00e9nitale<\/strong><\/p><ul><li><p><strong>PCR sur les urines ou la salive :<\/strong><\/p><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li><p>Doit \u00eatre r\u00e9alis\u00e9e dans les 3 premi\u00e8res semaines de vie.<\/p><\/li><li><p>Une PCR positive confirme l\u2019infection cong\u00e9nitale.<\/p><\/li><\/ul><\/li><\/ul><ul><li><p><strong>Diff\u00e9renciation infection cong\u00e9nitale vs postnatale :<\/strong><\/p><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li><p>Une infection diagnostiqu\u00e9e apr\u00e8s 3 semaines de vie est g\u00e9n\u00e9ralement postnatale, souvent asymptomatique et sans s\u00e9quelles graves.<\/p><\/li><\/ul><\/li><\/ul><p><strong>2. \u00c9valuation clinique initiale<\/strong><\/p><ul><li><p><strong>Examen physique complet :<\/strong><\/p><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li><p>Recherche de signes d\u2019infection active : h\u00e9patospl\u00e9nom\u00e9galie, ict\u00e8re, purpura.<\/p><\/li><li>Signes neurologiques : microc\u00e9phalie, hypotonie, convulsions.<\/li><\/ul><\/li><\/ul><ul><li><strong>Tests compl\u00e9mentaires :<\/strong><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>Num\u00e9ration formule sanguine (thrombocytop\u00e9nie, an\u00e9mie).<\/li><li>Fonction h\u00e9patique (transaminases, bilirubine).<\/li><li>\u00c9chographie transfontanellaire pour rechercher des anomalies c\u00e9r\u00e9brales.<\/li><li>Examen ophtalmologique pour d\u00e9tecter des r\u00e9tinopathies associ\u00e9es.<\/li><\/ul><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>Une \u00e9valuation compl\u00e8te \u00e0 la naissance est essentielle pour stratifier les risques et guider la prise en charge initiale.<\/p><p><strong>5.3. Traitement postnatal des nouveau-n\u00e9s symptomatiques<\/strong><\/p><p><strong>1. Valganciclovir<\/strong><\/p><ul><li><p><strong>Indications :<\/strong><\/p><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li><p>Sympt\u00f4mes cliniques significatifs (neurologiques, auditifs, h\u00e9patiques).<\/p><\/li><li><p>Nouveau-n\u00e9s \u00e0 risque \u00e9lev\u00e9 de s\u00e9quelles, m\u00eame en absence de sympt\u00f4mes \u00e9vidents.<\/p><\/li><\/ul><\/li><\/ul><ul><li><p><strong>Posologie :<\/strong><\/p><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li><p>16 mg\/kg, administr\u00e9s deux fois par jour, pendant 6 mois.<\/p><\/li><\/ul><\/li><\/ul><ul><li><p><strong>Efficacit\u00e9 :<\/strong><\/p><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li><p>R\u00e9duction des s\u00e9quelles neurologiques \u00e0 12 et 24 mois.<\/p><\/li><li><p>Pr\u00e9vention de la progression de la surdit\u00e9.<\/p><\/li><\/ul><\/li><\/ul><ul><li><p><strong>Effets secondaires :<\/strong><\/p><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li><p>Neutrop\u00e9nie (30-50 % des cas), n\u00e9cessitant un suivi h\u00e9matologique mensuel.<\/p><\/li><li><p>Dysfonction h\u00e9patique transitoire.<\/p><\/li><\/ul><\/li><\/ul><p><strong>2. Support symptomatique<\/strong><\/p><ul><li><p><strong>Gestion des complications sp\u00e9cifiques :<\/strong><\/p><ul><li><p>Transfusions sanguines en cas d\u2019an\u00e9mie s\u00e9v\u00e8re.<\/p><\/li><li><p>Traitement de l\u2019ict\u00e8re n\u00e9onatal.<\/p><\/li><li><p>Prise en charge des convulsions avec des anticonvulsivants adapt\u00e9s.<\/p><\/li><\/ul><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>Le valganciclovir est le traitement de choix, mais il doit \u00eatre utilis\u00e9 avec pr\u00e9caution en raison de ses effets secondaires potentiels. Une prise en charge symptomatique peut \u00eatre n\u00e9cessaire pour les complications aigu\u00ebs.<\/p><p><strong>5.4. Suivi des enfants asymptomatiques<\/strong><\/p><p><strong>1. Raisons du suivi<\/strong><\/p><ul><li><p>Les enfants asymptomatiques \u00e0 la naissance sont souvent porteurs de s\u00e9quelles tardives, notamment :<\/p><ul><li><p>Surdit\u00e9 neurosensorielle progressive.<\/p><\/li><li><p>Retards cognitifs l\u00e9gers ou troubles du langage.<\/p><\/li><\/ul><\/li><\/ul><p><strong>2. \u00c9valuations recommand\u00e9es<\/strong><\/p><ul><li><p><strong>Tests auditifs :<\/strong><\/p><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li><p>R\u00e9p\u00e9t\u00e9s \u00e0 intervalles r\u00e9guliers (tous les 6 mois) jusqu\u2019\u00e0 l\u2019\u00e2ge de 5 ans.<\/p><\/li><li><p>Utilisation des potentiels \u00e9voqu\u00e9s auditifs pour d\u00e9tecter les d\u00e9ficits progressifs.<\/p><\/li><\/ul><\/li><\/ul><ul><li><p><strong>Surveillance neurod\u00e9veloppementale :<\/strong><\/p><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li><p>\u00c9valuation \u00e0 12, 24, et 36 mois pour d\u00e9pister les troubles du d\u00e9veloppement moteur, cognitif et du langage.<\/p><\/li><\/ul><\/li><\/ul><ul><li><p><strong>Imagerie c\u00e9r\u00e9brale :<\/strong><\/p><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li><p>IRM recommand\u00e9e en cas de suspicion de l\u00e9sions neurologiques.<\/p><\/li><\/ul><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>Un suivi rigoureux est crucial pour d\u00e9tecter et traiter rapidement les s\u00e9quelles tardives, m\u00eame chez les enfants asymptomatiques.<\/p><p><strong>5.5. Suivi des enfants symptomatiques<\/strong><\/p><p><strong>1. Objectifs du suivi<\/strong><\/p><ul><li><p>Pr\u00e9venir et minimiser les s\u00e9quelles \u00e0 long terme.<\/p><\/li><li><p>Fournir des soins continus pour r\u00e9pondre aux besoins sp\u00e9cifiques de l\u2019enfant.<\/p><\/li><\/ul><p><strong>2. \u00c9valuations sp\u00e9cialis\u00e9es<\/strong><\/p><ul><li><p><strong>Audiologiques :<\/strong><\/p><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li><p>D\u00e9pistage des surdit\u00e9s bilat\u00e9rales ou unilat\u00e9rales.<\/p><\/li><li><p>Appareillage auditif ou implants cochl\u00e9aires si n\u00e9cessaire.<\/p><\/li><\/ul><\/li><\/ul><ul><li><p><strong>Neurologiques :<\/strong><\/p><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li><p>Surveillance des convulsions et des troubles moteurs.<\/p><\/li><li><p>R\u00e9\u00e9ducation en cas de paralysie c\u00e9r\u00e9brale.<\/p><\/li><\/ul><\/li><\/ul><ul><li><p><strong>Ophtalmologiques :<\/strong><\/p><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li><p>D\u00e9tection des troubles visuels associ\u00e9s, comme la chorior\u00e9tinite.<\/p><\/li><\/ul><\/li><\/ul><ul><li><p><strong>Psychologiques et scolaires :<\/strong><\/p><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li><p>Soutien \u00e9ducatif et psychologique pour les enfants pr\u00e9sentant des retards d\u2019apprentissage.<\/p><\/li><\/ul><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>Les enfants symptomatiques n\u00e9cessitent une prise en charge multidisciplinaire pour maximiser leur potentiel fonctionnel et \u00e9ducatif.<\/p><p><strong>5.6. Prise en charge multidisciplinaire<\/strong><\/p><p><strong>1. R\u00f4les des diff\u00e9rents sp\u00e9cialistes<\/strong><\/p><ul><li><p><strong>Infectiologue p\u00e9diatrique :<\/strong><\/p><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li><p>Gestion des traitements antiviraux et suivi des complications infectieuses.<\/p><\/li><\/ul><\/li><\/ul><ul><li><p><strong>Neurologue :<\/strong><\/p><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li><p>\u00c9valuation des atteintes c\u00e9r\u00e9brales et planification de la r\u00e9habilitation.<\/p><\/li><\/ul><\/li><\/ul><ul><li><p><strong>ORL :<\/strong><\/p><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li><p>Surveillance et traitement des troubles auditifs.<\/p><\/li><\/ul><\/li><\/ul><ul><li><p><strong>P\u00e9diatre g\u00e9n\u00e9raliste :<\/strong><\/p><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li><p>Coordination des soins et surveillance globale.<\/p><\/li><\/ul><\/li><\/ul><ul><li><p><strong>Psychologue ou orthophoniste :<\/strong><\/p><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li><p>Soutien en cas de retard de d\u00e9veloppement cognitif ou linguistique.<\/p><\/li><\/ul><\/li><\/ul><p><strong>2. Soutien aux familles<\/strong><\/p><ul><li><p>Fournir des informations claires sur le pronostic et les options th\u00e9rapeutiques.<\/p><\/li><li><p>Offrir un accompagnement psychologique pour les parents.<\/p><\/li><li><p>Faciliter l\u2019acc\u00e8s aux ressources communautaires et \u00e9ducatives.<\/p><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>Une \u00e9quipe multidisciplinaire am\u00e9liore les r\u00e9sultats \u00e0 long terme en offrant une prise en charge globale adapt\u00e9e aux besoins de l\u2019enfant et de sa famille.<\/p><p><strong>5.7. Perspectives d\u2019am\u00e9lioration du suivi<\/strong><\/p><p><strong>1. D\u00e9veloppement de nouveaux outils de surveillance<\/strong><\/p><ul><li><p>Biomarqueurs pour pr\u00e9dire les s\u00e9quelles \u00e0 long terme.<\/p><\/li><li><p>Tests auditifs avanc\u00e9s pour une d\u00e9tection pr\u00e9coce des surdit\u00e9s progressives.<\/p><\/li><\/ul><p><strong>2. Interventions pr\u00e9coces<\/strong><\/p><ul><li><p>Programmes de r\u00e9habilitation auditive et neurologique.<\/p><\/li><li><p>Introduction rapide de supports \u00e9ducatifs adapt\u00e9s.<\/p><\/li><\/ul><p><strong>3. Optimisation des traitements<\/strong><\/p><ul><li><p>Recherche sur de nouveaux antiviraux plus s\u00fbrs et efficaces.<\/p><\/li><li><p>Vaccins pour pr\u00e9venir l\u2019infection maternelle et r\u00e9duire l\u2019incidence du CMV cong\u00e9nital.<\/p><\/li><\/ul><p><strong>Notes pour l\u2019orateur :<\/strong><br \/>L\u2019am\u00e9lioration des strat\u00e9gies de suivi et de traitement offrira de meilleures perspectives aux enfants infect\u00e9s par le CMV.<\/p><p><strong>Conclusion du Chapitre<\/strong><\/p><p><strong>R\u00e9sum\u00e9 des points cl\u00e9s<\/strong><\/p><ul><li><p>La gestion postnatale repose sur le diagnostic pr\u00e9coce, l\u2019instauration rapide du traitement antiviral chez les nouveau-n\u00e9s symptomatiques et un suivi \u00e0 long terme rigoureux.<\/p><\/li><li><p>Les enfants asymptomatiques doivent \u00eatre surveill\u00e9s pour d\u00e9tecter les s\u00e9quelles tardives.<\/p><\/li><li><p>Une prise en charge multidisciplinaire est essentielle pour optimiser les r\u00e9sultats fonctionnels et \u00e9ducatifs.<\/p><\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1993\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-1993\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Glossaire<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1993\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-1993\"><ul><li><strong>Avidit\u00e9 des IgG<\/strong> : Mesure de la force de liaison des anticorps IgG aux antig\u00e8nes viraux. Une faible avidit\u00e9 indique une infection r\u00e9cente (&lt;3 mois), tandis qu&#8217;une forte avidit\u00e9 exclut une infection r\u00e9cente.<\/li><li><strong>cCMV :<\/strong> Infection cong\u00e9nitale \u00e0 cytom\u00e9galovirus.<\/li><li><strong>Chorior\u00e9tinite<\/strong> : Inflammation de la choro\u00efde et de la r\u00e9tine. Peut entra\u00eener des troubles visuels et est parfois associ\u00e9e au CMV cong\u00e9nital.<\/li><li><strong>Cytotrophoblaste<\/strong> : Couche cellulaire du placenta jouant un r\u00f4le cl\u00e9 dans le transport de nutriments et de gaz. Premier site infect\u00e9 par le CMV lors de la transmission verticale<\/li><li><strong>Hyperimmunoglobulines (HIG)<\/strong> : Pr\u00e9parations d&#8217;anticorps sp\u00e9cifiques administr\u00e9es pour neutraliser un agent pathog\u00e8ne (ex. : CMV). Utilis\u00e9es dans certains cas pour r\u00e9duire la transmission verticale.<\/li><li><strong>IgG\/IgM :<\/strong> Types d&#8217;anticorps produits par le syst\u00e8me immunitaire en r\u00e9ponse \u00e0 une infection.<\/li><li><strong>PCR (Polymerase Chain Reaction)<\/strong><strong> :<\/strong> M\u00e9thode de biologie mol\u00e9culaire utilis\u00e9e pour d\u00e9tecter et quantifier l&#8217;ADN viral dans les fluides biologiques (sang, urine, liquide amniotique). Technique cl\u00e9 dans le diagnostic des infections \u00e0 CMV.<\/li><li><strong>Polymicrogyrie<\/strong> : Malformation c\u00e9r\u00e9brale caract\u00e9ris\u00e9e par des circonvolutions corticales anormalement petites et nombreuses. Associ\u00e9e \u00e0 des l\u00e9sions c\u00e9r\u00e9brales dues au CMV.<\/li><li><strong>R\u00e9activation virale<\/strong> : R\u00e9activation d&#8217;un virus latent dans un contexte d\u2019immunosuppression ou de grossesse. Le CMV peut se r\u00e9activer sans causer de sympt\u00f4mes chez la m\u00e8re mais entra\u00eener une transmission f\u0153tale.<\/li><li><strong>S\u00e9roconversion<\/strong> : Transition d\u2019un \u00e9tat s\u00e9rologique n\u00e9gatif (absence d\u2019anticorps) \u00e0 un \u00e9tat positif (pr\u00e9sence d\u2019anticorps), indiquant une infection r\u00e9cente.<\/li><li><strong>Surdit\u00e9 neurosensorielle<\/strong> : Perte auditive due \u00e0 des dommages dans l&#8217;oreille interne ou au niveau du nerf auditif. S\u00e9quelle fr\u00e9quente et parfois progressive chez les enfants infect\u00e9s par le CMV.<\/li><li><strong>Valaciclovir\/Valganciclovir :<\/strong> Antiviraux utilis\u00e9s pour traiter ou pr\u00e9venir les infections \u00e0 CMV.<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-869f46e elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"869f46e\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-dbbe598\" data-id=\"dbbe598\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-f9d8374 elementor-widget elementor-widget-text-editor\" data-id=\"f9d8374\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: justify;\">FAQ<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c98ce1d elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"c98ce1d\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-b5dbb7d elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"b5dbb7d\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-28c68ae\" data-id=\"28c68ae\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-da58028 elementor-widget elementor-widget-toggle\" data-id=\"da58028\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2281\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-2281\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Quels sont les principaux facteurs de risque de transmission ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2281\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-2281\"><p>Les infections primaires de la m\u00e8re pendant la grossesse, en particulier au premier trimestre, augmentent le risque de transmission. Les contacts \u00e9troits avec les jeunes enfants excr\u00e9tant le virus dans leur salive ou leur urine repr\u00e9sentent une source importante de contamination.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2282\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-2282\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Comment diagnostique-t-on une infection maternelle r\u00e9cente ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2282\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-2282\"><p>Une infection maternelle r\u00e9cente est diagnostiqu\u00e9e par s\u00e9rologie (tests IgG et IgM) suivie d\u2019un test d\u2019avidit\u00e9 des IgG. Une faible avidit\u00e9 des IgG indique une infection r\u00e9cente (moins de 3 mois).<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2283\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-2283\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Quel est le r\u00f4le de l\u2019amniocent\u00e8se dans le diagnostic du cCMV ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2283\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-2283\"><p>L\u2019amniocent\u00e8se permet de d\u00e9tecter la pr\u00e9sence de l\u2019ADN viral dans le liquide amniotique gr\u00e2ce \u00e0 un test PCR. Elle est r\u00e9alis\u00e9e apr\u00e8s 17 semaines de grossesse et 8 semaines apr\u00e8s l\u2019infection maternelle pr\u00e9sum\u00e9e.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2284\" class=\"elementor-tab-title\" data-tab=\"4\" role=\"button\" aria-controls=\"elementor-tab-content-2284\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Le d\u00e9pistage pr\u00e9natal est-il syst\u00e9matique ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2284\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"4\" role=\"region\" aria-labelledby=\"elementor-tab-title-2284\"><p>Non, le d\u00e9pistage pr\u00e9natal du CMV n&#8217;est pas syst\u00e9matique dans de nombreux pays, mais il est recommand\u00e9 pour les femmes \u00e0 risque \u00e9lev\u00e9 ou lorsqu\u2019une infection maternelle est suspect\u00e9e.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2285\" class=\"elementor-tab-title\" data-tab=\"5\" role=\"button\" aria-controls=\"elementor-tab-content-2285\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Quels sont les b\u00e9n\u00e9fices du valaciclovir ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2285\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"5\" role=\"region\" aria-labelledby=\"elementor-tab-title-2285\"><p>Le valaciclovir, administr\u00e9 \u00e0 une dose de 8 g\/jour, r\u00e9duit le risque de transmission verticale de 70 %, en particulier lorsque le traitement est initi\u00e9 rapidement apr\u00e8s l&#8217;infection maternelle.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2286\" class=\"elementor-tab-title\" data-tab=\"6\" role=\"button\" aria-controls=\"elementor-tab-content-2286\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\"> R\u00e9activation virale<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2286\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"6\" role=\"region\" aria-labelledby=\"elementor-tab-title-2286\"><p>R\u00e9activation d&#8217;un virus latent dans un contexte d\u2019immunosuppression ou de grossesse. Le CMV peut se r\u00e9activer sans causer de sympt\u00f4mes chez la m\u00e8re mais entra\u00eener une transmission f\u0153tale.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-dd31a45\" data-id=\"dd31a45\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-f90cbf7 elementor-widget elementor-widget-toggle\" data-id=\"f90cbf7\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2611\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-2611\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Avidit\u00e9 des IgG<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2611\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-2611\"><p>Mesure de la force de liaison des anticorps IgG aux antig\u00e8nes viraux. Une faible avidit\u00e9 indique une infection r\u00e9cente (&lt;3 mois), tandis qu&#8217;une forte avidit\u00e9 exclut une infection r\u00e9cente.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2612\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-2612\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Quelles sont les limites des HIG ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2612\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-2612\"><p>Les immunoglobulines sp\u00e9cifiques (HIG) peuvent r\u00e9duire la transmission, mais leur efficacit\u00e9 d\u00e9pend fortement d&#8217;une administration pr\u00e9coce apr\u00e8s l&#8217;infection maternelle. Les preuves de leur efficacit\u00e9 restent controvers\u00e9es.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2613\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-2613\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Quels types de s\u00e9quelles sont associ\u00e9s au cCMV ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2613\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-2613\"><p>Les s\u00e9quelles incluent la surdit\u00e9 neurosensorielle (souvent progressive), des troubles neurologiques, un retard mental, et des anomalies motrices. Ces s\u00e9quelles sont plus probables chez les f\u0153tus infect\u00e9s au premier trimestre.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2614\" class=\"elementor-tab-title\" data-tab=\"4\" role=\"button\" aria-controls=\"elementor-tab-content-2614\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Quels sont les effets secondaires des traitements antiviraux ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2614\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"4\" role=\"region\" aria-labelledby=\"elementor-tab-title-2614\"><p>Les effets secondaires incluent la neutrop\u00e9nie (baisse des globules blancs), des naus\u00e9es, des maux de t\u00eate et, dans de rares cas, des probl\u00e8mes r\u00e9naux. Une surveillance r\u00e9guli\u00e8re est n\u00e9cessaire pendant le traitement.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2615\" class=\"elementor-tab-title\" data-tab=\"5\" role=\"button\" aria-controls=\"elementor-tab-content-2615\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Les nouveau-n\u00e9s asymptomatiques n\u00e9cessitent-ils un suivi ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2615\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"5\" role=\"region\" aria-labelledby=\"elementor-tab-title-2615\"><p>Oui, les nouveau-n\u00e9s asymptomatiques peuvent d\u00e9velopper des s\u00e9quelles tardives, comme une surdit\u00e9 progressive. Un suivi audiologique et neurologique r\u00e9gulier est essentiel jusqu\u2019\u00e0 l\u2019\u00e2ge de 5 ans.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2616\" class=\"elementor-tab-title\" data-tab=\"6\" role=\"button\" aria-controls=\"elementor-tab-content-2616\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Un vaccin contre le CMV est-il disponible ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2616\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"6\" role=\"region\" aria-labelledby=\"elementor-tab-title-2616\"><p>Non, il n\u2019existe pas encore de vaccin approuv\u00e9 contre le CMV. Cependant, plusieurs candidats vaccins sont en phase d\u2019essais cliniques, et leur disponibilit\u00e9 est esp\u00e9r\u00e9e dans les 10 prochaines ann\u00e9es.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-c06ff0a elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"c06ff0a\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-355f3bc\" data-id=\"355f3bc\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a07df8a elementor-widget elementor-widget-text-editor\" data-id=\"a07df8a\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: justify;\">QCM<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-084f553 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"084f553\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-6a95fff elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"6a95fff\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-a97af1a\" data-id=\"a97af1a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-999692b elementor-widget elementor-widget-toggle\" data-id=\"999692b\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1611\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-1611\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">QCM 1-10<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1611\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-1611\"><ol><li><strong>Quel est le taux estim\u00e9 de pr\u00e9valence du CMV cong\u00e9nital ?<\/strong><br \/>a) 0,1 %<br \/>b) 0,5 %<br \/>c) 0,64 % \u00e0 2,2 %<br \/>d) 5 %<br \/>e) 10 %<br \/><strong>R\u00e9ponse : c)<\/strong> (Difficult\u00e9 : 1)<\/li><\/ol><p>\u00a0<\/p><ol start=\"2\"><li><strong>Quelle est la principale complication non g\u00e9n\u00e9tique associ\u00e9e au CMV cong\u00e9nital ?<\/strong><br \/>a) Cardiopathie cong\u00e9nitale<br \/>b) Surdit\u00e9 neurosensorielle<br \/>c) D\u00e9ficit immunitaire<br \/>d) Maladies h\u00e9patiques<br \/>e) Troubles endocriniens<br \/><strong>R\u00e9ponse : b)<\/strong> (Difficult\u00e9 : 1)<\/li><\/ol><p>\u00a0<\/p><ol start=\"3\"><li><strong>\u00c0 quel moment de la grossesse le risque de transmission verticale est-il le plus \u00e9lev\u00e9 ?<\/strong><br \/>a) Premier trimestre<br \/>b) Deuxi\u00e8me trimestre<br \/>c) Troisi\u00e8me trimestre<br \/>d) P\u00e9riode postnatale<br \/>e) Aucun<br \/><strong>R\u00e9ponse : c)<\/strong> (Difficult\u00e9 : 2)<\/li><\/ol><p>\u00a0<\/p><ol start=\"4\"><li><strong>Quelle mesure est efficace pour r\u00e9duire le risque de s\u00e9roconversion chez les femmes enceintes ?<\/strong><br \/>a) La vaccination<br \/>b) \u00c9viter les contacts avec des animaux<br \/>c) Lavage des mains fr\u00e9quent et mesures d\u2019hygi\u00e8ne<br \/>d) Prendre des antibiotiques<br \/>e) \u00c9viter les aliments crus<br \/><strong>R\u00e9ponse : c)<\/strong> (Difficult\u00e9 : 1)<\/li><\/ol><p>\u00a0<\/p><ol start=\"5\"><li><strong>Quel traitement a d\u00e9montr\u00e9 une r\u00e9duction de 70 % de la transmission verticale du CMV ?<\/strong><br \/>a) Immunoglobulines hyperimmunes<br \/>b) Valaciclovir<br \/>c) Aciclovir<br \/>d) Amoxicilline<br \/>e) Aspirine<br \/><strong>R\u00e9ponse : b)<\/strong> (Difficult\u00e9 : 1)<\/li><\/ol><p>\u00a0<\/p><ol start=\"6\"><li><strong>\u00c0 quel moment une administration d\u2019hyperimmunoglobulines est-elle potentiellement efficace ?<\/strong><br \/>a) Dans le dernier trimestre de grossesse<br \/>b) Apr\u00e8s 20 semaines de grossesse<br \/>c) Imm\u00e9diatement apr\u00e8s une infection primaire maternelle<br \/>d) \u00c0 la naissance du nouveau-n\u00e9<br \/>e) Lorsqu\u2019il y a des sympt\u00f4mes clairs chez la m\u00e8re<br \/><strong>R\u00e9ponse : c)<\/strong> (Difficult\u00e9 : 2)<\/li><\/ol><p>\u00a0<\/p><ol start=\"7\"><li><strong>Quelle m\u00e9thode est utilis\u00e9e pour diagnostiquer une infection maternelle r\u00e9cente ?<\/strong><br \/>a) Une \u00e9chographie<br \/>b) Le test IgG\/IgM et l\u2019analyse d\u2019avidit\u00e9<br \/>c) Une biopsie placentaire<br \/>d) Une analyse g\u00e9n\u00e9tique<br \/>e) Une num\u00e9ration formule sanguine<br \/><strong>R\u00e9ponse : b)<\/strong> (Difficult\u00e9 : 1)<\/li><li><strong>Quand l\u2019amniocent\u00e8se pour la d\u00e9tection du CMV est-elle recommand\u00e9e ?<\/strong><br \/>a) Avant 12 semaines de grossesse<br \/>b) Entre 13 et 15 semaines de grossesse<br \/>c) Apr\u00e8s 17 semaines de grossesse<br \/>d) \u00c0 n\u2019importe quel moment de la grossesse<br \/>e) Apr\u00e8s la naissance<br \/><strong>R\u00e9ponse : c)<\/strong> (Difficult\u00e9 : 1)<\/li><\/ol><p>\u00a0<\/p><ol start=\"8\"><li><strong>Que signifie une faible avidit\u00e9 des IgG dans un test s\u00e9rologique ?<\/strong><br \/>a) Immunit\u00e9 ancienne contre le CMV<br \/>b) Infection primaire r\u00e9cente<br \/>c) Immunit\u00e9 acquise via un vaccin<br \/>d) Absence totale de CMV<br \/>e) R\u00e9sultats non interpr\u00e9tables<br \/><strong>R\u00e9ponse : b)<\/strong> (Difficult\u00e9 : 2)<\/li><\/ol><p>\u00a0<\/p><ol start=\"9\"><li><strong>Quel antiviral est principalement utilis\u00e9 pour traiter les nouveau-n\u00e9s atteints de CMV symptomatique ?<\/strong><br \/>a) Valaciclovir<br \/>b) Valganciclovir<br \/>c) Aciclovir<br \/>d) Ganciclovir<br \/>e) Ribavirine<br \/><strong>R\u00e9ponse : b)<\/strong> (Difficult\u00e9 : 1)<\/li><\/ol><ul><li><strong>Pendant combien de temps le valganciclovir est-il administr\u00e9 aux nouveau-n\u00e9s symptomatiques ?<\/strong><br \/>a) 6 semaines<br \/>b) 3 mois<br \/>c) 6 mois<br \/>d) 1 an<br \/>e) Toute la vie<br \/><strong>R\u00e9ponse : c)<\/strong> (Difficult\u00e9 : 1)<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1612\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-1612\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">QCM 11-20<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1612\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-1612\"><ul><li><strong>Quels sont les principaux effets secondaires des antiviraux utilis\u00e9s pour traiter le CMV ?<\/strong><br \/>a) An\u00e9mie et hypotension<br \/>b) Neutrop\u00e9nie et insuffisance r\u00e9nale<br \/>c) Naus\u00e9es et diarrh\u00e9e l\u00e9g\u00e8re<br \/>d) Diminution de l&#8217;app\u00e9tit<br \/>e) Fi\u00e8vre persistante<br \/><strong>R\u00e9ponse : b)<\/strong> (Difficult\u00e9 : 2)<\/li><\/ul><p>\u00a0<\/p><ul><li><strong>Quelle complication est la plus fr\u00e9quente chez les enfants atteints de CMV cong\u00e9nital asymptomatique \u00e0 la naissance ?<\/strong><br \/>a) Surdit\u00e9 neurosensorielle<br \/>b) Maladie cardiaque<br \/>c) Paralysie c\u00e9r\u00e9brale<br \/>d) Retard de croissance intra-ut\u00e9rin<br \/>e) D\u00e9ficit immunitaire<br \/><strong>R\u00e9ponse : a)<\/strong> (Difficult\u00e9 : 2)<\/li><\/ul><p>\u00a0<\/p><ul><li><strong>Jusqu\u2019\u00e0 quel \u00e2ge le suivi audiologique est-il recommand\u00e9 chez les enfants infect\u00e9s par le CMV ?<\/strong><br \/>a) 2 ans<br \/>b) 3 ans<br \/>c) 5 ans<br \/>d) 10 ans<br \/>e) Pas n\u00e9cessaire si asymptomatique<br \/><strong>R\u00e9ponse : c)<\/strong> (Difficult\u00e9 : 1)<\/li><\/ul><p>\u00a0<\/p><ul><li><strong>Quelle est la meilleure strat\u00e9gie pour surveiller les anomalies neurologiques chez un enfant infect\u00e9 ?<\/strong><br \/>a) Scanner c\u00e9r\u00e9bral annuel<br \/>b) IRM c\u00e9r\u00e9brale et examens neurod\u00e9veloppementaux r\u00e9guliers<br \/>c) Examens neurologiques \u00e0 la demande des parents<br \/>d) Surveillance uniquement en cas de sympt\u00f4mes<br \/>e) Biopsie c\u00e9r\u00e9brale<br \/><strong>R\u00e9ponse : b)<\/strong> (Difficult\u00e9 : 2)<\/li><\/ul><p>\u00a0<\/p><ul><li><strong>Quelle proportion des nouveau-n\u00e9s atteints de CMV cong\u00e9nital sont symptomatiques \u00e0 la naissance ?<\/strong><br \/>a) 1 %<br \/>b) 10 %<br \/>c) 25 %<br \/>d) 50 %<br \/>e) 75 %<br \/><strong>R\u00e9ponse : b)<\/strong> (Difficult\u00e9 : 1)<\/li><\/ul><p>\u00a0<\/p><ul><li><strong>Quel est le principal mode de transmission verticale du CMV ?<\/strong><br \/>a) Sang maternel<br \/>b) Liquide amniotique<br \/>c) Placenta<br \/>d) Contact direct au moment de l&#8217;accouchement<br \/>e) Lait maternel<br \/><strong>R\u00e9ponse : c)<\/strong> (Difficult\u00e9 : 1)<\/li><\/ul><p>\u00a0<\/p><ul><li><strong>Parmi les s\u00e9quelles ci-dessous, laquelle est la plus fr\u00e9quente chez les enfants symptomatiques ?<\/strong><br \/>a) Malformation cardiaque<br \/>b) Insuffisance r\u00e9nale<br \/>c) Retard mental<br \/>d) Surdit\u00e9 neurosensorielle<br \/>e) Paralysie c\u00e9r\u00e9brale<br \/><strong>R\u00e9ponse : d)<\/strong> (Difficult\u00e9 : 2)<\/li><\/ul><p>\u00a0<\/p><ul><li><strong>Quelle est la principale source d&#8217;infection maternelle par le CMV ?<\/strong><br \/>a) Contacts avec des adultes infect\u00e9s<br \/>b) Contacts avec des enfants en bas \u00e2ge<br \/>c) Consommation d&#8217;eau contamin\u00e9e<br \/>d) Transmission a\u00e9rienne<br \/>e) Aliments non cuits<br \/><strong>R\u00e9ponse : b)<\/strong> (Difficult\u00e9 : 1)<\/li><\/ul><p>\u00a0<\/p><ul><li><strong>Quelle est l&#8217;efficacit\u00e9 estim\u00e9e des mesures d&#8217;hygi\u00e8ne pour pr\u00e9venir les infections primaires ?<\/strong><br \/>a) 20 %<br \/>b) 50 %<br \/>c) 70 %<br \/>d) 87 %<br \/>e) 95 %<br \/><strong>R\u00e9ponse : d)<\/strong> (Difficult\u00e9 : 2)<\/li><\/ul><p>\u00a0<\/p><ul><li><strong>Pourquoi les vaccins actuels contre le CMV ne sont-ils pas encore disponibles ?<\/strong><br \/>a) Manque d&#8217;efficacit\u00e9 prouv\u00e9e<br \/>b) Effets secondaires graves<br \/>c) Absence d&#8217;\u00e9tudes cliniques<br \/>d) Manque de financement<br \/>e) \u00c9chec des essais sur les animaux<br \/><strong>R\u00e9ponse : a)<\/strong> (Difficult\u00e9 : 2)<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-91ebf94\" data-id=\"91ebf94\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-705714f elementor-widget elementor-widget-toggle\" data-id=\"705714f\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1171\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-1171\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">QCM 21-30<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1171\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-1171\"><ul><li><strong>Quelle est la sp\u00e9cificit\u00e9 d\u2019un PCR sur liquide amniotique pour le diagnostic de CMV cong\u00e9nital ?<\/strong><br \/>a) 50 %<br \/>b) 75 %<br \/>c) 85 %<br \/>d) 95 %<br \/>e) 100 %<br \/><strong>R\u00e9ponse : e)<\/strong> (Difficult\u00e9 : 2)<\/li><\/ul><p>\u00a0<\/p><ul><li><strong>Quelle anomalie pr\u00e9natale d\u00e9tect\u00e9e \u00e0 l\u2019\u00e9chographie est la plus \u00e9vocatrice d\u2019un CMV cong\u00e9nital ?<\/strong><br \/>a) RCIU (Retard de croissance intra-ut\u00e9rin)<br \/>b) Microc\u00e9phalie<br \/>c) Hydramnios<br \/>d) Hypertrophie cardiaque<br \/>e) Kystes ovariens<br \/><strong>R\u00e9ponse : b)<\/strong> (Difficult\u00e9 : 2)<\/li><\/ul><p>\u00a0<\/p><ul><li><strong>Dans quel cas un test d\u2019avidit\u00e9 des IgG est-il utile ?<\/strong><br \/>a) Pour exclure une infection chronique<br \/>b) Pour confirmer une infection primaire r\u00e9cente<br \/>c) Pour d\u00e9tecter une r\u00e9infection maternelle<br \/>d) Pour \u00e9valuer la gravit\u00e9 d\u2019une infection<br \/>e) Pour d\u00e9tecter une infection n\u00e9onatale<br \/><strong>R\u00e9ponse : b)<\/strong> (Difficult\u00e9 : 2)<\/li><\/ul><p>\u00a0<\/p><ul><li><strong>Quelle est la principale limite de l\u2019utilisation du ganciclovir pendant la grossesse ?<\/strong><br \/>a) Effets t\u00e9ratog\u00e8nes<br \/>b) Inefficacit\u00e9 antivirale<br \/>c) Co\u00fbt \u00e9lev\u00e9<br \/>d) Risque de r\u00e9sistance virale<br \/>e) Faible biodisponibilit\u00e9<br \/><strong>R\u00e9ponse : a)<\/strong> (Difficult\u00e9 : 2)<\/li><\/ul><p>\u00a0<\/p><ul><li><strong>Quel est le principal b\u00e9n\u00e9fice du traitement pr\u00e9natal avec le valaciclovir ?<\/strong><br \/>a) R\u00e9duction des sympt\u00f4mes maternels<br \/>b) Pr\u00e9vention des l\u00e9sions c\u00e9r\u00e9brales f\u0153tales<br \/>c) Am\u00e9lioration de l&#8217;audition n\u00e9onatale<br \/>d) R\u00e9duction de la transmission horizontale<br \/>e) Traitement des anomalies \u00e9chographiques<br \/><strong>R\u00e9ponse : b)<\/strong> (Difficult\u00e9 : 2)<\/li><\/ul><p>\u00a0<\/p><ul><li><strong>Quel est le m\u00e9canisme d&#8217;action des antiviraux utilis\u00e9s pour traiter le CMV ?<\/strong><br \/>a) Blocage de la synth\u00e8se des prot\u00e9ines virales<br \/>b) Inhibition de la r\u00e9plication de l&#8217;ADN viral<br \/>c) Activation des cellules T cytotoxiques<br \/>d) Renforcement de la barri\u00e8re placentaire<br \/>e) Inhibition de l&#8217;entr\u00e9e du virus dans les cellules<br \/><strong>R\u00e9ponse : b)<\/strong> (Difficult\u00e9 : 1)<\/li><\/ul><p>\u00a0<\/p><ul><li><strong>Quelle est la m\u00e9thode principale de surveillance des enfants atteints de CMV cong\u00e9nital asymptomatique ?<\/strong><br \/>a) IRM annuelle<br \/>b) Examens audiologiques r\u00e9guliers<br \/>c) Dosage s\u00e9rique du CMV<br \/>d) Consultation neurologique trimestrielle<br \/>e) Biopsie c\u00e9r\u00e9brale<br \/><strong>R\u00e9ponse : b)<\/strong> (Difficult\u00e9 : 1)<\/li><\/ul><p>\u00a0<\/p><ul><li><strong>Quel est le principal objectif de l\u2019\u00e9valuation neurod\u00e9veloppementale \u00e0 24\u201336 mois ?<\/strong><br \/>a) D\u00e9pister les troubles de la vision<br \/>b) \u00c9valuer le d\u00e9veloppement moteur et cognitif<br \/>c) V\u00e9rifier la persistance de l\u2019infection<br \/>d) Identifier les anomalies cardiaques<br \/>e) D\u00e9terminer la n\u00e9cessit\u00e9 d\u2019une intervention chirurgicale<br \/><strong>R\u00e9ponse : b)<\/strong> (Difficult\u00e9 : 2)<\/li><\/ul><p>\u00a0<\/p><ul><li><strong>Quelle complication est la plus fr\u00e9quente chez les enfants symptomatiques \u00e0 la naissance ?<\/strong><br \/>a) Probl\u00e8mes respiratoires chroniques<br \/>b) Surdit\u00e9 unilat\u00e9rale ou bilat\u00e9rale<br \/>c) D\u00e9ficit en globules blancs<br \/>d) Maladie r\u00e9nale chronique<br \/>e) Troubles endocriniens<br \/><strong>R\u00e9ponse : b)<\/strong> (Difficult\u00e9 : 2)<\/li><\/ul><p>\u00a0<\/p><ol start=\"30\"><li><strong> Quelle est la diff\u00e9rence majeure entre une infection primaire et une r\u00e9activation du CMV chez la femme enceinte ?<\/strong><br \/>a) La r\u00e9activation entra\u00eene une transmission verticale plus fr\u00e9quente.<br \/>b) L\u2019infection primaire est associ\u00e9e \u00e0 un risque plus \u00e9lev\u00e9 de s\u00e9quelles f\u0153tales.<br \/>c) Les deux types d\u2019infection ont le m\u00eame risque de transmission verticale.<br \/>d) La r\u00e9activation est uniquement d\u00e9tectable par PCR.<br \/>e) L\u2019infection primaire ne peut \u00eatre diagnostiqu\u00e9e qu\u2019apr\u00e8s la naissance.<br \/><strong>R\u00e9ponse : b)<\/strong><\/li><\/ol><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1172\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-1172\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">QCM 31-40<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1172\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-1172\"><ol start=\"31\"><li><strong> Pourquoi les immunoglobulines hyperimmunes (HIG) sont-elles controvers\u00e9es comme traitement pr\u00e9ventif du CMV ?<br \/><\/strong>a) Elles ne r\u00e9duisent pas significativement les taux de transmission verticale.<br \/>b) Elles entra\u00eenent des anomalies graves chez le f\u0153tus.<br \/>c) Leur administration est trop complexe pour \u00eatre g\u00e9n\u00e9ralis\u00e9e.<br \/>d) Leur efficacit\u00e9 d\u00e9pend strictement du stade de la grossesse.<br \/>e) Elles augmentent le risque de pr\u00e9maturit\u00e9.<br \/><strong>R\u00e9ponse : a, d et e)<\/strong><\/li><\/ol><p><strong>\u00a0<\/strong><\/p><ol start=\"32\"><li><strong> Dans quel cas une faible avidit\u00e9 des IgG peut-elle \u00eatre faussement interpr\u00e9t\u00e9e ?<br \/><\/strong>a) En cas de faible concentration en IgG totale.<br \/>b) En pr\u00e9sence d\u2019une co-infection par un autre virus.<br \/>c) Lors d\u2019une infection r\u00e9cente mais non active.<br \/>d) Si le test est r\u00e9alis\u00e9 apr\u00e8s 6 mois de l&#8217;infection primaire.<br \/>e) Lors de l\u2019utilisation d\u2019un test s\u00e9rologique non standardis\u00e9.<br \/><strong>R\u00e9ponse : a et e)<\/strong><\/li><\/ol><p><strong>\u00a0<\/strong><\/p><ol start=\"33\"><li><strong> Quel est le principal m\u00e9canisme limitant la transmission verticale apr\u00e8s une infection maternelle au premier trimestre ?<br \/><\/strong>a) La barri\u00e8re immunitaire du placenta.<br \/>b) La faible virulence des souches virales pr\u00e9coces.<br \/>c) La lenteur de la r\u00e9plication virale pendant le premier trimestre.<br \/>d) Les facteurs anti-inflammatoires produits par la m\u00e8re.<br \/>e) Une concentration \u00e9lev\u00e9e d\u2019anticorps maternels neutralisants.<br \/><strong>R\u00e9ponse : a)<\/strong><\/li><\/ol><p><strong>\u00a0<\/strong><\/p><ol start=\"34\"><li><strong> Pourquoi l\u2019amniocent\u00e8se ne peut-elle pas toujours d\u00e9tecter une infection f\u0153tale par le CMV ?<br \/><\/strong>a) Le virus peut \u00eatre pr\u00e9sent \u00e0 un niveau ind\u00e9tectable dans le liquide amniotique.<br \/>b) Une infection tardive peut ne pas encore avoir atteint le f\u0153tus.<br \/>c) Les PCR utilis\u00e9es manquent de sensibilit\u00e9 pour les faibles charges virales.<br \/>d) La culture virale est plus fiable que la PCR pour ce diagnostic.<br \/>e) Le CMV ne traverse pas toujours le placenta.<br \/><strong>R\u00e9ponse : a et b)<\/strong><\/li><\/ol><p><strong>\u00a0<\/strong><\/p><ol start=\"35\"><li><strong> Quel crit\u00e8re clinique ou biologique justifie le d\u00e9but d\u2019un traitement antiviral chez un nouveau-n\u00e9 symptomatique atteint de CMV ?<\/strong><br \/>a) La pr\u00e9sence de calcifications intracr\u00e2niennes \u00e0 l\u2019imagerie.<br \/>b) Une PCR positive dans le sang ou les urines.<br \/>c) Une thrombocytop\u00e9nie isol\u00e9e.<br \/>d) Une surdit\u00e9 d\u00e9tect\u00e9e au d\u00e9pistage n\u00e9onatal.<br \/>e) Une atteinte multisyst\u00e9mique prouv\u00e9e.<br \/><strong>R\u00e9ponse : a, d et e)<\/strong><\/li><\/ol><p><strong>\u00a0<\/strong><\/p><ol start=\"36\"><li><strong> Pourquoi le valaciclovir est-il pr\u00e9f\u00e9r\u00e9 au ganciclovir pour une utilisation pr\u00e9natale ?<br \/><\/strong>a) Il a une meilleure biodisponibilit\u00e9.<br \/>b) Il traverse mieux la barri\u00e8re placentaire.<br \/>c) Il a moins d\u2019effets t\u00e9ratog\u00e8nes document\u00e9s.<br \/>d) Il est plus efficace pour r\u00e9duire la charge virale.<br \/>e) Il est mieux tol\u00e9r\u00e9 chez la m\u00e8re.<br \/><strong>R\u00e9ponse : c et e)<\/strong><\/li><\/ol><p><strong>\u00a0<\/strong><\/p><ol start=\"37\"><li><strong> Quel est le facteur le plus important influen\u00e7ant l\u2019efficacit\u00e9 du traitement par valaciclovir pour pr\u00e9venir la transmission verticale ?<br \/><\/strong>a) La dose administr\u00e9e.<br \/>b) Le stade de la grossesse au d\u00e9but du traitement.<br \/>c) La sensibilit\u00e9 de la souche virale au valaciclovir.<br \/>d) La concentration en anticorps maternels pr\u00e9existants.<br \/>e) Le d\u00e9lai entre l&#8217;infection maternelle et l&#8217;administration du traitement.<br \/><strong>R\u00e9ponse : b et e)<\/strong><\/li><\/ol><p><strong>\u00a0<\/strong><\/p><ol start=\"38\"><li><strong> Quelles anomalies d\u00e9tect\u00e9es \u00e0 l\u2019IRM f\u0153tale sugg\u00e8rent un mauvais pronostic neurologique chez un f\u0153tus infect\u00e9 par le CMV ?<br \/><\/strong>a) Microc\u00e9phalie associ\u00e9e \u00e0 des calcifications p\u00e9riventriculaires.<br \/>b) Kystes de la fosse post\u00e9rieure.<br \/>c) Atrophie corticale diffuse.<br \/>d) H\u00e9t\u00e9rotopie de la substance grise.<br \/>e) Kystes biliaires f\u0153taux.<br \/><strong>R\u00e9ponse : a, c et d)<\/strong><\/li><\/ol><p><strong>\u00a0<\/strong><\/p><ol start=\"39\"><li><strong> Quel est le r\u00f4le des \u00e9valuations audiologiques r\u00e9p\u00e9t\u00e9es chez les enfants asymptomatiques atteints de CMV ?<\/strong><br \/>a) Identifier les cas de surdit\u00e9 progressive.<br \/>b) V\u00e9rifier l\u2019efficacit\u00e9 des traitements antiviraux.<br \/>c) D\u00e9pister les troubles auditifs unilat\u00e9raux souvent tardifs.<br \/>d) Exclure tout risque de perte auditive apr\u00e8s 5 ans.<br \/>e) \u00c9valuer la n\u00e9cessit\u00e9 d\u2019interventions chirurgicales.<br \/><strong>R\u00e9ponse : a et c)<\/strong><\/li><\/ol><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-d424c04 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"d424c04\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-9e7c249\" data-id=\"9e7c249\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-05d75e9 elementor-widget elementor-widget-text-editor\" data-id=\"05d75e9\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: justify;\">Quiz<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7f9729c elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"7f9729c\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-ec43788 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"ec43788\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-2bc0e78\" data-id=\"2bc0e78\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ab61931 elementor-widget elementor-widget-image\" data-id=\"ab61931\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"917\" height=\"1024\" src=\"https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/autoeval-mont-917x1024.jpg\" class=\"attachment-large size-large wp-image-3937\" alt=\"\" srcset=\"https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/autoeval-mont-917x1024.jpg 917w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/autoeval-mont-269x300.jpg 269w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/autoeval-mont-768x857.jpg 768w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/autoeval-mont.jpg 1376w\" sizes=\"(max-width: 917px) 100vw, 917px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-38c0fc9\" data-id=\"38c0fc9\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-aecc4e9 elementor-widget elementor-widget-text-editor\" data-id=\"aecc4e9\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: center;\">\n            <div class='ays-quiz-container ays_quiz_classic_light   ays-quiz-keyboard-active' data-quest-effect='none'  data-hide-bg-image='false' id='ays-quiz-container-4'>\n                \n                \n                <div class='ays-questions-container'>\n                    \n                    \n                    \n                    <form action='' method='post' id='ays_finish_quiz_4' \n                        class='ays-quiz-form  enable_questions_result '\n                    >\n            <input type='hidden' value='list' class='answer_view_class'>\n            <input type='hidden' value='' class='ays_qm_enable_arrows'><section  class='ays_quiz_timer_container'>\n                <div class='ays-quiz-timer ays-quiz-message-before-timer' data-timer='450'><p>Ce quiz comporte 15 QCM.<br \/>\nUne ou plusieurs r\u00e9ponses sont exactes pour chaque QCM.<br \/>\nUn score minimum de 75% de r\u00e9ponses exactes est requis.<br \/>\nLe temps imparti est de 7 minutes<\/p>\n<\/div>\n                <div class='ays-quiz-after-timer '><p>Le temps imparti est \u00e9coul\u00e9<\/p>\n<\/div>\n                <hr style='height:1px;'>\n            <\/section>\n            \n            \n            <div class='step active-step'>\n                <div class='ays-abs-fs ays-start-page'>\n                    \n                    \n                    <p class='ays-fs-title'>Infections cong\u00e9nitales \u00e0 cytom\u00e9galovirus : de la pr\u00e9vention \u00e0 la prise en charge postnatale<\/p>\n                    <div class='ays-fs-subtitle'><\/div>\n                    <input type='hidden' name='ays_quiz_id' value='4'\/>\n                    <input type='hidden' name='ays_quiz_finish_nonce' value='fd2e158c5d'>\n                    <input type='hidden' name='ays_quiz_curent_page_link' class='ays-quiz-curent-page-link' value='https:\/\/echonews.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F4007'\/>\n                    <input type='hidden' name='ays_quiz_questions' value='47,57,22,54,32,44,27,48,39,37,59,52,24,30,43'>\n                    \n                    \n                    <input type='button'   class='ays_next start_button action-button ays-quiz-keyboard-active' value='D\u00e9marrer' data-enable-leave-page=\"false\" \/>\n                    \n                    <\/div>\n                <\/div><div class='step ' data-question-id='47' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>1 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong>Quel est le m\u00e9canisme d&#8217;action des antiviraux utilis\u00e9s pour traiter le CMV ?<\/strong><\/p>\n\n                            <\/div>\n                            \n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-47]' id='ays-answer-220-4' value='220'\/>\n\n                <label for='ays-answer-220-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Renforcement de la barri\u00e8re placentaire<\/label><label for='ays-answer-220-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-47]' id='ays-answer-221-4' value='221'\/>\n\n                <label for='ays-answer-221-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Inhibition de l&#039;entr\u00e9e du virus dans les cellules<\/label><label for='ays-answer-221-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-47]' id='ays-answer-217-4' value='217'\/>\n\n                <label for='ays-answer-217-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Blocage de la synth\u00e8se des prot\u00e9ines virales<\/label><label for='ays-answer-217-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-47]' id='ays-answer-218-4' value='218'\/>\n\n                <label for='ays-answer-218-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Inhibition de la r\u00e9plication de l&#039;ADN viral<\/label><label for='ays-answer-218-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-47]' id='ays-answer-219-4' value='219'\/>\n\n                <label for='ays-answer-219-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Activation des cellules T cytotoxiques<\/label><label for='ays-answer-219-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_4 === 'undefined'){\n                window.quizOptions_4 = [];\n            }\n            window.quizOptions_4['47'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='57' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>2 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong>Pourquoi le valaciclovir est-il pr\u00e9f\u00e9r\u00e9 au ganciclovir pour une utilisation pr\u00e9natale ?<\/strong><\/p>\n\n                            <\/div>\n                            \n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-57]' id='ays-answer-268-4' value='268'\/>\n\n                <label for='ays-answer-268-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Il traverse mieux la barri\u00e8re placentaire.<\/label><label for='ays-answer-268-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-57]' id='ays-answer-269-4' value='269'\/>\n\n                <label for='ays-answer-269-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Il a moins d\u2019effets t\u00e9ratog\u00e8nes document\u00e9s.<\/label><label for='ays-answer-269-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-57]' id='ays-answer-267-4' value='267'\/>\n\n                <label for='ays-answer-267-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Il a une meilleure biodisponibilit\u00e9.<\/label><label for='ays-answer-267-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-57]' id='ays-answer-270-4' value='270'\/>\n\n                <label for='ays-answer-270-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Il est plus efficace pour r\u00e9duire la charge virale.<\/label><label for='ays-answer-270-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-57]' id='ays-answer-271-4' value='271'\/>\n\n                <label for='ays-answer-271-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Il est mieux tol\u00e9r\u00e9 chez la m\u00e8re.<\/label><label for='ays-answer-271-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_4 === 'undefined'){\n                window.quizOptions_4 = [];\n            }\n            window.quizOptions_4['57'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='22' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>3 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong>Quelle est la principale complication non g\u00e9n\u00e9tique associ\u00e9e au CMV cong\u00e9nital ?<\/strong><\/p>\n\n                            <\/div>\n                            \n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-22]' id='ays-answer-94-4' value='94'\/>\n\n                <label for='ays-answer-94-4' class='  ays_position_initial  ays-quiz-keyboard-label'>D\u00e9ficit immunitaire<\/label><label for='ays-answer-94-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-22]' id='ays-answer-96-4' value='96'\/>\n\n                <label for='ays-answer-96-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Troubles endocriniens<\/label><label for='ays-answer-96-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-22]' id='ays-answer-95-4' value='95'\/>\n\n                <label for='ays-answer-95-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Maladies h\u00e9patiques<\/label><label for='ays-answer-95-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-22]' id='ays-answer-92-4' value='92'\/>\n\n                <label for='ays-answer-92-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Cardiopathie cong\u00e9nitale<\/label><label for='ays-answer-92-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-22]' id='ays-answer-93-4' value='93'\/>\n\n                <label for='ays-answer-93-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Surdit\u00e9 neurosensorielle<\/label><label for='ays-answer-93-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_4 === 'undefined'){\n                window.quizOptions_4 = [];\n            }\n            window.quizOptions_4['22'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='54' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>4 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong>Quel est le principal m\u00e9canisme limitant la transmission verticale apr\u00e8s une infection maternelle au premier trimestre ?<\/strong><\/p>\n\n                            <\/div>\n                            \n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-54]' id='ays-answer-255-4' value='255'\/>\n\n                <label for='ays-answer-255-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Les facteurs anti-inflammatoires produits par la m\u00e8re.<\/label><label for='ays-answer-255-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-54]' id='ays-answer-253-4' value='253'\/>\n\n                <label for='ays-answer-253-4' class='  ays_position_initial  ays-quiz-keyboard-label'>La faible virulence des souches virales pr\u00e9coces.<\/label><label for='ays-answer-253-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-54]' id='ays-answer-252-4' value='252'\/>\n\n                <label for='ays-answer-252-4' class='  ays_position_initial  ays-quiz-keyboard-label'>La barri\u00e8re immunitaire du placenta.<\/label><label for='ays-answer-252-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-54]' id='ays-answer-256-4' value='256'\/>\n\n                <label for='ays-answer-256-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Une concentration \u00e9lev\u00e9e d\u2019anticorps maternels neutralisants.<\/label><label for='ays-answer-256-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-54]' id='ays-answer-254-4' value='254'\/>\n\n                <label for='ays-answer-254-4' class='  ays_position_initial  ays-quiz-keyboard-label'>La lenteur de la r\u00e9plication virale pendant le premier trimestre.<\/label><label for='ays-answer-254-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_4 === 'undefined'){\n                window.quizOptions_4 = [];\n            }\n            window.quizOptions_4['54'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='32' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>5 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong>Quels sont les principaux effets secondaires des antiviraux utilis\u00e9s pour traiter le CMV ?<\/strong><\/p>\n\n                            <\/div>\n                            \n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-32]' id='ays-answer-142-4' value='142'\/>\n\n                <label for='ays-answer-142-4' class='  ays_position_initial  ays-quiz-keyboard-label'>An\u00e9mie et hypotension<\/label><label for='ays-answer-142-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-32]' id='ays-answer-144-4' value='144'\/>\n\n                <label for='ays-answer-144-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Naus\u00e9es et diarrh\u00e9e l\u00e9g\u00e8re<\/label><label for='ays-answer-144-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-32]' id='ays-answer-146-4' value='146'\/>\n\n                <label for='ays-answer-146-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Fi\u00e8vre persistante<\/label><label for='ays-answer-146-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-32]' id='ays-answer-143-4' value='143'\/>\n\n                <label for='ays-answer-143-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Neutrop\u00e9nie et insuffisance r\u00e9nale<\/label><label for='ays-answer-143-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-32]' id='ays-answer-145-4' value='145'\/>\n\n                <label for='ays-answer-145-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Diminution de l&#039;app\u00e9tit<\/label><label for='ays-answer-145-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_4 === 'undefined'){\n                window.quizOptions_4 = [];\n            }\n            window.quizOptions_4['32'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='44' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>6 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong>Dans quel cas un test d\u2019avidit\u00e9 des IgG est-il utile ?<\/strong><\/p>\n\n                            <\/div>\n                            \n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-44]' id='ays-answer-206-4' value='206'\/>\n\n                <label for='ays-answer-206-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Pour d\u00e9tecter une infection n\u00e9onatale<\/label><label for='ays-answer-206-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-44]' id='ays-answer-204-4' value='204'\/>\n\n                <label for='ays-answer-204-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Pour d\u00e9tecter une r\u00e9infection maternelle<\/label><label for='ays-answer-204-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-44]' id='ays-answer-202-4' value='202'\/>\n\n                <label for='ays-answer-202-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Pour exclure une infection chronique<\/label><label for='ays-answer-202-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-44]' id='ays-answer-205-4' value='205'\/>\n\n                <label for='ays-answer-205-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Pour \u00e9valuer la gravit\u00e9 d\u2019une infection<\/label><label for='ays-answer-205-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-44]' id='ays-answer-203-4' value='203'\/>\n\n                <label for='ays-answer-203-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Pour confirmer une infection primaire r\u00e9cente<\/label><label for='ays-answer-203-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_4 === 'undefined'){\n                window.quizOptions_4 = [];\n            }\n            window.quizOptions_4['44'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='27' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>7 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong>Quelle m\u00e9thode est utilis\u00e9e pour diagnostiquer une infection maternelle r\u00e9cente ?<\/strong><\/p>\n\n                            <\/div>\n                            \n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-27]' id='ays-answer-121-4' value='121'\/>\n\n                <label for='ays-answer-121-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Une num\u00e9ration formule sanguine<\/label><label for='ays-answer-121-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-27]' id='ays-answer-120-4' value='120'\/>\n\n                <label for='ays-answer-120-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Une analyse g\u00e9n\u00e9tique<\/label><label for='ays-answer-120-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-27]' id='ays-answer-118-4' value='118'\/>\n\n                <label for='ays-answer-118-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Le test IgG\/IgM et l\u2019analyse d\u2019avidit\u00e9<\/label><label for='ays-answer-118-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-27]' id='ays-answer-117-4' value='117'\/>\n\n                <label for='ays-answer-117-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Une \u00e9chographie<\/label><label for='ays-answer-117-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-27]' id='ays-answer-119-4' value='119'\/>\n\n                <label for='ays-answer-119-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Une biopsie placentaire<\/label><label for='ays-answer-119-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_4 === 'undefined'){\n                window.quizOptions_4 = [];\n            }\n            window.quizOptions_4['27'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='48' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>8 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong>Quelle est la m\u00e9thode principale de surveillance des enfants atteints de CMV cong\u00e9nital asymptomatique ?<\/strong><\/p>\n\n                            <\/div>\n                            \n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-48]' id='ays-answer-226-4' value='226'\/>\n\n                <label for='ays-answer-226-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Biopsie c\u00e9r\u00e9brale<\/label><label for='ays-answer-226-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-48]' id='ays-answer-225-4' value='225'\/>\n\n                <label for='ays-answer-225-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Consultation neurologique trimestrielle<\/label><label for='ays-answer-225-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-48]' id='ays-answer-222-4' value='222'\/>\n\n                <label for='ays-answer-222-4' class='  ays_position_initial  ays-quiz-keyboard-label'>IRM annuelle<\/label><label for='ays-answer-222-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-48]' id='ays-answer-223-4' value='223'\/>\n\n                <label for='ays-answer-223-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Examens audiologiques r\u00e9guliers<\/label><label for='ays-answer-223-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-48]' id='ays-answer-224-4' value='224'\/>\n\n                <label for='ays-answer-224-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Dosage s\u00e9rique du CMV<\/label><label for='ays-answer-224-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_4 === 'undefined'){\n                window.quizOptions_4 = [];\n            }\n            window.quizOptions_4['48'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='39' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>9 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong>Quelle est la principale source d&#8217;infection maternelle par le CMV ?<\/strong><\/p>\n\n                            <\/div>\n                            \n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-39]' id='ays-answer-179-4' value='179'\/>\n\n                <label for='ays-answer-179-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Consommation d&#039;eau contamin\u00e9e<\/label><label for='ays-answer-179-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-39]' id='ays-answer-180-4' value='180'\/>\n\n                <label for='ays-answer-180-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Transmission a\u00e9rienne<\/label><label for='ays-answer-180-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-39]' id='ays-answer-181-4' value='181'\/>\n\n                <label for='ays-answer-181-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Aliments non cuits<\/label><label for='ays-answer-181-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-39]' id='ays-answer-178-4' value='178'\/>\n\n                <label for='ays-answer-178-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Contacts avec des enfants en bas \u00e2ge<\/label><label for='ays-answer-178-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-39]' id='ays-answer-177-4' value='177'\/>\n\n                <label for='ays-answer-177-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Contacts avec des adultes infect\u00e9s<\/label><label for='ays-answer-177-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_4 === 'undefined'){\n                window.quizOptions_4 = [];\n            }\n            window.quizOptions_4['39'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='37' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>10 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong>Quel est le principal mode de transmission verticale du CMV ?<\/strong><\/p>\n\n                            <\/div>\n                            \n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-37]' id='ays-answer-171-4' value='171'\/>\n\n                <label for='ays-answer-171-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Lait maternel<\/label><label for='ays-answer-171-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-37]' id='ays-answer-169-4' value='169'\/>\n\n                <label for='ays-answer-169-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Placenta<\/label><label for='ays-answer-169-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-37]' id='ays-answer-168-4' value='168'\/>\n\n                <label for='ays-answer-168-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Liquide amniotique<\/label><label for='ays-answer-168-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-37]' id='ays-answer-167-4' value='167'\/>\n\n                <label for='ays-answer-167-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Sang maternel<\/label><label for='ays-answer-167-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-37]' id='ays-answer-170-4' value='170'\/>\n\n                <label for='ays-answer-170-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Contact direct au moment de l&#039;accouchement<\/label><label for='ays-answer-170-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_4 === 'undefined'){\n                window.quizOptions_4 = [];\n            }\n            window.quizOptions_4['37'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='59' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>11 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong>Quelles anomalies d\u00e9tect\u00e9es \u00e0 l\u2019IRM f\u0153tale sugg\u00e8rent un mauvais pronostic neurologique chez un f\u0153tus infect\u00e9 par le CMV ?<\/strong><\/p>\n\n                            <\/div>\n                            \n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-59]' id='ays-answer-278-4' value='278'\/>\n\n                <label for='ays-answer-278-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Kystes de la fosse post\u00e9rieure.<\/label><label for='ays-answer-278-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-59]' id='ays-answer-280-4' value='280'\/>\n\n                <label for='ays-answer-280-4' class='  ays_position_initial  ays-quiz-keyboard-label'>H\u00e9t\u00e9rotopie de la substance grise.<\/label><label for='ays-answer-280-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-59]' id='ays-answer-279-4' value='279'\/>\n\n                <label for='ays-answer-279-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Atrophie corticale diffuse.<\/label><label for='ays-answer-279-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-59]' id='ays-answer-281-4' value='281'\/>\n\n                <label for='ays-answer-281-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Kystes biliaires f\u0153taux.<\/label><label for='ays-answer-281-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-59]' id='ays-answer-277-4' value='277'\/>\n\n                <label for='ays-answer-277-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Microc\u00e9phalie associ\u00e9e \u00e0 des calcifications p\u00e9riventriculaires.<\/label><label for='ays-answer-277-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_4 === 'undefined'){\n                window.quizOptions_4 = [];\n            }\n            window.quizOptions_4['59'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='52' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>12 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong>Pourquoi les immunoglobulines hyperimmunes (HIG) sont-elles controvers\u00e9es comme traitement pr\u00e9ventif du CMV ?<\/strong><\/p>\n\n                            <\/div>\n                            \n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-52]' id='ays-answer-245-4' value='245'\/>\n\n                <label for='ays-answer-245-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Leur efficacit\u00e9 d\u00e9pend strictement du stade de la grossesse.<\/label><label for='ays-answer-245-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-52]' id='ays-answer-243-4' value='243'\/>\n\n                <label for='ays-answer-243-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Elles entra\u00eenent des anomalies graves chez le f\u0153tus.<\/label><label for='ays-answer-243-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-52]' id='ays-answer-242-4' value='242'\/>\n\n                <label for='ays-answer-242-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Elles ne r\u00e9duisent pas significativement les taux de transmission verticale.<\/label><label for='ays-answer-242-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-52]' id='ays-answer-244-4' value='244'\/>\n\n                <label for='ays-answer-244-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Leur administration est trop complexe pour \u00eatre g\u00e9n\u00e9ralis\u00e9e.<\/label><label for='ays-answer-244-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-52]' id='ays-answer-246-4' value='246'\/>\n\n                <label for='ays-answer-246-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Elles augmentent le risque de pr\u00e9maturit\u00e9.<\/label><label for='ays-answer-246-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_4 === 'undefined'){\n                window.quizOptions_4 = [];\n            }\n            window.quizOptions_4['52'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='24' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>13 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong>Quelle mesure est efficace pour r\u00e9duire le risque de s\u00e9roconversion chez les femmes enceintes ?<\/strong><\/p>\n\n                            <\/div>\n                            \n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-24]' id='ays-answer-104-4' value='104'\/>\n\n                <label for='ays-answer-104-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Lavage des mains fr\u00e9quent et mesures d\u2019hygi\u00e8ne<\/label><label for='ays-answer-104-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-24]' id='ays-answer-102-4' value='102'\/>\n\n                <label for='ays-answer-102-4' class='  ays_position_initial  ays-quiz-keyboard-label'>La vaccination<\/label><label for='ays-answer-102-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-24]' id='ays-answer-106-4' value='106'\/>\n\n                <label for='ays-answer-106-4' class='  ays_position_initial  ays-quiz-keyboard-label'>\u00c9viter les aliments crus<\/label><label for='ays-answer-106-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-24]' id='ays-answer-105-4' value='105'\/>\n\n                <label for='ays-answer-105-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Prendre des antibiotiques<\/label><label for='ays-answer-105-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-24]' id='ays-answer-103-4' value='103'\/>\n\n                <label for='ays-answer-103-4' class='  ays_position_initial  ays-quiz-keyboard-label'>\u00c9viter les contacts avec des animaux<\/label><label for='ays-answer-103-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_4 === 'undefined'){\n                window.quizOptions_4 = [];\n            }\n            window.quizOptions_4['24'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='30' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>14 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong>Quel antiviral est principalement utilis\u00e9 pour traiter les nouveau-n\u00e9s atteints de CMV symptomatique ?<\/strong><\/p>\n\n                            <\/div>\n                            \n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-30]' id='ays-answer-135-4' value='135'\/>\n\n                <label for='ays-answer-135-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Ganciclovir<\/label><label for='ays-answer-135-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-30]' id='ays-answer-136-4' value='136'\/>\n\n                <label for='ays-answer-136-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Ribavirine<\/label><label for='ays-answer-136-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-30]' id='ays-answer-133-4' value='133'\/>\n\n                <label for='ays-answer-133-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Valganciclovir<\/label><label for='ays-answer-133-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-30]' id='ays-answer-134-4' value='134'\/>\n\n                <label for='ays-answer-134-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Aciclovir<\/label><label for='ays-answer-134-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-30]' id='ays-answer-132-4' value='132'\/>\n\n                <label for='ays-answer-132-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Valaciclovir<\/label><label for='ays-answer-132-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_4 === 'undefined'){\n                window.quizOptions_4 = [];\n            }\n            window.quizOptions_4['30'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='43' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>15 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong>Quelle anomalie pr\u00e9natale d\u00e9tect\u00e9e \u00e0 l\u2019\u00e9chographie est la plus \u00e9vocatrice d\u2019un CMV cong\u00e9nital ?<\/strong><\/p>\n\n                            <\/div>\n                            \n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-43]' id='ays-answer-199-4' value='199'\/>\n\n                <label for='ays-answer-199-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Hydramnios<\/label><label for='ays-answer-199-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-43]' id='ays-answer-197-4' value='197'\/>\n\n                <label for='ays-answer-197-4' class='  ays_position_initial  ays-quiz-keyboard-label'>RCIU (Retard de croissance intra-ut\u00e9rin)<\/label><label for='ays-answer-197-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-43]' id='ays-answer-200-4' value='200'\/>\n\n                <label for='ays-answer-200-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Hypertrophie cardiaque<\/label><label for='ays-answer-200-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-43]' id='ays-answer-198-4' value='198'\/>\n\n                <label for='ays-answer-198-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Microc\u00e9phalie<\/label><label for='ays-answer-198-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-43]' id='ays-answer-201-4' value='201'\/>\n\n                <label for='ays-answer-201-4' class='  ays_position_initial  ays-quiz-keyboard-label'>Kystes ovariens<\/label><label for='ays-answer-201-4' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_4 === 'undefined'){\n                window.quizOptions_4 = [];\n            }\n            window.quizOptions_4['43'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                            \n                            <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                            <input type='button' class='ays_previous action-button ays-quiz-keyboard-active '  value='Pr\u00e9c\u00e9dent' \/>\n                            <i class='ays_display_none ays_fa ays_fa_flag_checkered ays_finish action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active' tabindex='0'><\/i><input type='submit' name='ays_finish_quiz' class='  ays_next ays_finish action-button ays-quiz-keyboard-active' value='Voir le r\u00e9sultat'\/>\n                        <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ays_thank_you_fs'>\n            <div class='ays-abs-fs ays-end-page'><div data-class='lds-ellipsis' data-role='loader' class='ays-loader'><div><\/div><div><\/div><div><\/div><div><\/div><\/div><div class='ays_quiz_results_page'><div class='ays_score_message'><\/div><div class='ays_message'><\/div><p class='ays_score ays_score_display_none animated'>Your score is<\/p><p class='ays_average'>The average score is 9%<\/p><div class='ays-progress third'>\n                <span class='ays-progress-value third'>0%<\/span>\n                <div class='ays-progress-bg third'>\n                    <div class='ays-progress-bar third' style='width:0%;'><\/div>\n                <\/div>\n            <\/div><p class='ays_restart_button_p'><button type='button' class='action-button ays_restart_button ays-quiz-keyboard-active'>\n                    <i class='ays_fa ays_fa_undo'><\/i>\n                    <span>Relancer le quiz<\/span>\n                <\/button><\/p><\/div>\n            <\/div>\n        <\/div><style>\n            div#ays-quiz-container-4 * {\n                box-sizing: border-box;\n            }\n\n            #ays-quiz-container-4 [id^='ays_finish_quiz_'] div.step div.ays-abs-fs {\n                width: 90%;\n            }\n\n            \/* Styles for Internet Explorer start *\/\n            #ays-quiz-container-4 #ays_finish_quiz_4 {\n                \n            }\n\n            \/* Styles for Quiz container *\/\n            #ays-quiz-container-4{\n                min-height: 400px;\n                width:800px;\n                background-color:#fff;\n                background-position:center center;border-radius:8px;box-shadow: none;border-width: 1px;border-style: solid;border-color: #000;}\n\n            \/* Styles for questions *\/\n            #ays-quiz-container-4 #ays_finish_quiz_4 div.step {\n                min-height: 400px;\n            }\n\n            \/* Styles for text inside quiz container *\/\n            #ays-quiz-container-4 .ays-start-page *:not(input):not([class^='enlighter']),\n            #ays-quiz-container-4 .ays_question_hint,\n            #ays-quiz-container-4 label[for^=\"ays-answer-\"],\n            #ays-quiz-container-4 #ays_finish_quiz_4 p,\n            #ays-quiz-container-4 #ays_finish_quiz_4 .ays-fs-title,\n            #ays-quiz-container-4 .ays-fs-subtitle,\n            #ays-quiz-container-4 .logged_in_message,\n            #ays-quiz-container-4 .ays_score_message,\n            #ays-quiz-container-4 .ays_message{\n               color: #000000;\n               outline: none;\n            }\n\n            div#ays-quiz-container-4 .ays_question_hint.ays-quiz-keyboard-active,\n            div#ays-quiz-container-4 .ays_restart_button.ays-quiz-keyboard-active {\n                outline: revert;\n            }\n\n            #ays-quiz-container-4 .ays-quiz-password-message-box,\n            #ays-quiz-container-4 .ays-quiz-question-note-message-box,\n            #ays-quiz-container-4 .ays_quiz_question,\n            #ays-quiz-container-4 .ays-quiz-question-category-box,\n            #ays-quiz-container-4 .ays_quiz_question *:not([class^='enlighter']) {\n                color: #000000;\n            }\n\n            #ays-quiz-container-4 .ays-quiz-question-category-box em {\n                color: #000000;\n            }\n\n            #ays-quiz-container-4 textarea,\n            #ays-quiz-container-4 input::first-letter,\n            #ays-quiz-container-4 select::first-letter,\n            #ays-quiz-container-4 option::first-letter {\n                color: initial !important;\n            }\n            \n            #ays-quiz-container-4 p::first-letter:not(.ays_no_questions_message) {\n                color: #000000 !important;\n                background-color: transparent !important;\n                font-size: inherit !important;\n                font-weight: inherit !important;\n                float: none !important;\n                line-height: inherit !important;\n                margin: 0 !important;\n                padding: 0 !important;\n            }\n            \n            \n            #ays-quiz-container-4 .select2-container,\n            #ays-quiz-container-4 .ays-field * {\n                font-size: 15px !important;\n            }\n    \n            #ays-quiz-container-4 .ays_quiz_question p {\n                font-size: 16px;\n                text-align: inherit;\n            }\n\n            #ays-quiz-container-4 .ays-fs-subtitle p {\n                text-align:  center ;\n            }\n\n            #ays-quiz-container-4 .ays_quiz_question {\n                text-align:  center ;\n                margin-bottom: 10px;\n            }\n\n            #ays-quiz-container-4 .ays_quiz_question pre {\n                max-width: 100%;\n                white-space: break-spaces;\n            }\n\n            \/* Mango theme (Version: 1.4.202301041836) | tid=32449 | Start *\/\n            #ays-quiz-container-4 .ays_quiz_question img {\n                float: unset;\n                margin: 0;\n            }\n            \/* Mango theme (Version: 1.4.202301041836) | End *\/\n\n            #ays-quiz-container-4 .ays-quiz-timer p {\n                font-size: 16px;\n            }\n\n            #ays-quiz-container-4 section.ays_quiz_redirection_timer_container hr,\n            #ays-quiz-container-4 section.ays_quiz_timer_container hr {\n                margin: 0;\n            }\n\n            #ays-quiz-container-4 section.ays_quiz_timer_container.ays_quiz_timer_red_warning .ays-quiz-timer {\n                color: #ff0000;\n            }\n\n            #ays-quiz-container-4 .ays_thank_you_fs p {\n                text-align: center;\n            }\n\n            #ays-quiz-container-4 .ays_quiz_results_page .ays_score span {\n                visibility: visible;\n            }\n\n            #ays-quiz-container-4 input[type='button'],\n            #ays-quiz-container-4 input[type='submit'] {\n                color: #ffffff !important;\n            }\n\n            #ays-quiz-container-4 input[type='button']{\n                outline: none;\n            }\n\n            #ays-quiz-container-4 .information_form input[type='text'],\n            #ays-quiz-container-4 .information_form input[type='url'],\n            #ays-quiz-container-4 .information_form input[type='number'],\n            #ays-quiz-container-4 .information_form input[type='email'],\n            #ays-quiz-container-4 .information_form input[type='checkbox'],\n            #ays-quiz-container-4 .information_form input[type='tel'],\n            #ays-quiz-container-4 .information_form textarea,\n            #ays-quiz-container-4 .information_form select,\n            #ays-quiz-container-4 .information_form option {\n                color: initial !important;\n                outline: none;\n                background-image: unset;\n            }\n\n            #ays-quiz-container-4 .wrong_answer_text{\n                color:#ff4d4d;\n            }\n            #ays-quiz-container-4 .right_answer_text{\n                color:#33cc33;\n            }\n\n            #ays-quiz-container-4 .wrong_answer_text p {\n                font-size:15px;\n            }\n\n            #ays-quiz-container-4 .ays_questtion_explanation p {\n                font-size:15px;\n            }\n\n            #ays-quiz-container-4 .wrong_answer_text *:not(strong) {\n                text-transform:none;\n                text-decoration: none;\n                letter-spacing: 0px;\n                font-weight: normal;\n            }\n\n            #ays-quiz-container-4 .ays_questtion_explanation *:not(strong) {\n                text-transform:none;\n                text-decoration: none;\n                letter-spacing: 0px;\n                font-weight: normal;\n            }\n\n            #ays-quiz-container-4 .right_answer_text *:not(strong) {\n                text-transform:none;\n                text-decoration: none;\n                letter-spacing: 0px;\n                font-weight: normal;\n            }\n\n            #ays-quiz-container-4 .right_answer_text p {\n                font-size:15px;\n            }\n\n            #ays-quiz-container-4 .ays-quiz-question-note-message-box p {\n                font-size:14px;\n            }\n\n            #ays-quiz-container-4 .ays-quiz-question-note-message-box *:not(strong) {\n                text-transform:none;\n                text-decoration: none;\n                letter-spacing: 0px;\n                font-weight: normal;\n            }\n            \n            #ays-quiz-container-4 .ays_cb_and_a,\n            #ays-quiz-container-4 .ays_cb_and_a * {\n                color: rgb(0,0,0);\n                text-align: center;\n            }\n\n            \/* Quiz textarea height *\/\n            #ays-quiz-container-4 textarea {\n                height: 100px;\n                min-height: 100px;\n            }\n\n            \/* Quiz rate and passed users count *\/\n            #ays-quiz-container-4 .ays_quizn_ancnoxneri_qanak,\n            #ays-quiz-container-4 .ays_quiz_rete_avg {\n                color:#fff !important;\n                background-color:#000000;   \n            }\n\n            #ays-quiz-container-4 .ays-questions-container > .ays_quizn_ancnoxneri_qanak {\n                padding: 5px 20px;\n            }\n            #ays-quiz-container-4 div.for_quiz_rate.ui.star.rating .icon {\n                color: rgba(0,0,0,0.35);\n            }\n            #ays-quiz-container-4 .ays_quiz_rete_avg div.for_quiz_rate_avg.ui.star.rating .icon {\n                color: rgba(255,255,255,0.5);\n            }\n\n            #ays-quiz-container-4 .ays_quiz_rete .ays-quiz-rate-link-box .ays-quiz-rate-link {\n                color: #000000;\n            }\n\n            \/* Loaders *\/            \n            #ays-quiz-container-4 div.lds-spinner,\n            #ays-quiz-container-4 div.lds-spinner2 {\n                color: #000000;\n            }\n            #ays-quiz-container-4 div.lds-spinner div:after,\n            #ays-quiz-container-4 div.lds-spinner2 div:after {\n                background-color: #000000;\n            }\n            #ays-quiz-container-4 .lds-circle,\n            #ays-quiz-container-4 .lds-facebook div,\n            #ays-quiz-container-4 .lds-ellipsis div{\n                background: #000000;\n            }\n            #ays-quiz-container-4 .lds-ripple div{\n                border-color: #000000;\n            }\n            #ays-quiz-container-4 .lds-dual-ring::after,\n            #ays-quiz-container-4 .lds-hourglass::after{\n                border-color: #000000 transparent #000000 transparent;\n            }\n\n            \/* Stars *\/\n            #ays-quiz-container-4 .ui.rating .icon,\n            #ays-quiz-container-4 .ui.rating .icon:before {\n                font-family: Rating !important;\n            }\n\n            \/* Progress bars *\/\n            #ays-quiz-container-4 #ays_finish_quiz_4 .ays-progress {\n                border-color: rgba(0,0,0,0.8);\n            }\n            #ays-quiz-container-4 #ays_finish_quiz_4 .ays-progress-bg {\n                background-color: rgba(0,0,0,0.3);\n            }    \n            #ays-quiz-container-4 .ays-progress-value {\n                color: #000000;\n                text-align: center;\n            }\n            #ays-quiz-container-4 .ays-progress-bar {\n                background-color: #449aba;\n            }\n            #ays-quiz-container-4 .ays-question-counter .ays-live-bar-wrap {\n                direction:ltr !important;\n            }\n            #ays-quiz-container-4 .ays-live-bar-fill{\n                color: #000000;\n                border-bottom: 2px solid rgba(0,0,0,0.8);\n                text-shadow: 0px 0px 5px #fff;\n            }\n            #ays-quiz-container-4 .ays-live-bar-fill.ays-live-fourth,\n            #ays-quiz-container-4 .ays-live-bar-fill.ays-live-third,\n            #ays-quiz-container-4 .ays-live-bar-fill.ays-live-second {\n                text-shadow: unset;\n            }\n            #ays-quiz-container-4 .ays-live-bar-percent{\n                display:none;\n            }\n            #ays-quiz-container-4 #ays_finish_quiz_4 .ays_average {\n                text-align: center;\n            }\n            \n            \/* Music, Sound *\/\n            #ays-quiz-container-4 .ays_music_sound {\n                color:rgb(0,0,0);\n            }\n\n            \/* Dropdown questions scroll bar *\/\n            #ays-quiz-container-4 blockquote {\n                border-left-color: #000000 !important;                                      \n            }\n\n            \/* Quiz Password *\/\n            #ays-quiz-container-4 .ays-start-page > input[id^='ays_quiz_password_val_'],\n            #ays-quiz-container-4 .ays-quiz-password-toggle-visibility-box {\n                width: 100%;\n            }\n\n\n            \/* Question hint *\/\n            #ays-quiz-container-4 .ays_question_hint_container .ays_question_hint_text {\n                background-color:#fff;\n                box-shadow: 0 0 15px 3px rgba(201,201,201,0.6);\n                max-width: 270px;\n            }\n\n            #ays-quiz-container-4 .ays_question_hint_container .ays_question_hint_text p {\n                max-width: unset;\n            }\n\n            #ays-quiz-container-4 .ays-quiz-additonal-box {\n                display: flex;\n                justify-content: flex-end;\n                align-items: center;\n                position: relative;  \n            }\n\n            #ays-quiz-container-4 .ays_questions_hint_max_width_class {\n                max-width: 80%;\n            }\n\n            \/* Information form *\/\n            #ays-quiz-container-4 .ays-form-title{\n                color:rgb(0,0,0);\n            }\n\n            \/* Quiz timer *\/\n            #ays-quiz-container-4 div.ays-quiz-redirection-timer,\n            #ays-quiz-container-4 div.ays-quiz-timer{\n                color: #000000;\n                text-align: center;\n            }\n\n            #ays-quiz-container-4 div.ays-quiz-timer.ays-quiz-message-before-timer:before {\n                font-weight: 500;\n            }\n\n            \/* Quiz title \/ transformation *\/\n            #ays-quiz-container-4 .ays-fs-title{\n                text-transform: uppercase;\n                font-size: 23px;\n                text-align: center;\n                    text-shadow: none;\n            }\n            \n            \/* Quiz buttons *\/\n            #ays-quiz-container-4 .ays_arrow {\n                color:#ffffff!important;\n            }\n            #ays-quiz-container-4 input#ays-submit,\n            #ays-quiz-container-4 #ays_finish_quiz_4 .action-button,\n            div#ays-quiz-container-4 #ays_finish_quiz_4 .action-button.ays_restart_button,\n            #ays-quiz-container-4 + .ays-quiz-category-selective-main-container .ays-quiz-category-selective-restart-bttn,\n            #ays-quiz-container-4 .ays-quiz-category-selective-submit-bttn {\n                background: none;\n                background-color: #449aba;\n                color:#ffffff;\n                font-size: 15px;\n                padding: 10px 20px;\n                border-radius: 8px;\n                height: auto;\n                letter-spacing: 0;\n                box-shadow: unset;\n                width: auto;\n                \/* border: unset; *\/\n                min-height: unset;\n                line-height: normal;\n                text-shadow: unset;\n            }\n            #ays-quiz-container-4 input#ays-submit,\n            #ays-quiz-container-4 #ays_finish_quiz_4 input.action-button,\n            #ays-quiz-container-4 + .ays-quiz-category-selective-main-container .ays-quiz-category-selective-restart-bttn,\n            #ays-quiz-container-4 .ays-quiz-category-selective-submit-bttn {\n                \n            }\n\n            #ays-quiz-container-4 #ays_finish_quiz_4 .action-button.ays_check_answer {\n                padding: 5px 10px;\n                font-size: 15px !important;\n            }\n            #ays-quiz-container-4 #ays_finish_quiz_4 .action-button.ays_restart_button {\n                white-space: nowrap;\n                padding: 5px 10px;\n                white-space: normal;\n            }\n            #ays-quiz-container-4 input#ays-submit:hover,\n            #ays-quiz-container-4 input#ays-submit:focus,\n            #ays-quiz-container-4 #ays_finish_quiz_4 .action-button:hover,\n            #ays-quiz-container-4 #ays_finish_quiz_4 .action-button:focus,\n            #ays-quiz-container-4 + .ays-quiz-category-selective-main-container .ays-quiz-category-selective-restart-bttn:hover,\n            #ays-quiz-container-4 .ays-quiz-category-selective-submit-bttn:hover {\n                background: none;\n                box-shadow: 0 0 0 2px #ffffff;\n                background-color: #449aba;\n            }\n            #ays-quiz-container-4 .ays_restart_button {\n                color: #ffffff;\n            }\n            \n            #ays-quiz-container-4 .ays_restart_button_p,\n            #ays-quiz-container-4 .ays_buttons_div {\n                justify-content: center;\n            }\n\n            #ays-quiz-container-4 .ays_finish.action-button{\n                margin: 10px 5px;\n            }\n\n            #ays-quiz-container-4 .ays-share-btn.ays-share-btn-branded {\n                color: #fff;\n                display: inline-block;\n            }\n\n            #ays-quiz-container-4 .ays_quiz_results .ays-field.checked_answer_div.correct_div input:checked+label {\n                background-color: transparent;\n            }\n                        \n            \/* Question answers *\/\n            #ays-quiz-container-4 .ays-field {\n                    border-color: #dddddd;\n                    border-style: solid;\n                    border-width: 1px;\n                    box-shadow: none;flex-direction: row-reverse;\n            }\n            \n\n            \/* Answer maximum length of a text field *\/\n            #ays-quiz-container-4 .ays_quiz_question_text_message{\n                color: #000000;\n                text-align: left;\n                font-size: 12px;\n            }\n\n            div#ays-quiz-container-4 div.ays_quiz_question_text_error_message {\n                color: #ff0000;\n            }\n\n            \/* Questions answer image *\/\n            #ays-quiz-container-4 .ays-answer-image {\n                width:15em;\n                height:150px;\n                object-fit: cover;\n            }\n            \n            #ays-quiz-container-4 .ays-quiz-answers .ays-field:hover{\n                opacity: 1;\n            }\n            #ays-quiz-container-4 #ays_finish_quiz_4 .ays-field label.ays_answer_caption[for^='ays-answer-'] {\n                z-index: 1;\n                position:initial;bottom:0;}\n            #ays-quiz-container-4 #ays_finish_quiz_4 .ays-field input~label[for^='ays-answer-'] {\n                padding: 5px;\n            }\n\n            #ays-quiz-container-4 #ays_finish_quiz_4 .ays-field {\n                margin-bottom: 12px;\n            }\n            #ays-quiz-container-4 #ays_finish_quiz_4 .ays-field.ays_grid_view_item {\n                width: calc(50% - 6px);\n            }\n            #ays-quiz-container-4 #ays_finish_quiz_4 .ays-field.ays_grid_view_item:nth-child(odd) {\n                margin-right: 6px;\n            }\n            \n            #ays-quiz-container-4 #ays_finish_quiz_4 .ays-field input:checked+label:before {\n                border-color: #449aba;\n                background: #449aba;\n                background-clip: content-box;\n            }\n            #ays-quiz-container-4 .ays-quiz-answers div.ays-text-right-answer {\n                color: #000000;\n            }\n                        \n            \/* Questions answer right\/wrong icons *\/\n            #ays-quiz-container-4 .ays-field input~label.answered.correct:after{\n                content: url('https:\/\/echonews.fr\/wp-content\/plugins\/quiz-maker\/public\/images\/correct.png');          }\n            #ays-quiz-container-4 .ays-field input~label.answered.wrong:after{\n                content: url('https:\/\/echonews.fr\/wp-content\/plugins\/quiz-maker\/public\/images\/wrong.png');\n            }\n            #ays-quiz-container-4 .ays-field label.answered:last-of-type:after{\n                display: none;\n                height: auto;\n                left: 10px;top: 10px;}\n            \/* Dropdown questions *\/            \n            #ays-quiz-container-4 #ays_finish_quiz_4 .ays-field .select2-container--default .select2-selection--single {\n                border-bottom: 2px solid #449aba;\n                background-color: #449aba;\n            }\n            \n            #ays-quiz-container-4 .ays-field .select2-container--default .select2-selection--single .select2-selection__placeholder,\n            #ays-quiz-container-4 .ays-field .select2-container--default .select2-selection--single .select2-selection__rendered,\n            #ays-quiz-container-4 .ays-field .select2-container--default .select2-selection--single .select2-selection__arrow {\n                color: #ffffff;\n            }\n\n            #ays-quiz-container-4 .select2-container--default .select2-search--dropdown .select2-search__field:focus,\n            #ays-quiz-container-4 .select2-container--default .select2-search--dropdown .select2-search__field {\n                outline: unset;\n                padding: 0.75rem;\n            }\n\n            #ays-quiz-container-4 .ays-field .select2-container--default .select2-selection--single .select2-selection__rendered,\n            #ays-quiz-container-4 .select2-container--default .select2-results__option--highlighted[aria-selected] {\n                background-color: #449aba;\n            }\n\n            #ays-quiz-container-4 .ays-field .select2-container--default,\n            #ays-quiz-container-4 .ays-field .select2-container--default .selection,\n            #ays-quiz-container-4 .ays-field .select2-container--default .dropdown-wrapper,\n            #ays-quiz-container-4 .ays-field .select2-container--default .select2-selection--single .select2-selection__rendered,\n            #ays-quiz-container-4 .ays-field .select2-container--default .select2-selection--single .select2-selection__rendered .select2-selection__placeholder,\n            #ays-quiz-container-4 .ays-field .select2-container--default .select2-selection--single .select2-selection__arrow,\n            #ays-quiz-container-4 .ays-field .select2-container--default .select2-selection--single .select2-selection__arrow b[role='presentation'] {\n                font-size: 16px !important;\n            }\n\n            #ays-quiz-container-4 .select2-container--default .select2-results__option {\n                padding: 6px;\n            }\n            \n            \/* Dropdown questions scroll bar *\/\n            #ays-quiz-container-4 .select2-results__options::-webkit-scrollbar {\n                width: 7px;\n            }\n            #ays-quiz-container-4 .select2-results__options::-webkit-scrollbar-track {\n                background-color: rgba(255,255,255,0.35);\n            }\n            #ays-quiz-container-4 .select2-results__options::-webkit-scrollbar-thumb {\n                transition: .3s ease-in-out;\n                background-color: rgba(0,0,0,0.55);\n            }\n            #ays-quiz-container-4 .select2-results__options::-webkit-scrollbar-thumb:hover {\n                transition: .3s ease-in-out;\n                background-color: rgba(0,0,0,0.85);\n            }\n\n            \/* Audio \/ Video *\/\n            #ays-quiz-container-4 .mejs-container .mejs-time{\n                box-sizing: unset;\n            }\n            #ays-quiz-container-4 .mejs-container .mejs-time-rail {\n                padding-top: 15px;\n            }\n\n            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cong\u00e9nitales \u00e0 cytom\u00e9galovirus : de la pr\u00e9vention \u00e0 la prise en charge postnatale","description":"","quiz_image":"","quiz_category_id":"3","question_ids":"60,59,58,57,56,55,54,53,52,51,50,49,48,47,46,45,44,43,42,41,40,39,38,37,36,35,34,33,32,31,30,29,28,27,26,25,24,23,22,21","ordering":"3","published":"1","intervals":null,"quiz_url":"","author_id":"0","custom_post_id":null,"quiz_animation_top":100,"quiz_enable_animation_top":"on"}';\n        <\/script>\n                    <input type='hidden' name='quiz_id' value='4'\/>\n                    <input type='hidden' name='start_date' class='ays-start-date'\/>\n                <\/form><\/div>\n                            <\/div>\n                            <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-9b984c3 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"9b984c3\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-7c1aae1\" data-id=\"7c1aae1\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2bf23d9 elementor-widget elementor-widget-text-editor\" data-id=\"2bf23d9\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: left;\">QUESTIONS D&#8217;EXAMEN \u00c0 R\u00c9PONSES COURTES<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e1f22f6 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"e1f22f6\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-ac04a8e elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"ac04a8e\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-4d44bbe\" data-id=\"4d44bbe\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d470a27 elementor-widget elementor-widget-toggle\" data-id=\"d470a27\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2221\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-2221\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">D\u00e9crivez les principaux modes de transmission du CMV de la m\u00e8re au f\u0153tus.<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2221\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-2221\"><p>Le CMV se transmet principalement de mani\u00e8re verticale via le placenta. Cette transmission peut survenir apr\u00e8s une infection primaire, une r\u00e9activation virale ou une r\u00e9infection par une nouvelle souche. Le virus traverse le placenta et infecte le f\u0153tus, entra\u00eenant des atteintes multisyst\u00e9miques. La transmission est plus fr\u00e9quente aux stades avanc\u00e9s de la grossesse (66 % au troisi\u00e8me trimestre), mais les s\u00e9quelles graves sont principalement associ\u00e9es \u00e0 une transmission au cours du premier trimestre. D&#8217;autres modes de transmission incluent le contact avec les fluides maternels infect\u00e9s lors de l&#8217;accouchement ou l&#8217;allaitement, mais ces cas sont moins fr\u00e9quents.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2222\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-2222\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Quels sont les facteurs de risque d\u2019infection primaire au CMV chez la femme enceinte ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2222\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-2222\"><p>Les facteurs de risque incluent le contact fr\u00e9quent avec des jeunes enfants, qui excr\u00e8tent le virus dans leur salive et leur urine sur une p\u00e9riode prolong\u00e9e. Les femmes travaillant dans des cr\u00e8ches ou ayant des enfants en bas \u00e2ge \u00e0 domicile sont particuli\u00e8rement expos\u00e9es. Un statut s\u00e9rologique n\u00e9gatif avant la grossesse est \u00e9galement un facteur de risque important, car ces femmes n\u2019ont pas d\u2019immunit\u00e9 pr\u00e9existante contre le CMV. Un intervalle court entre les grossesses augmente \u00e9galement le risque, ainsi que des ant\u00e9c\u00e9dents de partenaires multiples.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2223\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-2223\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Pourquoi les infections \u00e0 CMV au premier trimestre sont-elles associ\u00e9es \u00e0 des s\u00e9quelles graves ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2223\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-2223\"><p>Le premier trimestre correspond \u00e0 une p\u00e9riode critique pour le d\u00e9veloppement f\u0153tal, en particulier pour le syst\u00e8me nerveux central. Les infections \u00e0 ce stade peuvent causer des atteintes irr\u00e9versibles comme la microc\u00e9phalie, des calcifications p\u00e9riventriculaires et des anomalies corticales (ex. : polymicrogyrie). Ces l\u00e9sions sont dues \u00e0 la r\u00e9plication active du virus dans les cellules en division rapide, ce qui entra\u00eene une destruction tissulaire. De plus, le syst\u00e8me immunitaire f\u0153tal est immature, ce qui limite sa capacit\u00e9 \u00e0 contr\u00f4ler l\u2019infection.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2224\" class=\"elementor-tab-title\" data-tab=\"4\" role=\"button\" aria-controls=\"elementor-tab-content-2224\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Expliquez le r\u00f4le des tests d\u2019avidit\u00e9 des IgG dans le diagnostic pr\u00e9natal du CMV.<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2224\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"4\" role=\"region\" aria-labelledby=\"elementor-tab-title-2224\"><p>Les tests d\u2019avidit\u00e9 des IgG mesurent la force de liaison des anticorps IgG au virus. Une faible avidit\u00e9 indique une infection r\u00e9cente (&lt;3 mois), tandis qu\u2019une forte avidit\u00e9 exclut une infection primaire r\u00e9cente. Ces tests sont particuli\u00e8rement utiles pour diff\u00e9rencier une infection ancienne d\u2019une infection r\u00e9cente chez les femmes enceintes avec des IgM positives. Cette distinction est essentielle pour \u00e9valuer le risque de transmission verticale et guider les d\u00e9cisions de prise en charge, notamment l\u2019administration de traitements pr\u00e9ventifs.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2225\" class=\"elementor-tab-title\" data-tab=\"5\" role=\"button\" aria-controls=\"elementor-tab-content-2225\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Quels sont les avantages et limites de l\u2019amniocent\u00e8se dans le diagnostic du CMV f\u0153tal ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2225\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"5\" role=\"region\" aria-labelledby=\"elementor-tab-title-2225\"><p>L\u2019amniocent\u00e8se permet de d\u00e9tecter l\u2019ADN du CMV dans le liquide amniotique via une PCR. Elle a une sp\u00e9cificit\u00e9 proche de 100 % et une sensibilit\u00e9 de 85\u201395 %. Elle est r\u00e9alis\u00e9e apr\u00e8s 17 semaines de grossesse et au moins 8 semaines apr\u00e8s l\u2019infection maternelle pr\u00e9sum\u00e9e. Cependant, elle comporte un risque faible mais r\u00e9el de complications, comme la rupture des membranes ou l\u2019infection. Une PCR n\u00e9gative n\u2019exclut pas totalement une infection f\u0153tale tardive, mais ces cas sont rarement associ\u00e9s \u00e0 des s\u00e9quelles.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2226\" class=\"elementor-tab-title\" data-tab=\"6\" role=\"button\" aria-controls=\"elementor-tab-content-2226\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">D\u00e9crivez les options th\u00e9rapeutiques pr\u00e9natales pour pr\u00e9venir la transmission verticale du CMV.<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2226\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"6\" role=\"region\" aria-labelledby=\"elementor-tab-title-2226\"><p>Les deux principales options sont le valaciclovir et les immunoglobulines hyperimmunes (HIG). Le valaciclovir, \u00e0 une dose de 8 g\/jour, r\u00e9duit le taux de transmission de 70 % lorsqu\u2019il est administr\u00e9 au premier trimestre. Les HIG ont \u00e9galement montr\u00e9 une efficacit\u00e9, mais leurs r\u00e9sultats sont variables selon les \u00e9tudes. Ces traitements doivent \u00eatre initi\u00e9s rapidement apr\u00e8s l\u2019infection maternelle pour \u00eatre efficaces. Ils visent \u00e0 r\u00e9duire la charge virale maternelle et \u00e0 pr\u00e9venir l\u2019infection placentaire.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-0e29c08\" data-id=\"0e29c08\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-078f63b elementor-widget elementor-widget-toggle\" data-id=\"078f63b\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-7921\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-7921\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Pourquoi un suivi prolong\u00e9 est-il n\u00e9cessaire pour les enfants infect\u00e9s par le CMV de mani\u00e8re asymptomatique ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-7921\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-7921\"><p>Les enfants asymptomatiques \u00e0 la naissance peuvent d\u00e9velopper des s\u00e9quelles tardives, telles qu\u2019une surdit\u00e9 neurosensorielle progressive ou des troubles du d\u00e9veloppement neurologique. Ces complications peuvent appara\u00eetre plusieurs mois ou ann\u00e9es apr\u00e8s la naissance. Un suivi r\u00e9gulier, incluant des tests auditifs et des \u00e9valuations neurod\u00e9veloppementales, est essentiel pour d\u00e9tecter et traiter pr\u00e9cocement ces anomalies, ce qui peut am\u00e9liorer les r\u00e9sultats \u00e0 long terme.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-7922\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-7922\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Expliquez les m\u00e9canismes d\u2019action des antiviraux utilis\u00e9s pour traiter le CMV.<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-7922\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-7922\"><p>Les antiviraux comme le valganciclovir inhibent la r\u00e9plication de l\u2019ADN viral en bloquant l\u2019action de l\u2019ADN polym\u00e9rase virale. Cela emp\u00eache la multiplication du virus dans les cellules infect\u00e9es. Le valganciclovir est utilis\u00e9 pour traiter les nouveau-n\u00e9s symptomatiques, car il r\u00e9duit la charge virale et pr\u00e9vient l\u2019aggravation des l\u00e9sions. Cependant, il peut entra\u00eener des effets secondaires, comme une neutrop\u00e9nie, n\u00e9cessitant une surveillance \u00e9troite.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-7923\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-7923\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Quels crit\u00e8res justifient le traitement d\u2019un nouveau-n\u00e9 atteint de CMV cong\u00e9nital ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-7923\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-7923\"><p>Le traitement est indiqu\u00e9 chez les nouveau-n\u00e9s pr\u00e9sentant des sympt\u00f4mes cliniques significatifs, tels que des calcifications intracr\u00e2niennes, une atteinte neurologique, une surdit\u00e9 ou une h\u00e9patospl\u00e9nom\u00e9galie. Les nouveau-n\u00e9s asymptomatiques ne re\u00e7oivent g\u00e9n\u00e9ralement pas de traitement, sauf en cas de risque \u00e9lev\u00e9 de surdit\u00e9 progressive. Une confirmation virologique par PCR dans le sang ou les urines est n\u00e9cessaire avant d\u2019initier le traitement.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-7924\" class=\"elementor-tab-title\" data-tab=\"4\" role=\"button\" aria-controls=\"elementor-tab-content-7924\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Quels facteurs influencent l\u2019efficacit\u00e9 des mesures d\u2019hygi\u00e8ne pour pr\u00e9venir les infections primaires au CMV ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-7924\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"4\" role=\"region\" aria-labelledby=\"elementor-tab-title-7924\"><p>L\u2019efficacit\u00e9 des mesures d\u2019hygi\u00e8ne d\u00e9pend de leur adoption pr\u00e9coce et stricte. Les femmes doivent \u00eatre inform\u00e9es de leur statut s\u00e9rologique et des recommandations, comme le lavage des mains, \u00e9viter de partager des ustensiles ou de donner des baisers sur la bouche \u00e0 de jeunes enfants. Une sensibilisation tardive, apr\u00e8s le premier trimestre, limite leur impact. La compr\u00e9hension et l\u2019adh\u00e9sion des patientes jouent \u00e9galement un r\u00f4le crucial.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-7925\" class=\"elementor-tab-title\" data-tab=\"5\" role=\"button\" aria-controls=\"elementor-tab-content-7925\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Pourquoi les enfants symptomatiques atteints de CMV cong\u00e9nital pr\u00e9sentent-ils souvent une surdit\u00e9 progressive ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-7925\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"5\" role=\"region\" aria-labelledby=\"elementor-tab-title-7925\"><p>Le CMV infecte les cellules de la cochl\u00e9e, entra\u00eenant une inflammation et une destruction progressive des structures auditives. La surdit\u00e9 peut ne pas \u00eatre apparente \u00e0 la naissance mais se d\u00e9velopper dans les premiers mois ou ann\u00e9es de vie. Cette progression est li\u00e9e \u00e0 la persistance ou la r\u00e9activation virale et peut affecter unilat\u00e9ralement ou bilat\u00e9ralement l\u2019audition, n\u00e9cessitant une surveillance audiologique prolong\u00e9e<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-7926\" class=\"elementor-tab-title\" data-tab=\"6\" role=\"button\" aria-controls=\"elementor-tab-content-7926\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Quelles sont les recommandations pour surveiller les enfants ayant une infection pr\u00e9natale au CMV avec une PCR n\u00e9gative \u00e0 l\u2019amniocent\u00e8se ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-7926\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"6\" role=\"region\" aria-labelledby=\"elementor-tab-title-7926\"><p>Bien qu\u2019une PCR n\u00e9gative \u00e0 l\u2019amniocent\u00e8se indique un faible risque de s\u00e9quelles, un suivi est recommand\u00e9. Ces enfants doivent subir des \u00e9valuations audiologiques r\u00e9guli\u00e8res jusqu\u2019\u00e0 l\u2019\u00e2ge de 5 ans pour d\u00e9tecter une \u00e9ventuelle surdit\u00e9 retard\u00e9e. Des examens neurod\u00e9veloppementaux peuvent \u00e9galement \u00eatre n\u00e9cessaires en cas de signes cliniques \u00e9vocateurs. L\u2019objectif est de pr\u00e9venir les cons\u00e9quences tardives m\u00eame en l\u2019absence de transmission f\u0153tale prouv\u00e9e.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-7be86bb elementor-section-full_width elementor-section-stretched elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"7be86bb\" data-element_type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-201c67c\" data-id=\"201c67c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-b3d5ef3 elementor-widget elementor-widget-image\" data-id=\"b3d5ef3\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"2560\" height=\"1106\" src=\"https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/illust-cascliniques.jpg\" class=\"attachment-full size-full wp-image-3950\" alt=\"\" srcset=\"https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/illust-cascliniques.jpg 2560w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/illust-cascliniques-300x130.jpg 300w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/illust-cascliniques-1024x442.jpg 1024w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/illust-cascliniques-768x332.jpg 768w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/illust-cascliniques-1536x664.jpg 1536w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/illust-cascliniques-2048x885.jpg 2048w\" sizes=\"(max-width: 2560px) 100vw, 2560px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-6ed280e elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"6ed280e\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-b2da2b8\" data-id=\"b2da2b8\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-780a6f4 elementor-widget elementor-widget-text-editor\" data-id=\"780a6f4\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: left;\">CAS CLINIQUES FICTIFS<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7a8d5b6 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"7a8d5b6\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-02c1236 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"02c1236\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-66bce04\" data-id=\"66bce04\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ac318c7 elementor-widget elementor-widget-toggle\" data-id=\"ac318c7\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1801\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-1801\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Cas clinique 1 : Contact suspect avec un enfant infect\u00e9<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1801\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-1801\"><p><strong>Situation :<\/strong> Une femme enceinte de 8 semaines est inform\u00e9e qu\u2019un de ses enfants, qui fr\u00e9quente une cr\u00e8che, a \u00e9t\u00e9 test\u00e9 positif au CMV. Elle est asymptomatique. Sa s\u00e9rologie montre IgG n\u00e9gatif et IgM positif avec une faible avidit\u00e9 des IgG.<br \/><strong>Question :<\/strong> Quelle est la prise en charge recommand\u00e9e ?<br \/><strong>R\u00e9ponse :<\/strong><br \/>Cette femme pr\u00e9sente une infection primaire r\u00e9cente. La prise en charge comprend :<\/p><ol><li>Initiation du traitement par valaciclovir (8 g\/jour) pour r\u00e9duire le risque de transmission verticale.<\/li><li>Surveillance \u00e9chographique r\u00e9guli\u00e8re pour d\u00e9tecter des anomalies f\u0153tales.<\/li><li>Amniocent\u00e8se \u00e0 17 semaines pour confirmer ou exclure l\u2019infection f\u0153tale.<\/li><\/ol><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1802\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-1802\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Cas clinique 2 : Infection tardive et suivi postnatal<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1802\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-1802\"><p><strong>Situation :<\/strong> Une femme enceinte de 32 semaines est diagnostiqu\u00e9e avec une infection primaire au CMV (IgG\/IgM positifs, faible avidit\u00e9). L\u2019\u00e9chographie ne montre aucune anomalie.<br \/><strong>Question :<\/strong> Quels sont les \u00e9l\u00e9ments \u00e0 surveiller pour le nouveau-n\u00e9 ?<br \/><strong>R\u00e9ponse :<\/strong><br \/>Les infections tardives entra\u00eenent rarement des s\u00e9quelles graves. Apr\u00e8s la naissance, le nouveau-n\u00e9 doit subir :<\/p><ol><li>Une PCR sur les urines ou la salive pour confirmer l\u2019infection.<\/li><li>Des tests auditifs \u00e0 la naissance et des suivis r\u00e9guliers jusqu\u2019\u00e0 5 ans pour d\u00e9tecter une \u00e9ventuelle surdit\u00e9 progressive.<\/li><\/ol><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1803\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-1803\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Cas clinique 3 : Anomalies \u00e9chographiques<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1803\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-1803\"><p><strong>Situation :<\/strong> \u00c0 20 semaines de grossesse, une \u00e9chographie d\u00e9tecte une microc\u00e9phalie et des calcifications intracr\u00e2niennes. La m\u00e8re a des ant\u00e9c\u00e9dents d\u2019infection primaire au premier trimestre.<br \/><strong>Question :<\/strong> Quelle est la prise en charge f\u0153tale ?<br \/><strong>R\u00e9ponse :<\/strong><\/p><ol><li>Une IRM f\u0153tale est recommand\u00e9e pour \u00e9valuer l\u2019\u00e9tendue des atteintes c\u00e9r\u00e9brales.<\/li><li>Un traitement antiviral pr\u00e9natal (valaciclovir) peut \u00eatre envisag\u00e9 pour limiter la progression des l\u00e9sions.<\/li><li>Conseil g\u00e9n\u00e9tique pour discuter du pronostic et des options, incluant une \u00e9ventuelle interruption m\u00e9dicale de grossesse (IMG).<\/li><\/ol><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1804\" class=\"elementor-tab-title\" data-tab=\"4\" role=\"button\" aria-controls=\"elementor-tab-content-1804\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Cas clinique 4 : Nouveau-n\u00e9 asymptomatique<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1804\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"4\" role=\"region\" aria-labelledby=\"elementor-tab-title-1804\"><p><strong>Situation :<\/strong> Un nouveau-n\u00e9, issu d\u2019une m\u00e8re ayant eu une infection primaire au CMV, est asymptomatique. Une PCR urinaire est positive.<br \/><strong>Question :<\/strong> Faut-il traiter cet enfant ?<br \/><strong>R\u00e9ponse :<\/strong><br \/>Les nouveau-n\u00e9s asymptomatiques ne n\u00e9cessitent g\u00e9n\u00e9ralement pas de traitement antiviral. Cependant, un suivi r\u00e9gulier est indispensable pour surveiller une surdit\u00e9 progressive ou d\u2019autres s\u00e9quelles tardives.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1805\" class=\"elementor-tab-title\" data-tab=\"5\" role=\"button\" aria-controls=\"elementor-tab-content-1805\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Cas clinique 5 : \u00c9chec du d\u00e9pistage pr\u00e9natal<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1805\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"5\" role=\"region\" aria-labelledby=\"elementor-tab-title-1805\"><p><strong>Situation :<\/strong> Une femme non d\u00e9pist\u00e9e pour le CMV pendant sa grossesse accouche d\u2019un enfant pr\u00e9sentant une surdit\u00e9 unilat\u00e9rale \u00e0 6 mois. Une PCR sur les urines confirme une infection cong\u00e9nitale.<br \/><strong>Question :<\/strong> Quels examens compl\u00e9mentaires recommandez-vous ?<br \/><strong>R\u00e9ponse :<\/strong><\/p><ol><li>IRM c\u00e9r\u00e9brale pour d\u00e9tecter d\u2019\u00e9ventuelles anomalies structurelles.<\/li><li>Tests auditifs bilat\u00e9raux r\u00e9guliers pour surveiller l\u2019\u00e9volution de la surdit\u00e9.<\/li><li>\u00c9valuation neurod\u00e9veloppementale \u00e0 12 et 24 mois.<\/li><\/ol><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1806\" class=\"elementor-tab-title\" data-tab=\"6\" role=\"button\" aria-controls=\"elementor-tab-content-1806\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Cas clinique 6 : Surdit\u00e9 progressive<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1806\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"6\" role=\"region\" aria-labelledby=\"elementor-tab-title-1806\"><p><strong>Situation :<\/strong> Un enfant n\u00e9 asymptomatique d\u00e9veloppe une perte auditive \u00e0 2 ans.<br \/><strong>Question :<\/strong> Quelle pourrait \u00eatre la cause et quel suivi recommandez-vous ?<br \/><strong>R\u00e9ponse :<\/strong><br \/>Le CMV cong\u00e9nital peut causer une surdit\u00e9 progressive. L\u2019enfant doit \u00eatre suivi r\u00e9guli\u00e8rement par un ORL et b\u00e9n\u00e9ficier de tests auditifs pour \u00e9valuer l\u2019\u00e9ligibilit\u00e9 \u00e0 une r\u00e9habilitation auditive, comme des implants cochl\u00e9aires si n\u00e9cessaire.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-6cf0e1d\" data-id=\"6cf0e1d\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0106038 elementor-widget elementor-widget-toggle\" data-id=\"0106038\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1071\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-1071\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Cas clinique 7 : Infection secondaire<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1071\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-1071\"><p><strong>Situation :<\/strong> Une femme enceinte s\u00e9ron\u00e9gative contracte une nouvelle souche de CMV au cours de sa deuxi\u00e8me grossesse.<br \/><strong>Question :<\/strong> Est-ce une infection primaire ou secondaire, et quel est le risque pour le f\u0153tus ?<br \/><strong>R\u00e9ponse :<\/strong><br \/>Il s\u2019agit d\u2019une r\u00e9infection. Le risque de transmission verticale est faible (&lt;2-3 %), et les s\u00e9quelles graves sont rares. Une surveillance standard est recommand\u00e9e.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1072\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-1072\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Cas clinique 8 : R\u00e9sultats discordants \u00e0 l\u2019amniocent\u00e8se<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1072\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-1072\"><p><strong>Situation :<\/strong> Une femme infect\u00e9e par le CMV au premier trimestre a une amniocent\u00e8se n\u00e9gative \u00e0 18 semaines.<br \/><strong>Question :<\/strong> Le f\u0153tus est-il compl\u00e8tement prot\u00e9g\u00e9 des s\u00e9quelles ?<br \/><strong>R\u00e9ponse :<\/strong><br \/>Un r\u00e9sultat n\u00e9gatif r\u00e9duit fortement le risque de s\u00e9quelles graves (proche de 0 %). Cependant, une infection tardive reste possible, n\u00e9cessitant une surveillance postnatale pour d\u00e9tecter des anomalies auditives ou neurologiques.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1073\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-1073\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Cas clinique 9 : IRM pr\u00e9natale<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1073\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-1073\"><p><strong>Situation :<\/strong> Une IRM f\u0153tale r\u00e9alis\u00e9e \u00e0 30 semaines r\u00e9v\u00e8le une polymicrogyrie.<br \/><strong>Question :<\/strong> Quel est le pronostic et que proposez-vous ?<br \/><strong>R\u00e9ponse :<\/strong><br \/>La polymicrogyrie est associ\u00e9e \u00e0 un mauvais pronostic neurologique (retard mental et troubles moteurs). Une discussion multidisciplinaire (m\u00e9decin, g\u00e9n\u00e9ticien, parents) est essentielle pour d\u00e9cider de la prise en charge postnatale.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1074\" class=\"elementor-tab-title\" data-tab=\"4\" role=\"button\" aria-controls=\"elementor-tab-content-1074\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Cas clinique 10 : Grossesse apr\u00e8s infection maternelle pass\u00e9e<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1074\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"4\" role=\"region\" aria-labelledby=\"elementor-tab-title-1074\"><p><strong>Situation :<\/strong> Une femme ayant eu une infection primaire confirm\u00e9e lors d\u2019une grossesse pr\u00e9c\u00e9dente est enceinte de nouveau.<br \/><strong>Question :<\/strong> Faut-il effectuer une surveillance pour le CMV ?<br \/><strong>R\u00e9ponse :<\/strong><br \/>Non, une immunit\u00e9 pr\u00e9existante conf\u00e8re une protection contre une nouvelle infection primaire. Aucune surveillance sp\u00e9cifique n\u2019est n\u00e9cessaire, sauf en cas de suspicion clinique.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1075\" class=\"elementor-tab-title\" data-tab=\"5\" role=\"button\" aria-controls=\"elementor-tab-content-1075\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Cas clinique 11 : Usage prolong\u00e9 d\u2019antiviraux chez le nouveau-n\u00e9<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1075\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"5\" role=\"region\" aria-labelledby=\"elementor-tab-title-1075\"><p><strong>Situation :<\/strong> Un nouveau-n\u00e9 symptomatique re\u00e7oit un traitement par valganciclovir pendant 6 mois. \u00c0 3 mois, une neutrop\u00e9nie est d\u00e9tect\u00e9e.<br \/><strong>Question :<\/strong> Que faites-vous ?<br \/><strong>R\u00e9ponse :<\/strong><br \/>Le traitement antiviral doit \u00eatre interrompu temporairement ou ajust\u00e9, avec un suivi h\u00e9matologique strict. Une r\u00e9\u00e9valuation de la n\u00e9cessit\u00e9 du traitement est recommand\u00e9e en collaboration avec un infectiologue p\u00e9diatrique.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1076\" class=\"elementor-tab-title\" data-tab=\"6\" role=\"button\" aria-controls=\"elementor-tab-content-1076\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Cas clinique 12 : D\u00e9pistage pr\u00e9conceptionnel<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1076\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"6\" role=\"region\" aria-labelledby=\"elementor-tab-title-1076\"><p><strong>Situation :<\/strong> Une femme souhaitant tomber enceinte est d\u00e9tect\u00e9e s\u00e9ron\u00e9gative pour le CMV.<br \/><strong>Question :<\/strong> Quels conseils de pr\u00e9vention lui donneriez-vous ?<br \/><strong>R\u00e9ponse :<\/strong><\/p><ol><li>Respect strict des mesures d\u2019hygi\u00e8ne (lavage des mains, \u00e9viter les contacts avec les fluides corporels des jeunes enfants).<\/li><li>Consultation r\u00e9guli\u00e8re pour un suivi s\u00e9rologique pendant la grossesse.<\/li><li>Surveillance particuli\u00e8re en cas de sympt\u00f4mes \u00e9vocateurs d\u2019une infection virale.<\/li><\/ol><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-c93b2a8 elementor-section-full_width elementor-section-stretched elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"c93b2a8\" data-element_type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-a4e8d97\" data-id=\"a4e8d97\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2e51568 elementor-widget elementor-widget-image\" data-id=\"2e51568\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"2560\" height=\"1106\" src=\"https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/illust-powerpo.jpg\" class=\"attachment-full size-full wp-image-3969\" alt=\"\" srcset=\"https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/illust-powerpo.jpg 2560w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/illust-powerpo-300x130.jpg 300w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/illust-powerpo-1024x442.jpg 1024w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/illust-powerpo-768x332.jpg 768w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/illust-powerpo-1536x664.jpg 1536w, https:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/illust-powerpo-2048x885.jpg 2048w\" sizes=\"(max-width: 2560px) 100vw, 2560px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-92c8785 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"92c8785\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-83d0e58\" data-id=\"83d0e58\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-cd64d3b elementor-widget elementor-widget-text-editor\" data-id=\"cd64d3b\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: left;\">DIAPOSITIVES POWERPOINT DU COURS<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-158cf8b elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"158cf8b\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-4d60741 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"4d60741\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-ee986e5\" data-id=\"ee986e5\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8b26a85 elementor-widget elementor-widget-toggle\" data-id=\"8b26a85\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1451\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-1451\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Diapositive 1 : Infections cong\u00e9nitales \u00e0 cytom\u00e9galovirus (cCMV) : de la pr\u00e9vention \u00e0 la prise en charge postnatale.<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1451\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-1451\"><ul><li>Introduction au CMV.<\/li><li>Objectifs de la pr\u00e9sentation : pr\u00e9vention, diagnostic, traitement, suivi.<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1452\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-1452\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Diapositive 2 : Qu\u2019est-ce que le CMV ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1452\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-1452\"><ul><li>Virus de la famille des herpesvirus.<\/li><li>Caract\u00e9ristique principale : infection latente et r\u00e9activations possibles.<\/li><li>Transmission par les fluides corporels : salive, urine, s\u00e9cr\u00e9tions g\u00e9nitales.<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1453\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-1453\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Diapositive 3 : \u00c9pid\u00e9miologie mondiale du CMV cong\u00e9nital<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1453\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-1453\"><ul><li>Pr\u00e9valence mondiale : 0,64 % \u00e0 2,2 % des naissances.<\/li><li>Transmission verticale dans 30 % \u00e0 66 % des cas.<\/li><li>Plus fr\u00e9quent dans les populations \u00e0 faibles ressources.<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1454\" class=\"elementor-tab-title\" data-tab=\"4\" role=\"button\" aria-controls=\"elementor-tab-content-1454\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Diapositive 4 : Cons\u00e9quences du CMV cong\u00e9nital<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1454\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"4\" role=\"region\" aria-labelledby=\"elementor-tab-title-1454\"><ul><li>Premi\u00e8re cause non g\u00e9n\u00e9tique de surdit\u00e9 neurosensorielle.<\/li><li>S\u00e9quelles neurologiques : microc\u00e9phalie, retard moteur, troubles cognitifs.<\/li><li>Complications multisyst\u00e9miques rares mais graves : atteinte h\u00e9patique, cardiaque.<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1455\" class=\"elementor-tab-title\" data-tab=\"5\" role=\"button\" aria-controls=\"elementor-tab-content-1455\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Diapositive 5 : Pr\u00e9vention primaire - Mesures d\u2019hygi\u00e8ne<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1455\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"5\" role=\"region\" aria-labelledby=\"elementor-tab-title-1455\"><ul><li>Lavage des mains apr\u00e8s contact avec les enfants.<\/li><li>\u00c9viter les baisers sur la bouche ou le partage d\u2019ustensiles avec les enfants.<\/li><li>Nettoyage r\u00e9gulier des surfaces.<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1456\" class=\"elementor-tab-title\" data-tab=\"6\" role=\"button\" aria-controls=\"elementor-tab-content-1456\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Diapositive 6 : Pr\u00e9vention primaire - Sensibilisation<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1456\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"6\" role=\"region\" aria-labelledby=\"elementor-tab-title-1456\"><ul><li>Information sur le CMV d\u00e8s les consultations pr\u00e9conceptionnelles.<\/li><li>Cibles : femmes enceintes s\u00e9ron\u00e9gatives et professionnelles de la petite enfance.<\/li><li>Importance d\u2019identifier les femmes \u00e0 haut risque.<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1457\" class=\"elementor-tab-title\" data-tab=\"7\" role=\"button\" aria-controls=\"elementor-tab-content-1457\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Pr\u00e9vention secondaire - Antiviraux<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1457\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"7\" role=\"region\" aria-labelledby=\"elementor-tab-title-1457\"><ul><li>Valaciclovir : r\u00e9duit de 70 % la transmission verticale.<\/li><li>Administration optimale au premier trimestre.<\/li><li>Surveillance des effets secondaires : troubles r\u00e9naux, maux de t\u00eate.<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1458\" class=\"elementor-tab-title\" data-tab=\"8\" role=\"button\" aria-controls=\"elementor-tab-content-1458\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Diapositive 8 : Pr\u00e9vention secondaire - Hyperimmunoglobulines<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1458\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"8\" role=\"region\" aria-labelledby=\"elementor-tab-title-1458\"><ul><li>R\u00e9duction modeste de la transmission verticale.<\/li><li>Administration pr\u00e9coce n\u00e9cessaire (&lt;10 jours apr\u00e8s l\u2019infection maternelle).<\/li><li>Effets secondaires possibles : r\u00e9actions allergiques, co\u00fbt \u00e9lev\u00e9.<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1459\" class=\"elementor-tab-title\" data-tab=\"9\" role=\"button\" aria-controls=\"elementor-tab-content-1459\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Diapositive 9 : Algorithme de d\u00e9pistage pr\u00e9natal<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1459\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"9\" role=\"region\" aria-labelledby=\"elementor-tab-title-1459\"><ul><li>Test s\u00e9rologique IgG\/IgM.<\/li><li>Analyse d\u2019avidit\u00e9 des IgG en cas d\u2019IgM positif.<\/li><li>Recommand\u00e9 au premier trimestre.<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-14510\" class=\"elementor-tab-title\" data-tab=\"10\" role=\"button\" aria-controls=\"elementor-tab-content-14510\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Diapositive 10 : Test d\u2019avidit\u00e9 des IgG<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-14510\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"10\" role=\"region\" aria-labelledby=\"elementor-tab-title-14510\"><ul><li>Faible avidit\u00e9 : infection r\u00e9cente (&lt;3 mois).<\/li><li>Forte avidit\u00e9 : infection ancienne (&gt;3 mois).<\/li><li>Utilit\u00e9 clinique : \u00e9valuer le risque de transmission verticale.<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-a18f778\" data-id=\"a18f778\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-fbb8eda elementor-widget elementor-widget-toggle\" data-id=\"fbb8eda\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2631\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-2631\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Diapositive 11 : Amniocent\u00e8se<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2631\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-2631\"><ul><li>R\u00e9alis\u00e9e apr\u00e8s 17 semaines de gestation.<\/li><li>PCR sur liquide amniotique (sp\u00e9cificit\u00e9 : 100 %).<\/li><li>Recommand\u00e9e si faible avidit\u00e9 IgG et anomalies \u00e9chographiques.<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2632\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-2632\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Diapositive 12 : Surveillance \u00e9chographique<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2632\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-2632\"><ul><li>Anomalies c\u00e9r\u00e9brales : calcifications p\u00e9riventriculaires, microc\u00e9phalie.<\/li><li>RCIU (retard de croissance intra-ut\u00e9rin).<\/li><li>\u00c9valuation \u00e0 intervalles r\u00e9guliers pour d\u00e9tecter les signes progressifs.<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2633\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-2633\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Diapositive 13 : Valaciclovir en pr\u00e9natal<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2633\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-2633\"><ul><li>Dose : 8 g\/jour en 4 prises.<\/li><li>R\u00e9duction de la charge virale maternelle.<\/li><li>\u00c9valuations r\u00e9guli\u00e8res des fonctions r\u00e9nales pendant le traitement.<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2634\" class=\"elementor-tab-title\" data-tab=\"4\" role=\"button\" aria-controls=\"elementor-tab-content-2634\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Diapositive 14 : Valganciclovir en n\u00e9onatal<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2634\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"4\" role=\"region\" aria-labelledby=\"elementor-tab-title-2634\"><ul><li>Indiqu\u00e9 chez les nouveau-n\u00e9s symptomatiques.<\/li><li>R\u00e9duction des s\u00e9quelles auditives et neurologiques.<\/li><li>Surveillance des effets secondaires : neutrop\u00e9nie.<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2635\" class=\"elementor-tab-title\" data-tab=\"5\" role=\"button\" aria-controls=\"elementor-tab-content-2635\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Diapositive 15 : Limites des options th\u00e9rapeutiques<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2635\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"5\" role=\"region\" aria-labelledby=\"elementor-tab-title-2635\"><ul><li>N\u00e9cessit\u00e9 d\u2019un diagnostic pr\u00e9coce pour maximiser l\u2019efficacit\u00e9.<\/li><li>Effets secondaires des antiviraux (valganciclovir, valaciclovir).<\/li><li>Absence de traitement standardis\u00e9 pour les infections asymptomatiques.<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2636\" class=\"elementor-tab-title\" data-tab=\"6\" role=\"button\" aria-controls=\"elementor-tab-content-2636\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Diapositive 16 : Tests auditifs<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2636\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"6\" role=\"region\" aria-labelledby=\"elementor-tab-title-2636\"><ul><li>\u00c9valuation d\u00e8s la naissance.<\/li><li>Tests r\u00e9guliers jusqu\u2019\u00e0 l\u2019\u00e2ge de 5 ans.<\/li><li>Surveillance pour d\u00e9tecter une surdit\u00e9 progressive.<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2637\" class=\"elementor-tab-title\" data-tab=\"7\" role=\"button\" aria-controls=\"elementor-tab-content-2637\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Diapositive 17 : \u00c9valuations neurologiques<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2637\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"7\" role=\"region\" aria-labelledby=\"elementor-tab-title-2637\"><ul><li>IRM c\u00e9r\u00e9brale en cas de signes \u00e9vocateurs.<\/li><li>Suivi neurod\u00e9veloppemental : \u00e9valuation \u00e0 12, 24, et 36 mois.<\/li><li>Identification pr\u00e9coce des retards cognitifs et moteurs.<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2638\" class=\"elementor-tab-title\" data-tab=\"8\" role=\"button\" aria-controls=\"elementor-tab-content-2638\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Diapositive 18 : Int\u00e9gration scolaire et sociale<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2638\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"8\" role=\"region\" aria-labelledby=\"elementor-tab-title-2638\"><ul><li>Soutien \u00e9ducatif pour les enfants avec s\u00e9quelles.<\/li><li>Adaptation des programmes scolaires.<\/li><li>Importance d\u2019une prise en charge psychologique pour les familles.<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2639\" class=\"elementor-tab-title\" data-tab=\"9\" role=\"button\" aria-controls=\"elementor-tab-content-2639\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Diapositive 19 : Synth\u00e8se des points cl\u00e9s<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2639\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"9\" role=\"region\" aria-labelledby=\"elementor-tab-title-2639\"><ul><li>Importance de la pr\u00e9vention primaire et secondaire.<\/li><li>D\u00e9pistage et diagnostic pr\u00e9natal essentiels pour guider la prise en charge.<\/li><li>Suivi postnatal \u00e0 long terme pour minimiser les s\u00e9quelles.<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-ab215b0 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"ab215b0\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-c6b6c83\" data-id=\"c6b6c83\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6e1f9a0 elementor-widget elementor-widget-text-editor\" data-id=\"6e1f9a0\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>ILLUSTRATIONS SUR LE SUJET. LIBRES DE DROITS<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2f52a90 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"2f52a90\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-b3c77be elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"b3c77be\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-f2fa627\" data-id=\"f2fa627\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0ba3490 elementor-widget elementor-widget-ucaddon_simple_slider\" data-id=\"0ba3490\" data-element_type=\"widget\" data-widget_type=\"ucaddon_simple_slider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\n<!-- start Simple Slider -->\n\t\t<link id='font-awesome-css' href='https:\/\/echonews.fr\/wp-content\/plugins\/unlimited-elements-for-elementor\/assets_libraries\/font-awesome6\/fontawesome-all.min.css' type='text\/css' rel='stylesheet' >\n\t\t<link id='font-awesome-4-shim-css' href='https:\/\/echonews.fr\/wp-content\/plugins\/unlimited-elements-for-elementor\/assets_libraries\/font-awesome6\/fontawesome-v4-shims.min.css' type='text\/css' rel='stylesheet' >\n\t\t<link id='uc_ac_assets_file_slick_css_1729-css' href='https:\/\/echonews.fr\/wp-content\/uploads\/ac_assets\/simple_animated_slider\/slick.css' type='text\/css' rel='stylesheet' >\n\n<style>\/* widget: Simple Slider *\/\n\n#uc_simple_slider_elementor_0ba3490\n{\n  overflow:hidden;\n  direction:ltr;\n}\n#uc_simple_slider_elementor_0ba3490 .ue_slide {\n  position: relative;\n}\n#uc_simple_slider_elementor_0ba3490 .slide__img {\n  width: 100%;\n  height: auto;\n  overflow: hidden;\n}\n\n#uc_simple_slider_elementor_0ba3490 .slide__img img {\n  max-width: 100%;\n  height: auto;\n  opacity: 1 !important; 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On y trouvera : Un plan du cours, Un d\u00e9veloppement de chacun des chapitres composant ce cours, Une s\u00e9rie de 12 FAQ, Une s\u00e9rie de 40 QCM, Un Quizz permettant \u00e0 l&#8217;\u00e9tudiant de s&#8217;auto-\u00e9valuer par le score obtenu, 12 Questions d&#8217;examen \u00e0 r\u00e9ponses courtes, 12 cas cliniques fictifs, 19 diapositives Powerpoint \u00e0 destination de l&#8217;enseignant pour son cours, 5 illustrations originales libres de droits. Infections cong\u00e9nitales \u00e0 cytom\u00e9galovirus : de la pr\u00e9vention \u00e0 la prise en charge postnatale Dr Pierre Dupont Hm-envelop Linkedin X-twitter Dr Margaret Smith Hm-envelop Linkedin Dr Fran\u00e7oise durand Hm-envelop Youtube Linkedin Le cours Plan du cours Dur\u00e9e totale : 2 heures Introduction \u00e0 l&rsquo;infection cong\u00e9nitale \u00e0 CMV (10 min) D\u00e9finition et importance clinique \u00c9pid\u00e9miologie et pathophysiologie Strat\u00e9gies de pr\u00e9vention primaire et secondaire (20 min) Mesures d&rsquo;hygi\u00e8ne R\u00f4le potentiel des vaccins Utilisation du valaciclovir et des immunoglobulines D\u00e9pistage et diagnostic pr\u00e9natal (30 min) Algorithmes s\u00e9rologiques (IgG\/IgM, avidit\u00e9) R\u00f4le de l\u2019amniocent\u00e8se et du PCR Options th\u00e9rapeutiques pr\u00e9natales et n\u00e9onatales (20 min) Traitements antiviraux : valaciclovir et valganciclovir Suivi des nouveau-n\u00e9s symptomatiques Gestion postnatale et suivi \u00e0 long terme (20 min) S\u00e9quelles potentielles (surdit\u00e9, retard neurologique) Protocoles de suivi jusqu\u2019\u00e0 l\u2019\u00e2ge scolaire Discussion et \u00e9tudes de cas (20 min) Exemples pratiques bas\u00e9s sur les m\u00e9ta-analyses Questions ouvertes Chapitre 1 : Introduction au CMV Cong\u00e9nital 1.1. Qu\u2019est-ce que le CMV ? Caract\u00e9ristiques biologiques Famille des herpesvirus : Virus ADN double brin. Propri\u00e9t\u00e9 de latence : persiste dans les cellules h\u00f4tes apr\u00e8s une infection primaire. Peut se r\u00e9activer en cas d\u2019immunosuppression. Modes de transmission : Contact direct avec les fluides corporels : Salive, urine, lait maternel, s\u00e9cr\u00e9tions g\u00e9nitales. Transmission verticale : Pendant la grossesse (placenta), l\u2019accouchement ou l\u2019allaitement. Pr\u00e9valence : Le CMV infecte 50 % \u00e0 90 % de la population adulte mondiale. L\u2019infection est souvent asymptomatique chez les individus immunocomp\u00e9tents. Notes pour l\u2019orateur :Le CMV est un virus ubiquitaire, souvent b\u00e9nin, mais ses cons\u00e9quences peuvent \u00eatre graves lorsqu\u2019il est transmis au f\u0153tus. Sa propri\u00e9t\u00e9 de latence et sa capacit\u00e9 de r\u00e9activation compliquent sa gestion. 1.2. \u00c9pid\u00e9miologie mondiale du CMV cong\u00e9nital Pr\u00e9valence de l\u2019infection cong\u00e9nitale Taux global : 0,64 % \u00e0 2,2 % des naissances dans le monde. Variation selon les r\u00e9gions : Pr\u00e9valence plus \u00e9lev\u00e9e dans les pays \u00e0 faibles ressources (environ 1 % \u00e0 5 %). Pr\u00e9valence plus faible dans les pays d\u00e9velopp\u00e9s (environ 0,3 % \u00e0 1 %). Caract\u00e9ristiques des infections maternelles : 50 % des cas dus \u00e0 une infection primaire pendant la grossesse. 50 % dus \u00e0 une r\u00e9activation ou \u00e0 une r\u00e9infection (g\u00e9n\u00e9ralement moins graves). Facteurs de risque Exposition aux enfants en bas \u00e2ge : Les jeunes enfants excr\u00e8tent le virus dans leur salive et leur urine pendant plusieurs mois apr\u00e8s une infection. Professionnels de la petite enfance \u00e0 risque \u00e9lev\u00e9. Statut s\u00e9rologique : Femmes s\u00e9ron\u00e9gatives : pas d\u2019immunit\u00e9 contre le CMV. Risque accru lors d\u2019une grossesse rapproch\u00e9e d\u2019une pr\u00e9c\u00e9dente grossesse. Transmission verticale Risque de transmission verticale en fonction du moment de l\u2019infection maternelle : 30 % au premier trimestre. 40 % au deuxi\u00e8me trimestre. 66 % au troisi\u00e8me trimestre. Notes pour l\u2019orateur :Bien que la transmission soit plus fr\u00e9quente en fin de grossesse, les infections pr\u00e9coces (premier trimestre) sont associ\u00e9es aux s\u00e9quelles les plus graves. Ces diff\u00e9rences doivent \u00eatre clairement expliqu\u00e9es pour guider la pr\u00e9vention et la prise en charge. 1.3. Cons\u00e9quences cliniques du CMV cong\u00e9nital Chez le f\u0153tus Manifestations graves associ\u00e9es aux infections du premier trimestre : Microc\u00e9phalie. Calcifications intracr\u00e2niennes. Retard de croissance intra-ut\u00e9rin (RCIU). Hydramnios ou oligohydramnios. Signes \u00e9chographiques possibles : Ascite, h\u00e9patospl\u00e9nom\u00e9galie. Dilatation ventriculaire c\u00e9r\u00e9brale. Troubles du d\u00e9veloppement cortical (polymicrogyrie, ag\u00e9n\u00e9sie du corps calleux). \u00c0 la naissance Nouveau-n\u00e9s symptomatiques (10 % des cas) : Troubles neurologiques : convulsions, hypotonie, retard mental. Probl\u00e8mes sensoriels : surdit\u00e9, atteinte visuelle. Manifestations h\u00e9matologiques : thrombocytop\u00e9nie, an\u00e9mie. Nouveau-n\u00e9s asymptomatiques (90 % des cas) : Risque de s\u00e9quelles tardives, principalement une surdit\u00e9 neurosensorielle progressive (12 %). \u00c0 long terme S\u00e9quelles permanentes : Premi\u00e8re cause non g\u00e9n\u00e9tique de surdit\u00e9 neurosensorielle. Retard mental et cognitif. Troubles moteurs et \u00e9pilepsie. Notes pour l\u2019orateur :Les s\u00e9quelles d\u00e9pendent principalement du moment de l\u2019infection pendant la grossesse. Les l\u00e9sions c\u00e9r\u00e9brales pr\u00e9coces sont souvent irr\u00e9versibles et responsables des handicaps les plus graves. 1.4. Physiopathologie de la transmission verticale \u00c9tapes de l\u2019infection materno-f\u0153tale Infection maternelle primaire ou r\u00e9activation : Le virus infecte les cellules \u00e9pith\u00e9liales et se propage dans le sang. Infection du placenta : Le CMV traverse la barri\u00e8re placentaire, souvent via les cellules trophoblastiques. Le placenta agit comme un r\u00e9servoir, favorisant la transmission au f\u0153tus. Infection f\u0153tale : Propagation syst\u00e9mique dans les organes f\u0153taux : cerveau, foie, rein, oreille interne. Atteinte du syst\u00e8me nerveux central (CNS) : cible principale des l\u00e9sions graves. Facteurs influen\u00e7ant la gravit\u00e9 Charge virale maternelle : Plus \u00e9lev\u00e9e en cas d\u2019infection primaire. Moment de l\u2019infection : Premier trimestre : atteinte du CNS et anomalies graves. Troisi\u00e8me trimestre : atteinte multi-organes, g\u00e9n\u00e9ralement moins s\u00e9v\u00e8re. Notes pour l\u2019orateur :La physiopathologie explique pourquoi une prise en charge rapide et cibl\u00e9e est essentielle pour r\u00e9duire la transmission et les complications. 1.5. Importance du CMV comme probl\u00e8me de sant\u00e9 publique Impact sur la sant\u00e9 mondiale Premi\u00e8re cause d\u2019infection cong\u00e9nitale dans le monde. Responsable de 8 000 cas de s\u00e9quelles neurologiques par an aux \u00c9tats-Unis, surpassant les maladies comme la rub\u00e9ole cong\u00e9nitale. Co\u00fbt pour la soci\u00e9t\u00e9 Co\u00fbts m\u00e9dicaux directs : hospitalisations, traitements antiviraux, appareillages auditifs. Co\u00fbts indirects : soutien \u00e9ducatif, prise en charge des handicaps \u00e0 long terme. Absence de vaccination Contrairement \u00e0 d&rsquo;autres infections cong\u00e9nitales (ex. : rub\u00e9ole), il n\u2019existe pas encore de vaccin approuv\u00e9 pour le CMV. Les efforts de pr\u00e9vention reposent actuellement sur des strat\u00e9gies comportementales et m\u00e9dicales. Notes pour l\u2019orateur :Le CMV repr\u00e9sente une priorit\u00e9 en sant\u00e9 publique en raison de sa pr\u00e9valence \u00e9lev\u00e9e, de son impact sur les nouveau-n\u00e9s et des d\u00e9fis &hellip;<\/p>\n<p class=\"read-more\"> <a class=\"\" href=\"https:\/\/echonews.fr\/?page_id=4007\"> <span class=\"screen-reader-text\">Cours-cytomegalovirus<\/span> Lire la suite\u00a0\u00bb<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_canvas","meta":{"_eb_attr":"","site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-site-content-layout":"full-width-container","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.3 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Cours-cytomegalovirus -<\/title>\n<meta name=\"robots\" content=\"noindex, nofollow\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Cours-cytomegalovirus -\" \/>\n<meta property=\"og:description\" content=\"M\u00e9decine Droit Constitutionnel Psychologie Geopolitique Traitement des Iconographies Publications M\u00e9decine Droit Constitutionnel Psychologie Geopolitique Traitement des Iconographies Publications Production de RESSOURCES P\u00e9dagogiques assist\u00e9e par I.A.\u00a0\u00a0 Joseph Bonan D\u00e9mo D\u00e9mo Ci-dessous, \u00e0 titre d\u00e9monstration, un cours m\u00e9dical tr\u00e8s complet r\u00e9alis\u00e9 en utilisant notre m\u00e9thodologie d&#8217;assistance p\u00e9dagogique par I.A.. On y trouvera : Un plan du cours, Un d\u00e9veloppement de chacun des chapitres composant ce cours, Une s\u00e9rie de 12 FAQ, Une s\u00e9rie de 40 QCM, Un Quizz permettant \u00e0 l&#8217;\u00e9tudiant de s&#8217;auto-\u00e9valuer par le score obtenu, 12 Questions d&#8217;examen \u00e0 r\u00e9ponses courtes, 12 cas cliniques fictifs, 19 diapositives Powerpoint \u00e0 destination de l&#8217;enseignant pour son cours, 5 illustrations originales libres de droits. Infections cong\u00e9nitales \u00e0 cytom\u00e9galovirus : de la pr\u00e9vention \u00e0 la prise en charge postnatale Dr Pierre Dupont Hm-envelop Linkedin X-twitter Dr Margaret Smith Hm-envelop Linkedin Dr Fran\u00e7oise durand Hm-envelop Youtube Linkedin Le cours Plan du cours Dur\u00e9e totale : 2 heures Introduction \u00e0 l&rsquo;infection cong\u00e9nitale \u00e0 CMV (10 min) D\u00e9finition et importance clinique \u00c9pid\u00e9miologie et pathophysiologie Strat\u00e9gies de pr\u00e9vention primaire et secondaire (20 min) Mesures d&rsquo;hygi\u00e8ne R\u00f4le potentiel des vaccins Utilisation du valaciclovir et des immunoglobulines D\u00e9pistage et diagnostic pr\u00e9natal (30 min) Algorithmes s\u00e9rologiques (IgG\/IgM, avidit\u00e9) R\u00f4le de l\u2019amniocent\u00e8se et du PCR Options th\u00e9rapeutiques pr\u00e9natales et n\u00e9onatales (20 min) Traitements antiviraux : valaciclovir et valganciclovir Suivi des nouveau-n\u00e9s symptomatiques Gestion postnatale et suivi \u00e0 long terme (20 min) S\u00e9quelles potentielles (surdit\u00e9, retard neurologique) Protocoles de suivi jusqu\u2019\u00e0 l\u2019\u00e2ge scolaire Discussion et \u00e9tudes de cas (20 min) Exemples pratiques bas\u00e9s sur les m\u00e9ta-analyses Questions ouvertes Chapitre 1 : Introduction au CMV Cong\u00e9nital 1.1. Qu\u2019est-ce que le CMV ? Caract\u00e9ristiques biologiques Famille des herpesvirus : Virus ADN double brin. Propri\u00e9t\u00e9 de latence : persiste dans les cellules h\u00f4tes apr\u00e8s une infection primaire. Peut se r\u00e9activer en cas d\u2019immunosuppression. Modes de transmission : Contact direct avec les fluides corporels : Salive, urine, lait maternel, s\u00e9cr\u00e9tions g\u00e9nitales. Transmission verticale : Pendant la grossesse (placenta), l\u2019accouchement ou l\u2019allaitement. Pr\u00e9valence : Le CMV infecte 50 % \u00e0 90 % de la population adulte mondiale. L\u2019infection est souvent asymptomatique chez les individus immunocomp\u00e9tents. Notes pour l\u2019orateur :Le CMV est un virus ubiquitaire, souvent b\u00e9nin, mais ses cons\u00e9quences peuvent \u00eatre graves lorsqu\u2019il est transmis au f\u0153tus. Sa propri\u00e9t\u00e9 de latence et sa capacit\u00e9 de r\u00e9activation compliquent sa gestion. 1.2. \u00c9pid\u00e9miologie mondiale du CMV cong\u00e9nital Pr\u00e9valence de l\u2019infection cong\u00e9nitale Taux global : 0,64 % \u00e0 2,2 % des naissances dans le monde. Variation selon les r\u00e9gions : Pr\u00e9valence plus \u00e9lev\u00e9e dans les pays \u00e0 faibles ressources (environ 1 % \u00e0 5 %). Pr\u00e9valence plus faible dans les pays d\u00e9velopp\u00e9s (environ 0,3 % \u00e0 1 %). Caract\u00e9ristiques des infections maternelles : 50 % des cas dus \u00e0 une infection primaire pendant la grossesse. 50 % dus \u00e0 une r\u00e9activation ou \u00e0 une r\u00e9infection (g\u00e9n\u00e9ralement moins graves). Facteurs de risque Exposition aux enfants en bas \u00e2ge : Les jeunes enfants excr\u00e8tent le virus dans leur salive et leur urine pendant plusieurs mois apr\u00e8s une infection. Professionnels de la petite enfance \u00e0 risque \u00e9lev\u00e9. Statut s\u00e9rologique : Femmes s\u00e9ron\u00e9gatives : pas d\u2019immunit\u00e9 contre le CMV. Risque accru lors d\u2019une grossesse rapproch\u00e9e d\u2019une pr\u00e9c\u00e9dente grossesse. Transmission verticale Risque de transmission verticale en fonction du moment de l\u2019infection maternelle : 30 % au premier trimestre. 40 % au deuxi\u00e8me trimestre. 66 % au troisi\u00e8me trimestre. Notes pour l\u2019orateur :Bien que la transmission soit plus fr\u00e9quente en fin de grossesse, les infections pr\u00e9coces (premier trimestre) sont associ\u00e9es aux s\u00e9quelles les plus graves. Ces diff\u00e9rences doivent \u00eatre clairement expliqu\u00e9es pour guider la pr\u00e9vention et la prise en charge. 1.3. Cons\u00e9quences cliniques du CMV cong\u00e9nital Chez le f\u0153tus Manifestations graves associ\u00e9es aux infections du premier trimestre : Microc\u00e9phalie. Calcifications intracr\u00e2niennes. Retard de croissance intra-ut\u00e9rin (RCIU). Hydramnios ou oligohydramnios. Signes \u00e9chographiques possibles : Ascite, h\u00e9patospl\u00e9nom\u00e9galie. Dilatation ventriculaire c\u00e9r\u00e9brale. Troubles du d\u00e9veloppement cortical (polymicrogyrie, ag\u00e9n\u00e9sie du corps calleux). \u00c0 la naissance Nouveau-n\u00e9s symptomatiques (10 % des cas) : Troubles neurologiques : convulsions, hypotonie, retard mental. Probl\u00e8mes sensoriels : surdit\u00e9, atteinte visuelle. Manifestations h\u00e9matologiques : thrombocytop\u00e9nie, an\u00e9mie. Nouveau-n\u00e9s asymptomatiques (90 % des cas) : Risque de s\u00e9quelles tardives, principalement une surdit\u00e9 neurosensorielle progressive (12 %). \u00c0 long terme S\u00e9quelles permanentes : Premi\u00e8re cause non g\u00e9n\u00e9tique de surdit\u00e9 neurosensorielle. Retard mental et cognitif. Troubles moteurs et \u00e9pilepsie. Notes pour l\u2019orateur :Les s\u00e9quelles d\u00e9pendent principalement du moment de l\u2019infection pendant la grossesse. Les l\u00e9sions c\u00e9r\u00e9brales pr\u00e9coces sont souvent irr\u00e9versibles et responsables des handicaps les plus graves. 1.4. Physiopathologie de la transmission verticale \u00c9tapes de l\u2019infection materno-f\u0153tale Infection maternelle primaire ou r\u00e9activation : Le virus infecte les cellules \u00e9pith\u00e9liales et se propage dans le sang. Infection du placenta : Le CMV traverse la barri\u00e8re placentaire, souvent via les cellules trophoblastiques. Le placenta agit comme un r\u00e9servoir, favorisant la transmission au f\u0153tus. Infection f\u0153tale : Propagation syst\u00e9mique dans les organes f\u0153taux : cerveau, foie, rein, oreille interne. Atteinte du syst\u00e8me nerveux central (CNS) : cible principale des l\u00e9sions graves. Facteurs influen\u00e7ant la gravit\u00e9 Charge virale maternelle : Plus \u00e9lev\u00e9e en cas d\u2019infection primaire. Moment de l\u2019infection : Premier trimestre : atteinte du CNS et anomalies graves. Troisi\u00e8me trimestre : atteinte multi-organes, g\u00e9n\u00e9ralement moins s\u00e9v\u00e8re. Notes pour l\u2019orateur :La physiopathologie explique pourquoi une prise en charge rapide et cibl\u00e9e est essentielle pour r\u00e9duire la transmission et les complications. 1.5. Importance du CMV comme probl\u00e8me de sant\u00e9 publique Impact sur la sant\u00e9 mondiale Premi\u00e8re cause d\u2019infection cong\u00e9nitale dans le monde. Responsable de 8 000 cas de s\u00e9quelles neurologiques par an aux \u00c9tats-Unis, surpassant les maladies comme la rub\u00e9ole cong\u00e9nitale. Co\u00fbt pour la soci\u00e9t\u00e9 Co\u00fbts m\u00e9dicaux directs : hospitalisations, traitements antiviraux, appareillages auditifs. Co\u00fbts indirects : soutien \u00e9ducatif, prise en charge des handicaps \u00e0 long terme. Absence de vaccination Contrairement \u00e0 d&rsquo;autres infections cong\u00e9nitales (ex. : rub\u00e9ole), il n\u2019existe pas encore de vaccin approuv\u00e9 pour le CMV. Les efforts de pr\u00e9vention reposent actuellement sur des strat\u00e9gies comportementales et m\u00e9dicales. Notes pour l\u2019orateur :Le CMV repr\u00e9sente une priorit\u00e9 en sant\u00e9 publique en raison de sa pr\u00e9valence \u00e9lev\u00e9e, de son impact sur les nouveau-n\u00e9s et des d\u00e9fis &hellip; Cours-cytomegalovirus Lire la suite\u00a0\u00bb\" \/>\n<meta property=\"og:url\" content=\"https:\/\/echonews.fr\/?page_id=4007\" \/>\n<meta property=\"article:modified_time\" content=\"2025-03-19T09:42:05+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/Bandeau-accueil-learning-V4-BIS.jpg\" \/>\n<meta name=\"twitter:label1\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data1\" content=\"50 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/echonews.fr\/?page_id=4007\",\"url\":\"https:\/\/echonews.fr\/?page_id=4007\",\"name\":\"Cours-cytomegalovirus -\",\"isPartOf\":{\"@id\":\"http:\/\/echonews.fr\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/echonews.fr\/?page_id=4007#primaryimage\"},\"image\":{\"@id\":\"https:\/\/echonews.fr\/?page_id=4007#primaryimage\"},\"thumbnailUrl\":\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/Bandeau-accueil-learning-V4-BIS.jpg\",\"datePublished\":\"2025-01-12T21:33:58+00:00\",\"dateModified\":\"2025-03-19T09:42:05+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/echonews.fr\/?page_id=4007#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/echonews.fr\/?page_id=4007\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/echonews.fr\/?page_id=4007#primaryimage\",\"url\":\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/Bandeau-accueil-learning-V4-BIS.jpg\",\"contentUrl\":\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/Bandeau-accueil-learning-V4-BIS.jpg\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/echonews.fr\/?page_id=4007#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Accueil\",\"item\":\"http:\/\/echonews.fr\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Cours-cytomegalovirus\"}]},{\"@type\":\"WebSite\",\"@id\":\"http:\/\/echonews.fr\/#website\",\"url\":\"http:\/\/echonews.fr\/\",\"name\":\"\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"http:\/\/echonews.fr\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"fr-FR\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Cours-cytomegalovirus -","robots":{"index":"noindex","follow":"nofollow"},"og_locale":"fr_FR","og_type":"article","og_title":"Cours-cytomegalovirus -","og_description":"M\u00e9decine Droit Constitutionnel Psychologie Geopolitique Traitement des Iconographies Publications M\u00e9decine Droit Constitutionnel Psychologie Geopolitique Traitement des Iconographies Publications Production de RESSOURCES P\u00e9dagogiques assist\u00e9e par I.A.\u00a0\u00a0 Joseph Bonan D\u00e9mo D\u00e9mo Ci-dessous, \u00e0 titre d\u00e9monstration, un cours m\u00e9dical tr\u00e8s complet r\u00e9alis\u00e9 en utilisant notre m\u00e9thodologie d&#8217;assistance p\u00e9dagogique par I.A.. On y trouvera : Un plan du cours, Un d\u00e9veloppement de chacun des chapitres composant ce cours, Une s\u00e9rie de 12 FAQ, Une s\u00e9rie de 40 QCM, Un Quizz permettant \u00e0 l&#8217;\u00e9tudiant de s&#8217;auto-\u00e9valuer par le score obtenu, 12 Questions d&#8217;examen \u00e0 r\u00e9ponses courtes, 12 cas cliniques fictifs, 19 diapositives Powerpoint \u00e0 destination de l&#8217;enseignant pour son cours, 5 illustrations originales libres de droits. Infections cong\u00e9nitales \u00e0 cytom\u00e9galovirus : de la pr\u00e9vention \u00e0 la prise en charge postnatale Dr Pierre Dupont Hm-envelop Linkedin X-twitter Dr Margaret Smith Hm-envelop Linkedin Dr Fran\u00e7oise durand Hm-envelop Youtube Linkedin Le cours Plan du cours Dur\u00e9e totale : 2 heures Introduction \u00e0 l&rsquo;infection cong\u00e9nitale \u00e0 CMV (10 min) D\u00e9finition et importance clinique \u00c9pid\u00e9miologie et pathophysiologie Strat\u00e9gies de pr\u00e9vention primaire et secondaire (20 min) Mesures d&rsquo;hygi\u00e8ne R\u00f4le potentiel des vaccins Utilisation du valaciclovir et des immunoglobulines D\u00e9pistage et diagnostic pr\u00e9natal (30 min) Algorithmes s\u00e9rologiques (IgG\/IgM, avidit\u00e9) R\u00f4le de l\u2019amniocent\u00e8se et du PCR Options th\u00e9rapeutiques pr\u00e9natales et n\u00e9onatales (20 min) Traitements antiviraux : valaciclovir et valganciclovir Suivi des nouveau-n\u00e9s symptomatiques Gestion postnatale et suivi \u00e0 long terme (20 min) S\u00e9quelles potentielles (surdit\u00e9, retard neurologique) Protocoles de suivi jusqu\u2019\u00e0 l\u2019\u00e2ge scolaire Discussion et \u00e9tudes de cas (20 min) Exemples pratiques bas\u00e9s sur les m\u00e9ta-analyses Questions ouvertes Chapitre 1 : Introduction au CMV Cong\u00e9nital 1.1. Qu\u2019est-ce que le CMV ? Caract\u00e9ristiques biologiques Famille des herpesvirus : Virus ADN double brin. Propri\u00e9t\u00e9 de latence : persiste dans les cellules h\u00f4tes apr\u00e8s une infection primaire. Peut se r\u00e9activer en cas d\u2019immunosuppression. Modes de transmission : Contact direct avec les fluides corporels : Salive, urine, lait maternel, s\u00e9cr\u00e9tions g\u00e9nitales. Transmission verticale : Pendant la grossesse (placenta), l\u2019accouchement ou l\u2019allaitement. Pr\u00e9valence : Le CMV infecte 50 % \u00e0 90 % de la population adulte mondiale. L\u2019infection est souvent asymptomatique chez les individus immunocomp\u00e9tents. Notes pour l\u2019orateur :Le CMV est un virus ubiquitaire, souvent b\u00e9nin, mais ses cons\u00e9quences peuvent \u00eatre graves lorsqu\u2019il est transmis au f\u0153tus. Sa propri\u00e9t\u00e9 de latence et sa capacit\u00e9 de r\u00e9activation compliquent sa gestion. 1.2. \u00c9pid\u00e9miologie mondiale du CMV cong\u00e9nital Pr\u00e9valence de l\u2019infection cong\u00e9nitale Taux global : 0,64 % \u00e0 2,2 % des naissances dans le monde. Variation selon les r\u00e9gions : Pr\u00e9valence plus \u00e9lev\u00e9e dans les pays \u00e0 faibles ressources (environ 1 % \u00e0 5 %). Pr\u00e9valence plus faible dans les pays d\u00e9velopp\u00e9s (environ 0,3 % \u00e0 1 %). Caract\u00e9ristiques des infections maternelles : 50 % des cas dus \u00e0 une infection primaire pendant la grossesse. 50 % dus \u00e0 une r\u00e9activation ou \u00e0 une r\u00e9infection (g\u00e9n\u00e9ralement moins graves). Facteurs de risque Exposition aux enfants en bas \u00e2ge : Les jeunes enfants excr\u00e8tent le virus dans leur salive et leur urine pendant plusieurs mois apr\u00e8s une infection. Professionnels de la petite enfance \u00e0 risque \u00e9lev\u00e9. Statut s\u00e9rologique : Femmes s\u00e9ron\u00e9gatives : pas d\u2019immunit\u00e9 contre le CMV. Risque accru lors d\u2019une grossesse rapproch\u00e9e d\u2019une pr\u00e9c\u00e9dente grossesse. Transmission verticale Risque de transmission verticale en fonction du moment de l\u2019infection maternelle : 30 % au premier trimestre. 40 % au deuxi\u00e8me trimestre. 66 % au troisi\u00e8me trimestre. Notes pour l\u2019orateur :Bien que la transmission soit plus fr\u00e9quente en fin de grossesse, les infections pr\u00e9coces (premier trimestre) sont associ\u00e9es aux s\u00e9quelles les plus graves. Ces diff\u00e9rences doivent \u00eatre clairement expliqu\u00e9es pour guider la pr\u00e9vention et la prise en charge. 1.3. Cons\u00e9quences cliniques du CMV cong\u00e9nital Chez le f\u0153tus Manifestations graves associ\u00e9es aux infections du premier trimestre : Microc\u00e9phalie. Calcifications intracr\u00e2niennes. Retard de croissance intra-ut\u00e9rin (RCIU). Hydramnios ou oligohydramnios. Signes \u00e9chographiques possibles : Ascite, h\u00e9patospl\u00e9nom\u00e9galie. Dilatation ventriculaire c\u00e9r\u00e9brale. Troubles du d\u00e9veloppement cortical (polymicrogyrie, ag\u00e9n\u00e9sie du corps calleux). \u00c0 la naissance Nouveau-n\u00e9s symptomatiques (10 % des cas) : Troubles neurologiques : convulsions, hypotonie, retard mental. Probl\u00e8mes sensoriels : surdit\u00e9, atteinte visuelle. Manifestations h\u00e9matologiques : thrombocytop\u00e9nie, an\u00e9mie. Nouveau-n\u00e9s asymptomatiques (90 % des cas) : Risque de s\u00e9quelles tardives, principalement une surdit\u00e9 neurosensorielle progressive (12 %). \u00c0 long terme S\u00e9quelles permanentes : Premi\u00e8re cause non g\u00e9n\u00e9tique de surdit\u00e9 neurosensorielle. Retard mental et cognitif. Troubles moteurs et \u00e9pilepsie. Notes pour l\u2019orateur :Les s\u00e9quelles d\u00e9pendent principalement du moment de l\u2019infection pendant la grossesse. Les l\u00e9sions c\u00e9r\u00e9brales pr\u00e9coces sont souvent irr\u00e9versibles et responsables des handicaps les plus graves. 1.4. Physiopathologie de la transmission verticale \u00c9tapes de l\u2019infection materno-f\u0153tale Infection maternelle primaire ou r\u00e9activation : Le virus infecte les cellules \u00e9pith\u00e9liales et se propage dans le sang. Infection du placenta : Le CMV traverse la barri\u00e8re placentaire, souvent via les cellules trophoblastiques. Le placenta agit comme un r\u00e9servoir, favorisant la transmission au f\u0153tus. Infection f\u0153tale : Propagation syst\u00e9mique dans les organes f\u0153taux : cerveau, foie, rein, oreille interne. Atteinte du syst\u00e8me nerveux central (CNS) : cible principale des l\u00e9sions graves. Facteurs influen\u00e7ant la gravit\u00e9 Charge virale maternelle : Plus \u00e9lev\u00e9e en cas d\u2019infection primaire. Moment de l\u2019infection : Premier trimestre : atteinte du CNS et anomalies graves. Troisi\u00e8me trimestre : atteinte multi-organes, g\u00e9n\u00e9ralement moins s\u00e9v\u00e8re. Notes pour l\u2019orateur :La physiopathologie explique pourquoi une prise en charge rapide et cibl\u00e9e est essentielle pour r\u00e9duire la transmission et les complications. 1.5. Importance du CMV comme probl\u00e8me de sant\u00e9 publique Impact sur la sant\u00e9 mondiale Premi\u00e8re cause d\u2019infection cong\u00e9nitale dans le monde. Responsable de 8 000 cas de s\u00e9quelles neurologiques par an aux \u00c9tats-Unis, surpassant les maladies comme la rub\u00e9ole cong\u00e9nitale. Co\u00fbt pour la soci\u00e9t\u00e9 Co\u00fbts m\u00e9dicaux directs : hospitalisations, traitements antiviraux, appareillages auditifs. Co\u00fbts indirects : soutien \u00e9ducatif, prise en charge des handicaps \u00e0 long terme. Absence de vaccination Contrairement \u00e0 d&rsquo;autres infections cong\u00e9nitales (ex. : rub\u00e9ole), il n\u2019existe pas encore de vaccin approuv\u00e9 pour le CMV. Les efforts de pr\u00e9vention reposent actuellement sur des strat\u00e9gies comportementales et m\u00e9dicales. Notes pour l\u2019orateur :Le CMV repr\u00e9sente une priorit\u00e9 en sant\u00e9 publique en raison de sa pr\u00e9valence \u00e9lev\u00e9e, de son impact sur les nouveau-n\u00e9s et des d\u00e9fis &hellip; Cours-cytomegalovirus Lire la suite\u00a0\u00bb","og_url":"https:\/\/echonews.fr\/?page_id=4007","article_modified_time":"2025-03-19T09:42:05+00:00","og_image":[{"url":"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/Bandeau-accueil-learning-V4-BIS.jpg","type":"","width":"","height":""}],"twitter_misc":{"Dur\u00e9e de lecture estim\u00e9e":"50 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/echonews.fr\/?page_id=4007","url":"https:\/\/echonews.fr\/?page_id=4007","name":"Cours-cytomegalovirus -","isPartOf":{"@id":"http:\/\/echonews.fr\/#website"},"primaryImageOfPage":{"@id":"https:\/\/echonews.fr\/?page_id=4007#primaryimage"},"image":{"@id":"https:\/\/echonews.fr\/?page_id=4007#primaryimage"},"thumbnailUrl":"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/Bandeau-accueil-learning-V4-BIS.jpg","datePublished":"2025-01-12T21:33:58+00:00","dateModified":"2025-03-19T09:42:05+00:00","breadcrumb":{"@id":"https:\/\/echonews.fr\/?page_id=4007#breadcrumb"},"inLanguage":"fr-FR","potentialAction":[{"@type":"ReadAction","target":["https:\/\/echonews.fr\/?page_id=4007"]}]},{"@type":"ImageObject","inLanguage":"fr-FR","@id":"https:\/\/echonews.fr\/?page_id=4007#primaryimage","url":"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/Bandeau-accueil-learning-V4-BIS.jpg","contentUrl":"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/Bandeau-accueil-learning-V4-BIS.jpg"},{"@type":"BreadcrumbList","@id":"https:\/\/echonews.fr\/?page_id=4007#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Accueil","item":"http:\/\/echonews.fr\/"},{"@type":"ListItem","position":2,"name":"Cours-cytomegalovirus"}]},{"@type":"WebSite","@id":"http:\/\/echonews.fr\/#website","url":"http:\/\/echonews.fr\/","name":"","description":"","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"http:\/\/echonews.fr\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"fr-FR"}]}},"_links":{"self":[{"href":"https:\/\/echonews.fr\/index.php?rest_route=\/wp\/v2\/pages\/4007"}],"collection":[{"href":"https:\/\/echonews.fr\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/echonews.fr\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/echonews.fr\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/echonews.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=4007"}],"version-history":[{"count":0,"href":"https:\/\/echonews.fr\/index.php?rest_route=\/wp\/v2\/pages\/4007\/revisions"}],"wp:attachment":[{"href":"https:\/\/echonews.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=4007"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}