Toxic shock associated with Clostridium sordellii and Clostridium perfringens after medical and spontaneous abortion.
OBJECTIVE
To better understand the risk of fatal toxic shock caused by Clostridium sordellii in women who had a recent medical abortion with mifepristone and misoprostol.


METHODS
We performed active and passive surveillance for cases of toxic shock associated with medical or spontaneous abortion. To identify the cause of toxic shock, immunohistochemical assays for multiple bacteria were performed on formalin-fixed surgical and autopsy tissues. We extracted DNA from tissues, performed Clostridium species-specific polymerase chain reaction assays, and sequenced amplified products for confirmation of Clostridium species.


RESULTS
We report four patients with toxic shock associated with Clostridium species infection after medical or spontaneous abortion. Two women had fatal Clostridium perfringens infections after medically induced abortions: one with laminaria and misoprostol and one with the regimen of mifepristone and misoprostol. One woman had a nonfatal Clostridium sordellii infection after spontaneous abortion. Another woman had a fatal C sordellii infection after abortion with mifepristone and misoprostol. All four patients had a rapidly progressive illness with necrotizing endomyometritis.


CONCLUSIONS
Toxic shock after abortion can be caused by C perfringens as well as C sordellii, can be nonfatal, and can occur after spontaneous abortion and abortion induced by medical regimens other than mifepristone and misoprostol.


METHODS
III.
Cohen
Adam L
AL
Prevention and Response Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. ALCohen1@cdc.gov
Bhatnagar
Julu
J
Reagan
Sarah
S
Zane
Suzanne B
SB
D'Angeli
Marisa A
MA
Fischer
Marc
M
Killgore
George
G
Kwan-Gett
Tao Sheng
TS
Blossom
David B
DB
Shieh
Wun-Ju
WJ
Guarner
Jeannette
J
Jernigan
John
J
Duchin
Jeffrey S
JS
Zaki
Sherif R
SR
McDonald
L Clifford
LC
D000019:Abortifacient Agents / Q000009:adverse effects*; D000032:Abortion, Therapeutic / Q000009:adverse effects* / Q000379:methods; D000282:Administration, Intravaginal; D001427:Bacterial Toxins; D003015:Clostridium Infections / Q000209:etiology*; D003016:Clostridium perfringens / Q000472:pathogenicity*; D047989:Paraclostridium sordellii / Q000472:pathogenicity*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007795:Laminaria; D015735:Mifepristone / Q000009:adverse effects; D016595:Misoprostol / Q000008:administration & dosage / Q000009:adverse effects*; D009336:Necrosis / Q000382:microbiology / Q000473:pathology; D011247:Pregnancy; D012772:Shock, Septic / Q000382:microbiology* / Q000503:physiopathology; D014599:Uterus / Q000382:microbiology / Q000473:pathology
D000019:Abortifacient Agents; D001427:Bacterial Toxins; C073548:toxin L, Clostridium sordellii; D016595:Misoprostol; D015735:Mifepristone