title: Toxic shock associated with Clostridium sordellii and Clostridium perfringens after medical and spontaneous abortion.
abstract: 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.
authors.affiliation: Prevention and Response Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. ALCohen1@cdc.gov
authors.forename: Adam L
authors.initials: AL
authors.lastname: Cohen
authors.forename: Julu
authors.initials: J
authors.lastname: Bhatnagar
authors.forename: Sarah
authors.initials: S
authors.lastname: Reagan
authors.forename: Suzanne B
authors.initials: SB
authors.lastname: Zane
authors.forename: Marisa A
authors.initials: MA
authors.lastname: D'Angeli
authors.forename: Marc
authors.initials: M
authors.lastname: Fischer
authors.forename: George
authors.initials: G
authors.lastname: Killgore
authors.forename: Tao Sheng
authors.initials: TS
authors.lastname: Kwan-Gett
authors.forename: David B
authors.initials: DB
authors.lastname: Blossom
authors.forename: Wun-Ju
authors.initials: WJ
authors.lastname: Shieh
authors.forename: Jeannette
authors.initials: J
authors.lastname: Guarner
authors.forename: John
authors.initials: J
authors.lastname: Jernigan
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Duchin
authors.forename: Sherif R
authors.initials: SR
authors.lastname: Zaki
authors.forename: L Clifford
authors.initials: LC
authors.lastname: McDonald
mesh_terms: 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
chemical_list: D000019:Abortifacient Agents; D001427:Bacterial Toxins; C073548:toxin L, Clostridium sordellii; D016595:Misoprostol; D015735:Mifepristone