Undiagnosed cases of fatal Clostridium-associated toxic shock in Californian women of childbearing age.
OBJECTIVE
In 2005, 4 Clostridium sordellii-associated toxic shock fatalities were reported in young Californian women after medical abortions. The true incidence of this rare disease is unknown, and a population-based study has never been performed. Additional clostridia-associated deaths were sought to describe associated clinical characteristics.


METHODS
Population-based death certificate review and a clinical case definition for clostridial-associated toxic shock identified women with likelihood of dying from a Clostridium infection. Formalin-fixed autopsy tissues underwent immunohistochemical and polymerase chain reaction assays.


RESULTS
Thirty-eight women were suspected of having C sordellii-associated death. Five tested positive for Clostridium species: 3 for Clostridium perfringens, 1 for C sordellii, and 1 for both. Deaths occurred after the medical procedures for cervical dysplasia (n = 2), surgical abortion (n = 1), stillborn delivery (n = 1), and term live birth (n = 1). None had a medical abortion.


CONCLUSIONS
C sordellii and C perfringens are associated with undiagnosed catastrophic infectious gynecologic illnesses among women of childbearing age.
Ho
Christine S
CS
Surveillance for Unexplained Deaths Project, California Emerging Infections Program, Oakland, CA, USA.
Bhatnagar
Julu
J
Cohen
Adam L
AL
Hacker
Jill K
JK
Zane
Suzanne B
SB
Reagan
Sarah
S
Fischer
Marc
M
Shieh
Wun-Ju
WJ
Guarner
Jeannette
J
Ahmad
Shabbir
S
Zaki
Sherif R
SR
McDonald
L Clifford
LC
D000328:Adult; D002140:California / Q000453:epidemiology; D003015:Clostridium Infections / Q000150:complications* / Q000401:mortality*; D047989:Paraclostridium sordellii; D005260:Female; D006801:Humans; D012189:Retrospective Studies; D012772:Shock, Septic / Q000382:microbiology* / Q000401:mortality*