title: Undiagnosed cases of fatal Clostridium-associated toxic shock in Californian women of childbearing age.
abstract: 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.
authors.affiliation: Surveillance for Unexplained Deaths Project, California Emerging Infections Program, Oakland, CA, USA.
authors.forename: Christine S
authors.initials: CS
authors.lastname: Ho
authors.forename: Julu
authors.initials: J
authors.lastname: Bhatnagar
authors.forename: Adam L
authors.initials: AL
authors.lastname: Cohen
authors.forename: Jill K
authors.initials: JK
authors.lastname: Hacker
authors.forename: Suzanne B
authors.initials: SB
authors.lastname: Zane
authors.forename: Sarah
authors.initials: S
authors.lastname: Reagan
authors.forename: Marc
authors.initials: M
authors.lastname: Fischer
authors.forename: Wun-Ju
authors.initials: WJ
authors.lastname: Shieh
authors.forename: Jeannette
authors.initials: J
authors.lastname: Guarner
authors.forename: Shabbir
authors.initials: S
authors.lastname: Ahmad
authors.forename: Sherif R
authors.initials: SR
authors.lastname: Zaki
authors.forename: L Clifford
authors.initials: LC
authors.lastname: McDonald
mesh_terms: 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*