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Obstetrics & Gynecology 2007;110:1027-1033
© 2007 by The American College of Obstetricians and Gynecologists
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ORIGINAL ARTICLES

Toxic Shock Associated With Clostridium sordellii and Clostridium perfringens After Medical and Spontaneous Abortion

Adam L. Cohen, MD, MPH1,2, Julu Bhatnagar, PhD3, Sarah Reagan, MPH3, Suzanne B. Zane, DVM, Marisa A. D'Angeli, MD5, Marc Fischer, MD, MPH3,4, George Killgore, DrPH2, Tao Sheng Kwan-Gett, MD, MPH5, David B. Blossom, MD1,2, Wun-Ju Shieh, MD, PhD3, Jeannette Guarner, MD3,7, John Jernigan, MD2, Jeffrey S. Duchin, MD5,6, Sherif R. Zaki, MD, PhD3 and L. Clifford McDonald, MD2

From the 1Epidemic Intelligence Service, Office of Workforce and Career Development, 2Prevention and Response Branch, Division of Healthcare Quality Promotion, 3Infectious Disease Pathology Branch, Division of Viral Diseases, and 4Maternal and Infant Health Branch, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia; 5Public Health-Seattle and King County, Seattle, Washington; 6Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington; and 7Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia.

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.

CONCLUSION: 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.

LEVEL OF EVIDENCE: III




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