Fatal Toxic Shock Syndrome Associated with<i>Clostridium sordellii</i>after Medical Abortion

Fischer, Marc; Bhatnagar, Julu; Guarner, Jeannette; Reagan, Sarah; Hacker, Jill K.; Meter, Sharon H. Van; Poukens, Vadims; Whiteman, David B.; Iton, Anthony; Cheung, Michèle; Dassey, David E.; Shieh, Wun‐Ju; Zaki, Sherif R.

doi:10.1056/nejmoa051620

Cited by 230 publications

(154 citation statements)

References 31 publications

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“…A fatal case of Clostridium sordellii after using vaginal misoprostol had been reported however after extensive investigation there is still no consensus as to the mechanism of infection in these cases. 19 Low infection rate in the present study could be explained with the use of prophylactic antibiotic in every cases.…”

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confidence: 48%

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Use of Misoprostol in the Management of Early Pregnancy Loss

Gurung¹,

Rana²,

Baral³

2014

Nepal j. obstet. gynaecol.

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aims:To evaluate the effectiveness of Misoprostol administered vaginally to assist complete evacuation in early pregnancy losses (incomplete abortion, missed abortion and blighted ovum). Methods:It is a descriptive study conducted in the Department of Ob/Gyn and Emergency Department Tribhuvan University Teaching hospital. All women with clinical/USG diagnosis of incomplete abortion, missed abortion and blighted ovum ≤12 weeks POG either from last menstrual period (LMP) or USG were inserted tab. misoprostol 800 mcg in the posterior fornix. Same dose was repeated when the evacuation was incomplete on day 3 of follow-up. Manual vacuum aspiration (MVA) was offered on day 14 if evacuation was incomplete or any complications like excessive bleeding/severe pain occurred during this period.results: A hundred and thirty three women with incomplete/missed/blighted ovum were reported, of which 112 (84.3%) were analyzed as 21(15.7%) lost to follow up. Among the 112, 51 (45.5%) were incomplete abortion, 34(30.3%) blighted and 27 (24.1%) missed abortion. Complete evacuation was achieved in 98/112 (87.5%) cases [73 (65%) cases with single dose & 25(22.3%) with double doses]. Evacuation was failed in 14(12.5%) cases [incomplete abortion 6 (42%), blighted 7 (50%) & missed abortion 1 (7.1%)]. Failure for complete evacuation (n=14) related to gestational age: 10-12 weeks 9/14(64%), 7-9 weeks 5 (35%) and none in the ≤6 weeks. Although the plan was to evacuate on day 14 of follow-up for incomplete evacuation which was applicable only in 11(78.5%) cases, 3(21.5%) cases were surgically (MVA) treated beforehand (2 for excessive bleeding, 1 for severe pain). No severe complications and side effects requiring treatment were observed. Conclusions:Vaginal Misoprostol is proved to be effective and safe in cases of incomplete abortion, missed abortion and blighted ovum. In the cases that failed to achieve complete evacuation by medical means using misoprostol were subjected to surgical manual vacuum aspiration (MVA) on day 14 of follow-up.

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confidence: 48%

“…According to study done by Niinimaki et al 20 70% would choose the medical method in future. Similarly in different studies 7,19,21,22,23 70-93% women want to choose same if required.…”

mentioning

confidence: 99%

Use of Misoprostol in the Management of Early Pregnancy Loss

Gurung¹,

Rana²,

Baral³

2014

Nepal j. obstet. gynaecol.

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“…Gynecological infections in human after childbirth and abortion [147][148][149][150], post-operative infections [4], and necrotizing soft tissue infections associated with heroin use [4,151] can be attributable to infection with C. sordellii. Two toxins are a main responsible virulence factors of C. sordellii: hemorrhagic toxin (TcsH) and lethal toxin (TcsL) [152][153][154][155].…”

Section: Sordellii Toxinsmentioning

confidence: 99%

Rapid Tests for Detection of Main Clostridial Toxins

Pérez-Etcheverry

Carmen

2017

IRA-JAS

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“…Fisher et al, 9 Cohen Al et al 10 have reported a fatal case after abortion with mifepristone and misoprostol. Sosolik 11 et al have reported a case of primipara developing an episiotomy infection which progressed to involve the underlying fascia and muscle.…”

Section: Diagnosismentioning

confidence: 99%

Clostridium sordellii Infection of Female Genital Tract: A Rare but Fulminating Reaction

Pathak¹,

Pathak²

2015

Journal of South Asian Federation of Obstetrics and Gynaecology

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Clostridium sordellii, an anaerobic pathogen, is ubiquitously distributed in the environment and causes fatal necrotizing infections in approximately 70% of all reported cases.Characteristic clinical features include absence of fever and rash, dramatic leukemoid reaction (LR), capillary leak and fluid sequestration with hemoconcentration, refractory tachycardia and hypotension, and marked edema of infected tissues without gas production or extensive myonecrosis. C. sordellii has rarely been identified in the genital tract, other Clostridium species colonize the vagina in 4 to 18% of healthy women and commonly are associated with postpartum endometritis and septic abortion. Pregnancy, childbirth, or abortion may predispose a some women to acquire C. sordellii in the vaginal tract. Dilatation of the cervix may lead to ascending infection of necrotic decidual tissue. The acidic pH of the vaginal tract may enhance the cytopathic effects of C. sordellii lethal toxin C. sordellii infections pose difficult clinical challenges and are usually fatal.

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Fatal Toxic Shock Syndrome Associated withClostridium sordelliiafter Medical Abortion

Cited by 230 publications

References 31 publications

Use of Misoprostol in the Management of Early Pregnancy Loss

Use of Misoprostol in the Management of Early Pregnancy Loss

Rapid Tests for Detection of Main Clostridial Toxins

Clostridium sordellii Infection of Female Genital Tract: A Rare but Fulminating Reaction

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