American Journal of Obstetrics & Gynecology
Volume 201, Issue 5 , Pages 459.e1-459.e7 , November 2009

Undiagnosed cases of fatal Clostridium-associated toxic shock in Californian women of childbearing age

  • Christine S. Ho, MD, MPH

      Affiliations

    • Surveillance for Unexplained Deaths (SUDS) Project, California Emerging Infections Program, Oakland, CA
    • Corresponding Author InformationReprints: Christine S. Ho, MD, CDC Field Medical Officer, SFDPH TB/Control 1001 Potrero Ave., Ward 94, San Francisco, CA 94110
  • ,
  • Julu Bhatnagar, PhD

      Affiliations

    • Division of Viral and Rickettsial Diseases, Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Atlanta, GA
  • ,
  • Adam L. Cohen, MD, MPH

      Affiliations

    • Division of Healthcare Quality Promotion, Prevention and Response Branch, Centers for Disease Control and Prevention, Atlanta, GA
  • ,
  • Jill K. Hacker, PhD, MPH

      Affiliations

    • Surveillance for Unexplained Deaths (SUDS) Project, California Emerging Infections Program, Oakland, CA
  • ,
  • Suzanne B. Zane, DVM

      Affiliations

    • Division of Reproductive Health, Maternal and Infant Health Branch, Centers for Disease Control and Prevention, Atlanta, GA
  • ,
  • Sarah Reagan, MPH

      Affiliations

    • Unexplained Deaths Project, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, GA
  • ,
  • Marc Fischer, MD, MPH

      Affiliations

    • Unexplained Deaths Project, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, GA
  • ,
  • Wun-Ju Shieh, MD, PhD, MPH

      Affiliations

    • Division of Viral and Rickettsial Diseases, Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Atlanta, GA
  • ,
  • Jeannette Guarner, MD

      Affiliations

    • Division of Viral and Rickettsial Diseases, Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Atlanta, GA
  • ,
  • Shabbir Ahmad, DVM, PhD, MS

      Affiliations

    • California Maternal, Child and Adolescent Health Program, Sacramento, CA
  • ,
  • Sherif R. Zaki, MD, PhD

      Affiliations

    • Division of Viral and Rickettsial Diseases, Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Atlanta, GA
  • ,
  • L. Clifford McDonald, MD

      Affiliations

    • Division of Healthcare Quality Promotion, Prevention and Response Branch, Centers for Disease Control and Prevention, Atlanta, GA

Received 25 December 2008 ,Revised 28 March 2009 ,Accepted 14 May 2009.

References 

  1. Bitti A, Mastrantonio P, Spigaglia P, et al. A fatal postpartum Clostridium sordellii associated with toxic shock syndrome. J Clin Pathol. 1997;50:259–260
  2. Hogan SF, Ireland K. Fatal acute spontaneous endometritis resulting from Clostridium sordellii. Am J Clin Pathol. 1989;91:104–106
  3. MacGregor JA, Soper DE, Lovell G, Todd JK. Maternal deaths associated with Clostridium sordellii infection. Am J Obstet Gynecol. 1989;161:987–995
  4. Soper DE. Clostridial myonecrosis arising from an episiotomy. Obstet Gynecol. 1986;68(suppl 3):26S–28S
  5. Rorbye C, Petersen IS, Nilas L. Postpartum Clostridium sordellii infection associated with fatal toxic shock syndrome. Acta Obstet Gynecol Scand. 2000;79:1134–1135
  6. Abdulla A, Yee L. The clinical spectrum of Clostridium sordellii bacteraemia: two case reports and a review of the literature. J Clin Pathol. 2000;53:709–712
  7. Sosolik R, Savage B, Vaccarello L. Clostridium sordellii toxic shock syndrome: a case report and review of the literature. Infect Dis Obstet Gynecol. 1996;4:31–35
  8. Fischer M, Bhatnagar J, Guarner J, et al. Fatal toxic shock syndrome associated with Clostridium sordellii after medical abortion. N Engl J Med. 2005;353:2352–2360
  9. Zane S, Berg C. Deaths from Clostridium sordellii after medical abortion. N Engl J Med. 2006;354:1646–1647author reply 1647
  10. Aldape MJ, Bryant AE, Stevens DL. Clostridium sordellii infection: epidemiology, clinical findings, and current perspectives on diagnosis and treatment. Clin Infect Dis. 2006;43:1436–1446
  11. Cohen AL, Bhatnagar J, Reagan S, et al. Toxic shock associated with Clostridium sordellii and Clostridium perfringens after medical and spontaneous abortion. Obstet Gynecol. 2007;110:1027–1033
  12. Carbonell JL, Torres MA, Reyes R, Ortega L, Garcia-Gallego F, Sanchez C. Second-trimester pregnancy termination with 600-μg vs. 800-μg vaginal misoprostol and systematice curretage expulsion: a randomized trial. Contraception. 2008;77:50–55
  13. Pepin J, Valiquette L, Cossette B. Mortality attributable to nosocomial Clostridium difficile-associated disease during an epidemic caused by a hypervirulent strain in Quebec. CMAJ. 2005;173:1037–1042
  14. McDonald LC, Killgore GE, Thompson A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med. 2005;353:2433–2441
  15. Shibru D, Newton C, Svahn J. Acute gangrenous appendicitis associated with Clostridium sordellii-induced toxic shock syndrome. Surg Rounds. 2006;530–535
  16. Deland É, Sinave C, Le Templier GL, Blouin D, Léveillé F. Toxic shock syndrome due to Clostridium sordellii: a dramatic postpartum and postabortion disease. Clin Infect Dis. 2002;35:1441–1443
  17. Fach P, Popoff MR. Detection of enterotoxigenic Clostridium perfringens in food and fecal samples with a duplex PCR and the slide latex agglutination test. Appl Environ Microbiol. 1997;63:4232–4236
  18. California Department of Health ServicesCenter for Health Statistics. http://www.dhs.ca.gov/hisp/chs/ohir/tables/datafiles/vsofca/0116.xlsAccessed March 30, 2007
  19. Martinez RD, Wilkins TD. Comparison of Clostridium sordellii toxins HT and LT with toxins A and B of c. difficile. J Med Microbiol. 1992;36:30–36
  20. Karasawa T, Wang X, Maegawa T, et al. Clostridium sordellii phospholipase C: gene cloning and comparison of enzymatic and biological activities with those of Clostridium perfringens and Clostridium bifermentans phospholipase C. Infect Immun. 2003;71:641–646
  21. Barbier J, Popoff MR, Molgo J. Degeneration and regeneration of murine skeletal neuromuscular junctions after intramuscular infection with a sublethal dose of Clostridium sordellii lethal toxin. Infect Immun. 2004;3120–3128
  22. Qa'Dan M, Spyres LM, Ballard JD. pH-enhanced cytopathic effects of Clostridium sordellii lethal toxin. Infect Immun. 2001;69:5487–5493
  23. Voth DE, Martinez OV, Ballard JD. Variations in lethal toxin and cholesterol-dependent cytolysin production correspond to differences in cytotoxicity among strains of Clostridium sordellii. FEMS Microbiol Lett. 2006;259:295–302
  24. Grimes DA. Risks of mifepristone abortion in context. Contraception. 2005;71:161
  25. McGregor JA, Equiles O. Risks of mifepristone abortion in context. Contraception. 2005;72:393–397
  26. Grimes DA. Risks of mifepristone abortion in context. Contraception. 2005;71:161
  27. Crockett SA. Risks of mifepristone abortion in context. Contraception. 2006;74:174;reply 175-6
  28. Grimes DA. Risks of mifepristone abortion in context. Contraception. 2006;74:174–175reply 175-6
  29. McGregor JA, Equils O. Risks of mifepristone abortion in context. Contraception. 2005;74:174–177
  30. Golde S, Ledger WJ. Necrotizing fasciitis in postpartum patients: a report of four cases. Obstet Gynecol. 1977;50:670–673

 Cite this article as: Ho CS, Bhatnagar J, Cohen AL, et al. Undiagnosed cases of fatal Clostridium-associated toxic shock in Californian women of childbearing age. Am J Obstet Gynecol 2009;201:459.e1-7.

 This study was supported by the Centers for Disease Control and Prevention Cooperative Agreement no. 1-U01/CI000309-02, California Emerging Infections Program, Oakland, CA.

PII: S0002-9378(09)00531-6

doi: 10.1016/j.ajog.2009.05.023

American Journal of Obstetrics & Gynecology
Volume 201, Issue 5 , Pages 459.e1-459.e7 , November 2009