Advertisement

Maternal deaths associated with Clostridium sordellii infection

  • James A. McGregor
    Correspondence
    Reprint requests: Dr. James A. McGregor, University of Colorado Health Sciences Center, 4200 E. 9th Ave., Denver, CO 80262.
    Affiliations
    From the Department of Obstetrics and Gynecology, Pediatrics, and Microbiology / Immunology, University of Colorado Sclwol of Medicine, Denver, Colorado
    Search for articles by this author
  • David E. Soper
    Affiliations
    From the Department of Obstetrics and Gynecology, Pediatrics, and Microbiology / Immunology, University of Colorado Sclwol of Medicine, Denver, Colorado
    Search for articles by this author
  • Gary Lovell
    Affiliations
    From the Department of Obstetrics and Gynecology, Pediatrics, and Microbiology / Immunology, University of Colorado Sclwol of Medicine, Denver, Colorado
    Search for articles by this author
  • James K. Todd
    Affiliations
    From the Department of Obstetrics and Gynecology, Pediatrics, and Microbiology / Immunology, University of Colorado Sclwol of Medicine, Denver, Colorado
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Clostridium sordellii is a common soil and enteric bacterium that is infrequently recovered from the vagina. We describe three women in which C. sordellii caused puerperal infection and a distinctive and lethal toxic shock-like syndrome. Patients were <1 week post partum and each had a single, limited focus of infection including infection associated with a retained vaginal sponge, a cesarean section operative site, and endometritis. Each patient had a distinctive course characterized by sudden onset of clinical shock marked by severe and unrelenting hypotension associated with marked, generalized tissue edema and “third spacing” with increased hematocrit, presence of marked leukemoid reaction with total neutrophil counts of 84,000/mm3, 66,000/mm3, and 93,600/mm3, absence of rash or fever, limited or no myonecrosis, and a rapid and uniformly lethal course. Hypoalbuminemia was also noted. Similar findings were noted in prior isolated reports of C. sordellii-mediated postpartum or surgical infection. Treatment of animals with C. sordellii or closely related C. difficile toxins produces similar findings. We suggest that localized infection with toxin-producing strains of C. sordellii can produce a rapidly lethal toxic shock-like syndrome. Further study and earlier recognition of this syndrome may be life-saving in other patients.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Weinstein L
        • Barza MA
        Gas gangrene.
        N Engl J Med. 1973; 289: 1129-1131
        • Gorbach SL
        • Thadepalli H
        Isolation of Clostridium in human infections: evaluation of 114 cases.
        J Infect Dis. 1975; 131: S81-S85
        • Popoff MR
        Purification and characterization of Clostridium sordellii lethal toxin and cross-reactivity with Clostridium difficile cytotoxin.
        Infect Immun. 1987; 55: 35-43
        • Jewett JF
        Committee on maternal welfare: fatal perinatal sepsis.
        N Engl J Med. 1972; 286: 1213-1216
        • Sweet RL
        • Ledger WJ
        Puerperal infectious morbidity.
        Am J Obstet Gynecol. 1973; 117: 1093-1100
        • Browdie DA
        • Davis JH
        • Koplewitz MJ
        • Cordary L
        • Leadbetter AW
        Clostridium sordellii infection.
        J Trauma. 1975; 15: 515-519
        • MacLennon JD
        The histotoxic clostridial infections in man.
        Bacterial Rev. 1962; 26: 177-274
        • Thys JP
        • Ectors P
        • Noel P
        Non-traumatic clostridial myosites: an unusual feature of brain death.
        Postgrad Med J. 1980; 56: 501-503
        • Ewing TL
        • Smale LE
        • Elliott FA
        Maternal deaths associated with postpartum vulvar edema.
        Am J Obstet Gynecol. 1979; 134: 173-179
        • Golde S
        • Ledger WJ
        Necrotizing fasciitis in post-partum patients: a report of four cases.
        Obstet Gynecol. 1977; 50: 670-673
        • Shy KK
        • Eschenbach DA
        Fatal perineal cellulitis from an episiotomy site.
        Obstet Gynecol. 1979; 54: 292-298
        • Soper DE
        Clostridial myonecrosis arising from an episiotomy.
        Obstet Gynecol. 1986; 68: 26-28
        • Scott WC
        • Ewing TL
        • Smale LE
        • Elliott FA
        Maternal deaths associated with postpartum vulvar edema.
        Amj Obstet Gynecol. 1979; 134: 173-179
        • Altemeier WA
        • Fuller VD
        Prevention and treatment of gas gangrene.
        JAMA. 1971; 217: 806-809
        • Stevens DL
        • Troyer BE
        • Merrick DT
        • Mitten JE
        • Olson RD
        Lethal effects and cardiovascular effects of purified alpha and theta-toxins from Clostridium perfringens.
        J Infect Dis. 1989; 157: 272-275
        • Stamenkovic I
        • Lew PD
        Early recognition of potentially fatal necrotizing fasciitis.
        N Engl J Med. 1984; 310: 1689-1693
        • Nord C-E
        • Wadstrom T
        • Dornbusch K
        • Wretlind B
        Extracellular proteins in five Clostridial species from human infections.
        Med Microbiol Immunol. 1975; 161: 145-154
        • Arseculeratne SN
        • Panabokké RG
        • Wijesundera S
        The toxins responsible for the lesion of Clostridium sordellii gas gangrene.
        J Med Microbiol. 1969; 2: 37-53
        • Martinez RD
        • Wilkins TD
        Purification and characterization of C. sordellii hemorrhagic toxin and cross-reactivity with C. difficile toxin A (Enterotoxin).
        Infect Immun. 1988; 56: 1215-1221
        • Rifkin GD
        • Fekety FR
        • Silva J
        • Sack RB
        Antibiotic induced colitis: implication of a toxin neutralized by Clostridium sordellii antitoxin.
        Lancet. 1977; 2: 1103-1106
        • Arnon SS
        • Mills DC
        • Day PA
        • Henrickson RV
        • Sullivan NM
        • Wilkins TD
        Rapid death of infant rhesus monkeys infected with Clostridium difficile toxins A and B: physiologic and pathologic basis.
        J Pediatr. 1984; 104: 34-40
        • Katner HP
        • Pankey GA
        • Bonis SL
        Fatal Colistridium difficile cellulitis.
        J Pediatr Infec Dis. 1987; 6: 794-795
        • File Jr, TM
        • Fass RJ
        • Perkins RL
        Pneumonia and empyema caused by Clostridium sordellii.
        Am J Med Sci. 1977; 274: 211-212
        • Spindler AJ
        • Musa H
        Clostridium sordellii septic arthritis.
        J Rheumatol. 1987; 14: 635-636
        • Kim P-H
        • Iaconis JP
        • Rolfe RD
        Immunization of adult hamsters against Clostridium difficile-associated Ileocecitin and transfer of protein to infant hamsters.
        Infect Immun. 1987; 55: 2984-2987
        • Goplerud CP
        • Ohm MJ
        • Galask RP
        Aerobic and anaerobic flora of the cervix during pregnancy and the puerperium.
        Am J Obstet Gynecol. 1976; 126: 858-868