Toxic shock associated with Clostridium sordellii and Clostridium perfringens after medical and spontaneous abortion
Toxic shock associated with Clostridium sordellii and Clostridium perfringens after medical and spontaneous abortion
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DOI：
10.1097/01.aog.0000287291.19230.ba
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发表时间：
2007-11-01
影响因子：
7.2
通讯作者：
McDonald, L. Clifford
中科院分区：
文献类型：
--
作者：
Cohen, Adam L.;Bhatnagar, Jufulu;McDonald, L. Clifford
目的：为了更好地了解致命的中毒性休克的风险梭菌sordellii在最近的药物流产与米非司酮和misopropolysine.Methods：我们进行了主动和被动监测的情况下，中毒性休克与药物流产或自然流产。为了确定中毒性休克的原因，对福尔马林固定的手术和尸检组织进行了多种细菌的免疫组织化学测定。我们从组织中提取DNA，进行梭菌属物种特异性聚合酶链反应测定，并测序扩增产物的确认Clostridium species.Results：我们报告4例药物流产或自然流产后与梭菌属感染相关的中毒性休克患者。两名妇女在药物引产后出现致命的产气荚膜梭菌感染：一名使用海带和米索前列醇，另一名使用米非司酮和米索前列醇。一名妇女有一个非致命性梭菌感染后自然流产。另一名妇女在使用米非司酮和米索前列醇流产后发生了致命的索氏梭菌感染。所有4例患者都有一个快速进展的疾病坏死性子宫内膜炎。结论：流产后中毒性休克可引起产气荚膜梭菌以及C sordellii，可以是非致命的，并可能发生在自然流产和流产后的药物方案比米非司酮和米索前列醇。
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.