Cohen Adam L, Bhatnagar Julu, Reagan Sarah, Zane Suzanne B, D'Angeli Marisa A, Fischer Marc, Killgore George, Kwan-Gett Tao Sheng, Blossom David B, Shieh Wun-Ju, Guarner Jeannette, Jernigan John, Duchin Jeffrey S, Zaki Sherif R, McDonald L Clifford
Prevention and Response Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Obstet Gynecol. 2007 Nov;110(5):1027-33. doi: 10.1097/01.AOG.0000287291.19230.ba.
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.
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.
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.
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.
III.
为了更好地了解近期使用米非司酮和米索前列醇进行药物流产的女性发生致命性梭状芽孢杆菌中毒性休克的风险。
我们对与药物流产或自然流产相关的中毒性休克病例进行了主动和被动监测。为了确定中毒性休克的病因，对福尔马林固定的手术组织和尸检组织进行了多种细菌的免疫组织化学检测。我们从组织中提取DNA，进行梭状芽孢杆菌属特异性聚合酶链反应检测，并对扩增产物进行测序以确认梭状芽孢杆菌属。
我们报告了4例药物流产或自然流产后与梭状芽孢杆菌属感染相关的中毒性休克患者。两名女性在药物流产后发生了致命的产气荚膜梭菌感染：一名使用海藻棒和米索前列醇，另一名使用米非司酮和米索前列醇方案。一名女性在自然流产后发生了非致命性的索氏梭菌感染。另一名女性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例患者均患有快速进展性疾病并伴有坏死性子宫内膜炎。
流产后的中毒性休克可由产气荚膜梭菌以及索氏梭菌引起，可能是非致命性的，并且可发生在自然流产以及使用米非司酮和米索前列醇以外的药物方案诱导的流产后。
III级。
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