加利福尼亚育龄妇女中未确诊的与梭状芽孢杆菌相关的致命性中毒性休克病例。
Undiagnosed cases of fatal Clostridium-associated toxic shock in Californian women of childbearing age.
作者信息
Ho Christine S, Bhatnagar Julu, Cohen Adam L, Hacker Jill K, Zane Suzanne B, Reagan Sarah, Fischer Marc, Shieh Wun-Ju, Guarner Jeannette, Ahmad Shabbir, Zaki Sherif R, McDonald L Clifford
机构信息
Surveillance for Unexplained Deaths Project, California Emerging Infections Program, Oakland, CA, USA.
出版信息
Am J Obstet Gynecol. 2009 Nov;201(5):459.e1-7. doi: 10.1016/j.ajog.2009.05.023. Epub 2009 Jul 22.
OBJECTIVE
In 2005, 4 Clostridium sordellii-associated toxic shock fatalities were reported in young Californian women after medical abortions. The true incidence of this rare disease is unknown, and a population-based study has never been performed. Additional clostridia-associated deaths were sought to describe associated clinical characteristics.
STUDY DESIGN
Population-based death certificate review and a clinical case definition for clostridial-associated toxic shock identified women with likelihood of dying from a Clostridium infection. Formalin-fixed autopsy tissues underwent immunohistochemical and polymerase chain reaction assays.
RESULTS
Thirty-eight women were suspected of having C sordellii-associated death. Five tested positive for Clostridium species: 3 for Clostridium perfringens, 1 for C sordellii, and 1 for both. Deaths occurred after the medical procedures for cervical dysplasia (n = 2), surgical abortion (n = 1), stillborn delivery (n = 1), and term live birth (n = 1). None had a medical abortion.
CONCLUSION
C sordellii and C perfringens are associated with undiagnosed catastrophic infectious gynecologic illnesses among women of childbearing age.
目的
2005年，有报道称加利福尼亚州年轻女性在药物流产后发生4例与索氏梭菌相关的中毒性休克死亡病例。这种罕见疾病的真实发病率尚不清楚，且从未进行过基于人群的研究。为描述相关临床特征，对其他梭菌相关死亡病例进行了查找。
研究设计
基于人群的死亡证明审查以及梭菌相关中毒性休克的临床病例定义，确定了可能死于梭菌感染的女性。对福尔马林固定的尸检组织进行免疫组织化学和聚合酶链反应检测。
结果
38名女性被怀疑死于与索氏梭菌相关的疾病。5例梭菌检测呈阳性：3例为产气荚膜梭菌，1例为索氏梭菌，1例两种梭菌均呈阳性。死亡发生在宫颈发育异常的治疗（n = 2）、人工流产（n = 1）、死产（n = 1）和足月活产（n = 1）之后。均未进行药物流产。
结论
索氏梭菌和产气荚膜梭菌与育龄期女性未被诊断出的灾难性感染性妇科疾病有关。
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