1/13. Fatal clostridial sepsis after spontaneous abortion.BACKGROUND: Although obstetric mortality due to complications of clostridium perfringens infection is rare at present, we report a case of fatal clostridial sepsis secondary to a septic spontaneous abortion. CASE: A woman at 6-8 weeks' gestation presented with vaginal bleeding and abdominal pain. Although afebrile, the patient was hypotensive, tachycardic, and tachypneic. physical examination was remarkable for a 10-weeks'-gestation-size uterus, mild pelvic tenderness, a closed cervix without signs of trauma, and moderate vaginal bleeding. Laboratory studies were consistent with infection, hemolysis, and coagulopathy. Sonography demonstrated echolucencies consistent with gas formation in the endometrial cavity. Despite fluid resuscitation, transfusions, antibiotic therapy, and a dilation and curettage, persistent vaginal bleeding required an emergency hysterectomy. hypotension ensued, and despite aggressive resuscitation attempts, the patient died. CONCLUSION:Rare cases of fatal sepsis secondary to pelvic infection with clostridium perfringens continue to occur. hemolysis, anuria, coagulopathy, and characteristic sonographic findings should heighten suspicion of this potentially fatal infection.- - - - - - - - - - ranking = 1keywords = abortion (Clic here for more details about this article) |
2/13. Toxic shock syndrome due to clostridium sordellii: a dramatic postpartum and postabortion disease.We describe a young woman who developed clostridium sordellii toxic shock syndrome after having had an abortion medically induced by mifepristone (RU-486; Mifeprex [Danco laboratories]) 7 days before admission to our hospital. Although the patient was aggressively treated, death occurred <3 days after admission. It is hoped that very early recognition of this disease will decrease the mortality associated with this rarely reported ailment that occurs among young, otherwise healthy women.- - - - - - - - - - ranking = 1keywords = abortion (Clic here for more details about this article) |
3/13. Recovery after prolonged anuria following septic abortion.After a criminal abortion, a 21-year-old woman developed clostridial sepsis, massive hemolysis, shock, and protracted renal failure. anuria was present for 3 weeks and hemodialysis was required for 35 days. Because of the prolonged anuria, the patient was thought to have irreversible renal cortical necrosis. A renal biopsy demonstrated tubular necrosis only. Shortly after the biopsy procedure, urinary volumes began to increase, and renal function gradually returned to normal levels. This case demonstrates that a protracted course of renal failure following clostridial infection is not necessarily due to cortical necrosis but may result from tubular necrosis, and renal function may return to normal.- - - - - - - - - - ranking = 1keywords = abortion (Clic here for more details about this article) |
4/13. Metastatic clostridial myonecrosis associated with intra-uterine clostridial infection: a report of three cases.Three cases of metastatic Clostridial myonecrosis are reported, two following spontaneous and one following criminal abortion. This particular combination has not been reported before. The two survivors were managed by hysterectomy and disarticulation of the leg through the hip. The patient who died did so before surgery could be undertaken. The literature on gas gangrene infections of the uterus and metastatic Clostridial myonecrosis is reviewed and guidelines for management are discussed.- - - - - - - - - - ranking = 0.2keywords = abortion (Clic here for more details about this article) |
5/13. A fatal case of clostridium sordellii septic shock syndrome associated with medical abortion.BACKGROUND: Clostridia bacteria are infrequent human pathogens. In the obstetric and gynecologic literature, clostridium sordellii infections have been very rarely reported. This is a case of infection following medical termination of early pregnancy with mifepristone and misoprostol. CASE: A 27-year-old woman presented for termination of pregnancy at 5.5 weeks from her last menstrual period. She received mifepristone 200 mg orally followed by 800 microg vaginal misoprostol. Three days after administration of misoprostol, she complained of dizziness, pelvic pain, and bleeding. The next day, she experienced worsening of symptoms and was hospitalized. She developed pulmonary edema, ascites, and heart failure. Despite supportive measures, antibiotics, and hysterectomy, she died 3 days later. The post mortem examinations indicated that death was caused by shock secondary to C sordellii infection. CONCLUSION: The frequency of infection following medical abortion is low. The rapid and fatal course of this infection is similar to other obstetric and gynecologic cases reported in the literature. Although providers should remain vigilant to the possibility of infection following medical abortion, the overall proven safety of medical abortion remains the same.- - - - - - - - - - ranking = 1.4keywords = abortion (Clic here for more details about this article) |
6/13. Fatal toxic shock syndrome associated with clostridium sordellii after medical abortion.endometritis and toxic shock syndrome associated with clostridium sordellii have previously been reported after childbirth and, in one case, after medical abortion. We describe four deaths due to endometritis and toxic shock syndrome associated with C. sordellii that occurred within one week after medically induced abortions. Clinical findings included tachycardia, hypotension, edema, hemoconcentration, profound leukocytosis, and absence of fever. These cases indicate the need for physician awareness of this syndrome and for further study of its association with medical abortion.- - - - - - - - - - ranking = 1.4keywords = abortion (Clic here for more details about this article) |
7/13. clostridium septicum infections in children: a case report and review of the literature.Clostridium myonecrosis is a rare and deadly infection that progresses very rapidly; thus, prompt diagnosis and treatment is vital. In adults, clostridial myonecrosis used to be a well-known complication of war wounds. Today, it is usually seen in settings of trauma, surgery, malignancy, skin infections/burns, and septic abortions. More recently, cases of nontraumatic or spontaneous clostridial myonecrosis have been reported in both adults and children. clostridium perfringens and clostridium septicum are responsible for the majority of the clinically relevant infections. Higher mortality rates are seen when C septicum is the causative agent. Here we present a child who survived a severe case of C septicum myonecrosis involving both abdominal and thoracic cavities. This rare infection has a high mortality rate and might be easily misdiagnosed in children, even by experienced clinicians, because of its nonspecific presentation. We also review all reported pediatric cases of C septicum infection and myonecrosis and discuss the surgical and medical interventions associated with improved survival. We identified a total of 47 cases of C septicum infection; of these, 22 (47%) were cases of C septicum associated with myonecrosis. Several factors, if available, were analyzed for each case: age, gender, infection location, previous diagnoses, presenting signs and symptoms, neutropenia, gross pathology of the colon, antibiotic use, surgical intervention, and final outcome. We found that conditions related with C septicum infection in children can be grouped into 3 major categories: patients with neutrophil dysfunction; patients with associated bowel ischemia; and patients with a history of trauma. Malignancies were found in 49% of the cases, cyclic or congenital neutropenia in 21%, hemolytic-uremic syndrome in 11%, structural bowel ischemia in 4%, and local extremity trauma in 6%. In addition, 6% of the cases had no known underlying disorder. Abdominal symptoms including vomiting, diarrhea, blood per rectum, abdominal pain, anorexia, and/or acute abdomen, were reported in 85% of the children. fever was also a common finding. The mainstay of treatment for C septicum infection was parenteral antibiotics and/or surgical intervention. The mortality rate for children with C septicum infection and myonecrosis was 57% and 59%, respectively. Although 82% of all cases received antibiotics, only 43% underwent therapeutic surgical intervention. Several clinical factors were found to be associated with improved survival. Only 35% of the children with gastrointestinal tract involvement survived, compared with 86% of the children without gastrointestinal tract involvement. The survival rates for other conditions ranged from 0% to 50%. One hundred percent survival was reported in patients with no previously diagnosed conditions and those with infections resulting from trauma to the extremities. All survivors received antibiotic treatment, compared with only 68% of the nonsurvivors. Most survivors (84%) underwent therapeutic surgical intervention, compared with only 12% of nonsurvivors. Other treatments were used adjunctively, including hyperbaric oxygen, granulocyte colony-stimulating factor, granulocyte transfusions, and intravenous immunoglobulin. C septicum infections in children are often fatal; thus, one needs to have a high index of suspicion in at-risk patients. This review describes who these patients are, their clinical presentation, and the therapeutic strategies associated with improved survival.- - - - - - - - - - ranking = 0.2keywords = abortion (Clic here for more details about this article) |
8/13. clostridium sordellii infection: epidemiology, clinical findings, and current perspectives on diagnosis and treatment.clostridium sordellii infections pose difficult clinical challenges and are usually fatal. Most commonly, these infections occur after trauma, childbirth, and routine gynecological procedures, but they have recently been associated with medically induced abortions and injection drug use. We report 2 fatal cases, one of which was associated with minor trauma, and the other of which was associated with normal childbirth, and we summarize the clinical features of 43 additional cases of reported C. sordellii infection. Of these 45 cases, 8 (18%) were associated with normal childbirth, 5 (11%) were associated with medically induced abortion, and 2 (0.4%) were associated with spontaneous abortion. The case-fatality rate was 100% in these groups. Ten (22%) of the C. sordellii infections occurred in injection drug users, and 50% of these patients died. Other cases of C. sordellii infection (in 19 patients [43%]) occurred after trauma or surgery, mostly in healthy persons, and 53% these patients died. overall, the mortality rate was 69% (31 of 45 patients). Eighty-five percent of all patients with fatal cases died within 2-6 days of initial infection, and nearly 80% of fatal cases developed leukemoid reactions. Rapid diagnostic tests and improved treatments are needed to reduced the morbidity and mortality associated with this devastating infection.- - - - - - - - - - ranking = 0.6keywords = abortion (Clic here for more details about this article) |
9/13. Postpartum uterine infection with clostridium perfringens.clostridium perfringens is commonly present in the female genital tract. Uterine infection with this organism is a potentially fatal disease infrequently seen in obstetric practice. The manifestations of C. perfringens uterine infection are variable, ranging from endometritis to gas gangrene with fulminant septicemia. The usual precipitating event has been septic abortion, but such infections can also occur spontaneously in uterine tumors and after complicated deliveries requiring mechanical intervention. diagnosis may be aided by radiologic techniques, and treatment involves high-dose penicillin and possibly surgery. We report two cases and review the clinical presentation and the diagnostic and therapeutic aspects of this disease.- - - - - - - - - - ranking = 0.2keywords = abortion (Clic here for more details about this article) |
10/13. Clostridial sepsis after abortion with PGF2alpha and intracervical laminaria tents--a case report.A case of clostridial endomyometritis and sepsis necessitating total abdominal hysterectomy which occurred 12 hours following abortion induced with intraamniotic administration of prostaglandin F2 alpha and laminaria tent insertion is discussed. Cultures from cervical, blood, and surgical specimens all yielded clostridium perfringens. Intrauterine contamination with this microorganism most likely followed the insertion of laminaria tents through the cervical os, which was colonized with C. perfringens. Since C. perfringens may be present in the microflora of the lower female genital tract, great care must be taken to cleanse this area prior to intracervical laminaria tent insertion.- - - - - - - - - - ranking = 1keywords = abortion (Clic here for more details about this article) |
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