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For further information, see CMDT Part 33-05: Clostridial Diseases

Key Features

  • C sordellii is a rare cause of endometritis and toxic shock syndrome following childbirth

  • Fatal cases of uterine infection following medically induced abortion with mifepristone have been reported

Clinical Findings

  • Abdominal pain

  • Absence of fever

  • Onset of illness was within 4–5 days of ingestion of mifepristone

  • Clinical course is fulminant

  • Infection appeared to be limited to the uterus, which shows

    • Necrosis

    • Edema

    • Hemorrhage

    • Acute inflammatory changes

Diagnosis

  • Tachycardia, severe hypotension, capillary leak syndrome with edema

  • Profound leukocytosis, hemoconcentration

Treatment

  • Early recognition

  • Aggressive resuscitation from shock

  • Immediate surgical debridement with hysterectomy

  • Administration of an antimicrobial active against C sordellii, including

    • Penicillin

    • Ampicillin

    • Macrolide

    • Clindamycin

    • Tetracycline

    • Metronidazole

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