R C Sosolik1, B A Savage, L Vaccarello. 1. Department of Pathology Ohio State University Medical Center 129 Hamilton Hall 1645 Neil Avenue, Columbus, OH 43210, USA.
Abstract
BACKGROUND: Since the 1980s, there have been isolated reports of a toxic shock syndrome associated with Clostridium sordellii necrotizing subcutaneous infections during the puerperium. Relatively localized fascial and muscle necrosis is noted at the surgical incision sites. However, circulating toxins produce marked edema, resulting in shock and cardiovascular collapse. Despite aggressive surgical and supportive therapy, all postpartum cases thus far have been fatal. CASE: A 24-year-old primipara developed an episiotomy infection which progressed to involve the underlying fascia and muscle. Despite early and adequate debridement of the devitalized tissue, she developed anasarca, marked leukocytosis, refractory hypotension, hypothermia, and a persistent coagulopathy, and expired on postpartum day 5. The cultures from the excised tissue grew C. sordellii All blood cultures were negative. CONCLUSION: Treatment modalities aimed solely at the eradication of the microbe and removal of necrotic tissue, although essential components of therapy, have proved inadequate. Future efforts should be directed toward neutralization or elimination of the circulating exotoxins responsible for the systemic shock.
BACKGROUND: Since the 1980s, there have been isolated reports of a toxic shock syndrome associated with Clostridium sordellii necrotizing subcutaneous infections during the puerperium. Relatively localized fascial and muscle necrosis is noted at the surgical incision sites. However, circulating toxins produce marked edema, resulting in shock and cardiovascular collapse. Despite aggressive surgical and supportive therapy, all postpartum cases thus far have been fatal. CASE: A 24-year-old primipara developed an episiotomy infection which progressed to involve the underlying fascia and muscle. Despite early and adequate debridement of the devitalized tissue, she developed anasarca, marked leukocytosis, refractory hypotension, hypothermia, and a persistent coagulopathy, and expired on postpartum day 5. The cultures from the excised tissue grew C. sordellii All blood cultures were negative. CONCLUSION: Treatment modalities aimed solely at the eradication of the microbe and removal of necrotic tissue, although essential components of therapy, have proved inadequate. Future efforts should be directed toward neutralization or elimination of the circulating exotoxins responsible for the systemic shock.
Authors: Seth T Walk; Ruchika Jain; Itishree Trivedi; Sylvia Grossman; Duane W Newton; Tennille Thelen; Yibai Hao; J Glenn Songer; Glen P Carter; Dena Lyras; Vincent B Young; David M Aronoff Journal: Anaerobe Date: 2011-06-25 Impact factor: 3.331
Authors: Francisco A Uzal; Luis G Arroyo; Mauricio A Navarro; Diego E Gomez; Javier Asín; Eileen Henderson Journal: J Vet Diagn Invest Date: 2021-11-11 Impact factor: 1.569
Authors: Akinyi C Nyaoke; Mauricio A Navarro; Karina Fresneda; Santiago S Diab; Janet Moore; Dena Lyras; Milena Awad; Francisco A Uzal Journal: J Vet Diagn Invest Date: 2020-02-13 Impact factor: 1.279