Clostridium Sordellii

It’s easy to overlook medical problems that affect an extremely small number of people. After all, it has not made any headlines in health news. Unless you’re a medical professional you may not have even heard about the bacteria called Clostridium sordellii. According to the New England Journal of Medicine, 10 cases were positively identified for C. sordellii.

The bacteria are anaerobes which means they lives in an oxygen-free environment. C. sordellii is found in the vagina of some women and is usually asymptomatic. However, when it causes infection it can affect the reproductive tract, cardiovascular or musculoskeletal system. Neonates can also become infected during delivery and develop TSS. The manner in which C. sordellii causes disease or its means of transmission remains unclear. Other Clostridium species have been known to spread via contaminated objects (fomites) or from person-to-person. However, when there is an infection problems such as endometritis, sepsis and TSS (toxic shock syndrome) may occur.

Endometritis refers to the inflammation or irritation of the uterine lining. This occurs most commonly because of infections. Endometritis can also be caused by childbirth, gynecological procedures or the use of an intrauterine device (IUD). Women usually experience abdominal discomfort, abnormal bleeding or discharge. Antibiotics are sufficient to treat this problem. However, if left untreated it can lead to serious infection and other complications such as infertility, septic shock or pelvic infection.

Sepsis is also called systemic inflammatory response syndrome (SIRS) and is life-threatening without immediate care. In sepsis the body is usually responding to an infection. However, the body’s immune system usually overreacts to the infection causing the blood to become overwhelmed with cells working to combat the infection. This results in clot formation and the blockage of blood vessels. Obstructed vessels lead to a lack of oxygenated blood to organs in the body. Without quick diagnosis and treatment the prognosis for survival is low. More than one third of people with sepsis die from it. Although healthy people have been reported to have this problem, it usually affects babies, the elderly and people with a weakened immune system. Treatment usually involves hospitalization with the administration of I.V. fluids and antibiotics.

Toxic Shock Syndrome (TSS) is most commonly associated with the bacteria Staphylococcus. In TSS, the bacteria release toxins causing patients to experience fever, rash, hypotension, vomiting and diarrhea. Risks for developing TSS are menstruation, prolonged use of tampons, usage of foreign substances to stop nose bleeds and childbirth. Treatment includes maintaining normal blood pressure, I.V. fluids and antibiotics. The association of C. sordellii and TSS is not really clear. However, TSS induced by this Clostridium species is fulminant and usually fatal.

Pregnancies, childbirth, spontaneous or induced abortion may lead to infection because cervical dilation allows the bacteria to travel into the body. It has been suggested that the toxic effects of C. sordellii may be due to the acidic environment of the vagina. Of the 10 reported cases, 8 occurred after childbirth, 1 happened after a medical abortion and 1 was not associated with pregnancy at all. It has been shown that 29% of women who have had medical abortions tested positive for C. sordellii. Whereas, 5%-10% of women who were not pregnant had signs of bacterial infection found in their vaginal fluid. Unfortunately, at this time there is no statistical information on either pregnant women or mothers who have recently delivered regarding the presence of bacteria.

Signs and symptoms associated with C. sordellii infection were similar to sepsis and TSS. Patients may present with hypotension, tachycardia, abdominal pain, vomiting, diarrhea, weakness and high amounts of white blood cells (leukocytosis). Surprisingly, it was noted that none of the women presented with fever. Fever is a sign that is usually indicative of sepsis.

The Center for Disease Control and Prevention conducted a mortality-related study and has found that 5 women have died from infection since 2001. These women were administered oral mifepristone (RU-486) and intravaginal misoprostol for medical abortions. However, the FDA has not found any links between these drugs and the infection.

Although a rare occurrence, both postpartum and postabortion patients need to be aware of the symptoms associated with this infection. Seeking medical help immediately if abdominal pain or flu-like symptoms develop is important because doctors can identify the infection and treat it with antibiotics. Early detection improves a patient’s chances for recovery and your doctor can notify the CDC and local health department of this incident. This will help to track of the number of incidents and gain more information about the infection. If the infection occurred after an abortion then the FDA’s MedWatch would also be informed. The collection of information by the FDA would help to begin drawing conclusions regarding any causal associations between abortive drugs and C. sordellii infection.

Sources: Michelle Snow, RN, BSN, MSHR, MSPH, “On alert for postpartum C. sordellii infection,” Nursing 2008, 38.1 (2008): 10, Marc Fischer, M.D., M.P.H., Julu Bhatnagar, Ph.D., Jeannette Guarner, M.D., et. al., “Fatal Toxic Shock Syndrome Associated with Clostridium sordellii after Medical Abortion,” New England Journal of Medicine, 353:22 (2005): 2352-2360