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Toxic shock syndrome due to Clostridium sordellii

Denis Spelman, MBBS, FRACP, FRCPA, MPH
Section Editor
John G Bartlett, MD
Deputy Editor
Elinor L Baron, MD, DTMH


Clostridium sordellii is part of the normal flora of the vagina and may gain entry to the uterus via the cervix during spontaneous or induced abortion, childbirth, or menstruation. C. sordellii is a cause of toxic shock syndrome associated with gynecologic procedures, childbirth, and abortion (including spontaneous, surgical, and medical abortion) [1-6]. C. sordellii toxic shock (CSTS) is an uncommonly reported condition with a limited number of case reports and small case series.

The epidemiology, microbiology, pathogenesis, clinical manifestations, diagnosis, and management of CSTS syndrome will be reviewed here. Other issues related to clostridial myonecrosis are discussed separately. (See "Clostridial myonecrosis".)


C. sordellii can be found in soil, sewage, and the gastrointestinal tracts of humans and animals [7]. C. sordellii has been identified in the gastrointestinal tracts of 0.5 percent of humans [8].

Healthy women can harbor clostridial species in the vagina. Clostridium perfringens is the most common clostridial species (4 to 18 percent of healthy women); C. sordellii is less common (0.5 to 10 percent of healthy women) [8-11]. Clostridial vaginal colonization following abortion has been observed in up to 29 percent of women [10]. Similarly, fecal vaginal contamination during or after childbirth could be the source of C. sordelli infection [8].

The incidence of C. sordellii toxic shock (CSTS) is unknown; one review of death certificates suggested that CSTS was the cause of 1 in 200 deaths among young women of childbearing age [6].

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Literature review current through: Nov 2017. | This topic last updated: Oct 10, 2017.
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