Re: C sordellii and maternal death
From: art fougner, md (evsono@pipeline.com)
Sat Mar 18 13:37:18 2006
Thanks Joanne
art
At Sat, 18 Mar 2006, Joanne Bulley, MD wrote:
>
>This info goes with the earlier poster who suggested it is the
>Mefipristone rather than the misoprostol.
>
>Now I will quit over-posting to the List!
>
>Joanne
>
>http://www.theannals.com/cgi/content/abstract/39/9/1483
>
>Pathophysiology of Mifepristone-Induced Septic Shock Due to Clostridium
>sordellii Ralph P Miech, MD PhD
>
>Associate Professor Emeritus, Department of Molecular Pharmacology,
>Physiology, and Biotechnology, Brown Medical School, Brown University,
>174 Meeting St., Providence, RI 02912-9107, fax 401/863-1595,
>Ralph_Miech@brown.edu
>
>Reprints: Dr. Miech
>
>OBJECTIVE: To explain the role of mifepristone in medical abortions that
>results in fulminant and lethal septic shock due to Clostridium
>sordellii.
>
>DATA SOURCES: MEDLINE, PubMed, and Google Scholar databases were
>searched (1984-March 2005). Key search terms were mifepristone,
>RU38486, RU486, Mifeprex, medical abortion, septic shock, innate immune
>system, cytokines, and Clostridium sordellii.
>
>STUDY SELECTION AND DATA EXTRACTION: All articles identified from the
>data sources were evaluated and all information deemed relevant was
>included for the information related to the development of the
>understanding of the pathophysiology of mifepristone-induced septic
>shock due to C. sordellii.
>
>DATA SYNTHESIS: The mechanisms of action of mifepristone were
>incorporated into the pathophysiology of septic shock due to C.
>sordellii. Mifepristone, by blocking both progesterone and
>glucocorticoid receptors, interferes with the controlled release and
>functioning of cortisol and cytokines. Failure of physiologically
>controlled cortisol and cytokine responses results in an impaired innate
>immune system that results in disintegration of the body's defense
>system necessary to prevent the endometrial spread of C. sordellii
>infection. The abnormal cortisol and cytokine responses due to
>mifepristone coupled to the release of potent exotoxins and an endotoxin
>from C. sordellii are the major contributors to the rapid development
>of lethal septic shock.
>
>CONCLUSIONS: Theoretically, it appears that the mechanisms of
>mifepristone action favor the development of infection that leads to
>septic shock and intensifies the actions of multiple inflammatory
>cytokines, resulting in fulminant, lethal septic shock.
>
>Key Words: abortion, Clostridium sordellii, mifepristone, septic shock
>
>Published Online, July 26, 2005. http://www.theannals.com, DOI
>10.1345/aph.1G189
>
>--
>Joanne Bulley, MD
>Keene, NH, USA
>
>"Love is indescribable and unconditional.
>I could tell you a thousand things that it is not, but not one that it is."
>— Duke Ellington, American jazz artist (1899-1974).
>
--
art fougner, md
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