A 24-year-old woman develops high fever, foul-smelling vaginal discharge, hypotension, icterus and reddish-brown urine five days after an unsafe induced abortion. Blood film shows fragments and spherocytes. Which organism is classically responsible for this presentation?

• A Group A Streptococcus
• B Escherichia coli
• C Neisseria gonorrhoeae
• D Clostridium perfringens ✓

Explanation

Clostridium perfringens sepsis after septic abortion produces massive intravascular hemolysis with hemoglobinuria, jaundice, oliguric acute kidney injury and shock due to its alpha toxin (phospholipase D). E. coli causes endotoxic shock but not this degree of hemolysis, while streptococcal and gonococcal infections do not produce intravascular hemolysis. Management needs high-dose penicillin, resuscitation and urgent evacuation of retained products.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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