What is the definition of Waterhouse-Friderichsen Syndrome?

Waterhouse-Friderichsen syndrome (WFS) is a group of symptoms resulting from the failure of the adrenal glands to function normally as a result of bleeding into the gland.

What are the alternative names for Waterhouse-Friderichsen Syndrome?

Fulminant meningococcemia - Waterhouse-Friderichsen syndrome; Fulminant meningococcal sepsis - Waterhouse-Friderichsen syndrome; Hemorrhagic adrenalitis

What are the causes for Waterhouse-Friderichsen Syndrome?

The adrenal glands are two triangle-shaped glands. One gland is located on top of each kidney. The adrenal glands produce and release different hormones that the body needs to function normally. The adrenal glands can be affected by many diseases, such as infections like WFS.

WFS is caused by severe infection with meningococcus bacteria or other bacteria, such as:

  • Group B streptococcus
  • Pseudomonas aeruginosa
  • Streptococcus pneumoniae
  • Staphylococcus aureus

What are the symptoms for Waterhouse-Friderichsen Syndrome?

Symptoms occur suddenly. They are due to the bacteria growing (multiplying) inside the body. Symptoms include:

  • Fever and chills
  • Joint and muscle pain
  • Headache
  • Vomiting

Infection with bacteria causes bleeding throughout the body, which causes:

  • Bodywide rash
  • Disseminated intravascular coagulation in which small blood clots cut off blood supply to the organs
  • Septic shock

Bleeding into the adrenal glands causes adrenal crisis, in which enough adrenal hormones are not produced. This leads to symptoms such as:

  • Dizziness, weakness
  • Very low blood pressure
  • Very fast heart rate
  • Confusion or coma

What are the current treatments for Waterhouse-Friderichsen Syndrome?

Antibiotics are started right away to treat the bacterial infection. Glucocorticoid medicines will also be given to treat adrenal gland insufficiency. Supportive treatments will be needed for other symptoms.

What is the outlook (prognosis) for Waterhouse-Friderichsen Syndrome?

WFS is fatal unless treatment for the bacterial infection is started right away and glucocorticoid drugs are given.

What are the possible complications for Waterhouse-Friderichsen Syndrome?

How do I prevent Waterhouse-Friderichsen Syndrome?

To prevent WFS caused by meningococcal bacteria, a vaccine is available.

Meningococcal lesions on the back
Adrenal gland hormone secretion

REFERENCES

Stephens DS. Neisseria meningitides. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier Saunders; 2020:chap 211.

Newell-Price JDC, Auchus RJ. The adrenal cortex. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 15.

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