Waterhouse Friderichsen Syndrome


Waterhouse-Friderichsen syndrome is an infection of adrenal glands leading to bleeding into one or both of the adrenal glands. Waterhouse-Friderichsen syndrome is caused by meningococcal infection of the adrenal glands or other similar severe infection of the adrenal glands. Apart from bleeding into the adrenal glands, Waterhouse-Friderichsen syndrome can also lead to necrosis of the adrenal glands and often causing adrenal failure. It is to be noted that Waterhouse-Friderichsen syndrome is a rare disease. Statistically, children are more prone to develop Waterhouse-Friderichsen syndrome as compared to adults. However, Waterhouse-Friderichsen syndrome can occur at any age. Waterhouse-Friderichsen syndrome got its name from an English doctor, Rupert Waterhouse and a Danish pediatrician, Carl Friderichsen.

Causes of disease

Waterhouse-Friderichsen syndrome is caused by bacterial infection of adrenal glands. The following species of bacteria can cause Waterhouse-Friderichsen syndrome.

The main bacteria which causes Waterhouse-Friderichsen syndrome is the bacterial speciesNeisseria meningitidis (Commonly known as Meningococcus). Waterhouse-Friderichsen syndrome can also be caused by bacterial species Streptococcus pneumoniae. However, Streptococcus pneumoniae is associated with infection in adults and elderly people. E-Coli, Pneumococcus andNeisseria Gonorrhoea are other types of bacteria which can cause Waterhouse-Friderichsen syndrome.

Symptoms and Signs

The following are the symptoms observed in patients suffering from Waterhouse-Friderichsen syndrome:

  • At the very beginning of the illness the patients have fever accompanied with cough and headache. The patients also complain of vomiting and rigors.
  • After the initial symptoms which are non-specific in nature, a rash appears on skin of the patient. The rash at the onset is muscular in nature and very similar to the rose spot of typhoid. Very soon, the rash develops into petechial form and turns into purple shade often having dusky gray color.
  • Patients often suffer from septic shocks
  • Low blood pressure is common.

The other symptoms are:

  • Lack of oxygen in blood supply
  • Sore throat
  • Hypoglycemia with Hyponatremia and Hyperkalemia.
  • Patients may slip to coma or may have altered mental state
  • Photo-phobia wherein patients develops a dislike for bright light
  • C-Reactive protein level might be elevated
  • Adrenal failure
  • Dysphagia
  • Atrophy of the tongue
  • Swelling of the optic disc
  • Dry cracks at the corner of the mouth

Treatment of disease

Several tests are performed to determine Waterhouse-Friderichsen syndrome. The treatment should be provided immediately to patients suffering from Waterhouse-Friderichsen syndrome since a delay can cause adrenal failure. Early treatment and appropriate care and management are important in case of Waterhouse-Friderichsen syndrome. Since this is a medical emergency the patient should be transferred to a hospital immediately. Antibiotics should be administered immediately even before transferring to the hospital. Patient should be provided with artificialoxygen supply in case the respiratory rate is raised. Antibiotic administration, volume resuscitation,ventilator and inotrope support is the key. Benzyl penicillin is the first choice as anti-biotic. However, anti-biotic like Cefotaxime and chloramphenicol are good alternatives. Surgical activity like plastic surgery and grafting is performed to deal with tissue necrosis.

Prevention of disease

Vaccination is available as a prevention measure against Waterhouse-Friderichsen syndrome. Men C vaccination is available and appears to be beneficial by reducing the number of cases of Waterhouse-Friderichsen syndrome. The vaccination is recommended for all children between eleven and eighteen years old. The vaccination is also recommended for people who have poor splenic function or who have low immune level.