Waterhouse-Friderichsen syndrome

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Waterhouse-Friderichsen syndrome (WFS) or hemorrhagic adrenalitis is a disease of the adrenal glands most commonly caused by the bacterium Neisseria meningitidis. The infection leads to massive hemorrhage into one or (usually) both adrenal glands.[1] It is characterized by overwhelming bacterial infection meningococcemia, low blood pressure and shock, disseminated intravascular coagulation (DIC) with widespread purpura, and rapidly developing adrenocortical insufficiency.

Contents

Epidemiology

Multiple species of bacteria can be associated with the condition:

  • Meningococcus is another term for the bacterial species Neisseria meningitidis, blood infection with which usually underlies WFS. While many infectious agents can infect the adrenals, an acute, selective infection is usually Meningococcus.
  • WFS can also be caused by Streptococcus pneumoniae infections, a common bacterial pathogen typically associated with meningitis in the adult and elderly population.[1]
  • Mycobacterium tuberculosis could also cause WFS. Tubercular invasion of the adrenal glands could cause hemorrhagic destruction of the glands and cause mineralocorticoid deficiency.
  • Cytomegalovirus can cause adrenal insufficiency,[5] especially in the immunocompromised.

Prevention

Routine vaccination against meningococcus is recommended by the Centers for Disease Control for all 11-18 year olds and people who have poor splenic function (who, for example, have had their spleen removed or who have sickle-cell disease which damages the spleen), or who have certain immune disorders, such as a complement deficiency.[6]

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