Waterhouse-Friderichsen Syndrome : causes, symptoms, diagnosis, treatment

Waterhouse-Friderichsen Syndrome (WFS) can be characterized as adrenal organ disappointment by seeping into adrenal organs, generally spread by extreme microbial (bacterial) contaminations. It can likewise characterize as Acute and serious meningococcemia followed by discharge into the adrenal organs.


When a person is attacked by bacteria, it leads to massive bleeding into adrenal glands. The syndrome is sometimes linked to meningococcal septicemia but may involve sepsis induced by some other organisms, like few streptococcal species.

This disorder may be linked splenectomy (spleen removal).Waterhouse–Friderichsen syndrome is named because of Rupert Waterhouse (1873–1958),physician, and Carl Friderichsen (1886–1979), pediatrician, who did research and wrote papers on the syndrome.

Causes of Waterhouse-Friderichsen Syndrome

Waterhouse–Friderichsen condition is adrenal organ disappointment because of seeping into the adrenal organ. It is normally brought about by serious meningococcal disease or other extreme, bacterial contamination.

Manifestations incorporate intense adrenal organ deficiency, and significant stun. Most patients with this condition are youngsters, despite the fact that grown-ups may infrequently be influenced. It is lethal if not treated right away.

Symptoms of Waterhouse-Friderichsen Syndrome

The symptoms of Waterhouse-Friderichsen syndrome are characterized into 3 types depending upon the time of the appearance of these symptoms.

  • Fever
  • Limb ache
  • Thirstiness
  • Diarrhea
  • Irregular skin shade
  • Conscious trouble

Typical structures

  • Stiffness or neck pain
  • Photophobia (Discomfort to eyes)

Pathological mechanism:

Here, we will focus on the pathogenicity of bacterial species. The bacterial species causing Waterhouse friderichsen syndrome in human invades into host body in following steps:

·         Binding to epithelial surfaces

·         Penetration into host cellular barriers

·         Resistance against host immune system

·         Activation of inflammatory action

Diagnosis of Waterhouse-Friderichsen Syndrome

  • It is hard to analyze this condition, explicitly in the setting of proceeding with sepsis, which may imagine as septic stun. It’s intriguing to realize that hypotension goes before stun just in roughly 50% of all patients.
  • There will be hypo glycaemia with hyponatremia and hyperkalemia, and the ACTH incitement test exhibits the intense adrenal disappointment. There might be Leukocytosis however in the event that leukopenia is seen.
  • C-responsive protein (test) level can be raised or practically typical. Thrombocytopenia (platelet tally), with change in prothrombin time (PT) and halfway thromboplastin time (PTT) sign of diffused intravascular coagulation.
  • Acidosis and intense renal disappointment can be viewed as in any extreme sepsis (a disturbing condition because of body reaction against germs).

 Treatment of Waterhouse-Friderichsen Syndrome

  • Treatment incorporates treatment for sepsis with blood misfortune control, utilization of anti-toxins, vasopressor to guarantee liquid stream, and legitimate consideration.
  • A portion of 5% dextrose with 0.9 % typical fundamental ought to be allowed more than 1 hour to address hypoglycemia. If stun is proceeding, increment portion of NS up to of 60 ml/kg for 60 minutes.
  • Hypoglycemia ought to be rectified offering 2 to 4 ml/kg of 25% dextrose as a food (bolus). Supplementary steroids given as hydrocortisone, up to 50 to 100 mg/m^2 in the bolus structure.
  • The normal observing of electrolytes and water level is unimaginably fundamental all through the treatment. When the circumstance is leveled out, the upkeep portion of glucocorticoid and mineralocorticoid gets checked consistently.
  • Conservative administration is that the suggested approach in instances of awful adrenal drain inside the shortfall of continuous dying. Traditionalist administration incorporates steady consideration, hematocrit observing, and presentation as required.


  • In Waterhouse-Friderichsen syndrome, the case fatality rate is 55-60%, particularly when the diagnosis is delayed. Death typically results from sepsis, despite aggressive treatment.

Some facts

  • This syndrome affects people off all ages including infants, children and adults.
  • This disease affects very limited amount of people.
  • It has very high mortality rate.
  • Asia has been the house of this disease.
  • Peoples from India are vulnerable to this disease due to their poor and unhygienic conditions.
  • From 1960 to 2005, total number of confirmed cases were 429 with 90% mortality rate.
  • This high death rate is due to adrenal hemorrhage and huge blood loss.

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