S. aureus Is Agent of Fatal Syndrome


Three children diagnosed with Waterhouse-Friderichsen syndrome died after rapidly progressive illness was traced to severe Staphylococcus aureus infection, said Patricia V. Adem, M.D., of the University of Chicago, and her associates.

The three patients—a 15-month-old girl, a 9-month-old girl, and a 17-month-old boy—had been in good health prior to the onset of infection. Premortem cultures yielded methicillin-susceptible S. aureus in the first patient and methicillin-resistant S. aureus (MRSA) in the next two patients. All the isolates were genetically related, which underscores the rise in community-associated MRSA, the investigators said (N. Engl. J. Med. 2005;353:1245–51).

Characteristics of Waterhouse-Friderichsen syndrome include petechial rash, coagulopathy, cardiovascular collapse, and bilateral adrenal hemorrhage. Although extracorporeal membrane oxygenation has been associated with adrenal hemorrhage in other studies, it was not associated with fatal illness in the two patients in this review who received it.

Noteworthy clinical features in all three children included leukopenia, neutropenia, profound tachycardia, and profound metabolic acidosis, and the course of the disease resembled fulminant meningococcemia.

Pathologic findings revealed severe sepsis and disseminated intravascular coagulation, but there was no evidence of myocarditis or endocarditis. The lungs of all three patients showed gram-positive cocci in clusters, some of which were found in the vascular walls.

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