Staphylococcus Aureus Sepsis and the Waterhouse-Friderichsen Syndrome in Children

N Engl J Med. 2005 Sep 22;353(12):1245-51. doi: 10.1056/NEJMoa044194.


Staphylococcus aureus has increasingly been recognized as a cause of severe invasive illness. We describe three children who died at our institution after rapidly progressive clinical deterioration from this infection, with necrotizing pneumonia and multiple-organ-system involvement. The identification of bilateral adrenal hemorrhage at autopsy was characteristic of the Waterhouse-Friderichsen syndrome, a constellation of findings usually associated with fulminant meningococcemia. The close genetic relationship among the three responsible isolates of S. aureus, one susceptible to methicillin and two resistant to methicillin, underscores the close relationship between virulent methicillin-susceptible S. aureus and methicillin-resistant S. aureus isolates now circulating in the community.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adrenal Gland Diseases / etiology
  • Adrenal Gland Diseases / pathology
  • Adrenal Glands / pathology
  • Fatal Outcome
  • Female
  • Hemorrhage / etiology
  • Hemorrhage / pathology
  • Humans
  • Infant
  • Lung / microbiology
  • Lung / pathology
  • Male
  • Methicillin Resistance
  • Staphylococcal Infections / complications*
  • Staphylococcal Infections / microbiology
  • Staphylococcus aureus / genetics
  • Staphylococcus aureus / isolation & purification
  • Staphylococcus aureus / pathogenicity
  • Systemic Inflammatory Response Syndrome / microbiology*
  • Waterhouse-Friderichsen Syndrome / microbiology*
  • Waterhouse-Friderichsen Syndrome / pathology