Viral Sepsis in Children

Gupta, Neha; Richter, Robert; Robert, Stephen; Kong, Michele

Viral sepsis can be defined as a severe inflammatory response to a suspected or confirmed viral infection. However, making the definitive diagnosis of viral sepsis in a child is particularly challenging for clinicians. The astute clinician must incorporate the patient's history of present illness, physical exam, laboratory and radiographic data to determine the likelihood of a viral etiology for sepsis. Even with a positive viral test, limitations of the testing result should be considered. Despite these challenges, timely diagnosis of viral sepsis has significant implications on clinical management, including guiding the use of appropriate antiviral therapy and informing isolation and containment strategies. Moreover, timely diagnosis of viral sepsis may prevent unnecessarily prolonged antibacterial treatment exposure and thus could help prevent consequent antibacterial resistance and deleterious effects on the host microbiome. This review outlines our current understanding of viral sepsis in children, including its epidemiology and the pathophysiology of the viral-host response during active infection. The clinical manifestations, appropriate diagnostic testing, and management unique to viral infections are outlined.