Viral Sepsis in Children

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

The true incidence of viral sepsis, particularly in the pediatric population, remains unknown. Since bacterial sepsis is amenable to treatment and is presumably more common, viral testing is frequently foregone in the acute presentation of sepsis. However, a recent study of adult patients with sepsis showed that viral respiratory pathogens, namely influenza A virus, human metapneumovirus, coronavirus, and respiratory syncytial virus (RSV), were overlooked in 70% of patients (7) . In a multinational epidemiological study of children with severe sepsis, an infectious etiology was only proven in 65% of patients and out of these, approximately one-third had a viral infection (8) . The most frequent sites of infection were the respiratory tract (40%) and bloodstream (20%), with rhinovirus, RSV, and adenovirus most commonly isolated. In contrast, the Australia and New Zealand sepsis study group identified a pathogen in approximately 50% of patients with sepsis and septic shock (9) . Of these patients, only one-fifth had a viral etiology, with RSV, cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus (HSV), varicella zoster virus (VZV) and influenza being the most common viruses identified in this study. Recently, Ames et al. reported that 16% of pediatric patients who presented with septic shock had a primary viral disease (10) . In another study of neonates with sepsis, bacterial etiology was found in only approximately 15% of cases, making viral infection more likely as a plausible cause of sepsis in these patients (11) .