Viral Sepsis in Children

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

As with other types of sepsis, virus-induced sepsis requires a high index of suspicion, especially in very young children and those with chronic medical conditions. Neonates and young infants are at higher risk of sepsis from HSV, HPeVs, and enterovirus. HSV is usually acquired perinatally from mothers with genital herpes. Mothers with primary herpes are more likely to transmit the infection when compared to those with recurrent and non-primary herpes (77) . Nielsen et al reported that second born children are at higher risk of HPeV-3 infection than the firstborn (78) . Seizures, drowsiness and lethargy, and absence of oral lesions are associated with severe enteroviral infection in children (79). In RSV infection, comorbid conditions reported to increase the risk for severe infection include the history of prematurity, congenital heart disease, chronic lung disease, and immunodeficiency (13) . In a recent study, Eggleston et al found that patients with metapneumovirus infection were more likely to be older and have congenital heart disease compared to RSV infected patients (80) . In contrast, asthmatics and premature infants were at higher risk for rhinovirus infection (81) . Finally, predisposing conditions for severe pediatric influenza infection include age less than 2 years; asthma; cardiac, renal, hepatic, hematologic, neurologic or neuromuscular conditions; long-term aspirin therapy; immunosuppressive therapy and residence in a chronic care facility (82) . Risk of mother-to-child perinatal HIV transmission is higher in mothers with CD4 count < 200 cells/µL and lower in infants receiving antiretroviral prophylaxis (83, 84) . If patients with any of these conditions present with sepsis, diagnostic viral testing and appropriate empiric antiviral treatment should be strongly considered according to the individual's risk factors.