Systemic Inflammatory Response Syndrome and Sepsis in Children - Clinical Manifestations, Diagnosis, and Treatment

What Is Systemic Inflammatory Response Syndrome and Sepsis?

Systemic inflammatory response syndrome is a life-threatening condition in response to the excessive immune response of the body due to several factors. It results in inflammation of the body due to any bacterial infection or trauma. In severe and untreated cases, it may lead to multiple organ failures. Systemic inflammatory response syndrome occurring due to infections or any medical conditions is called sepsis. If there is a hemodynamic imbalance in addition to sepsis, it is called septic shock. All patients with septic infection may have systemic inflammatory response syndrome, but all patients with systemic inflammatory response syndrome do not necessarily have sepsis. There should be any two following criteria necessary for this inflammatory response. They are :

• Increased body temperature over 38 degrees Celsius or decreased body temperature to less than 36 degrees celsius.

• Increased heart rate by more than 90 beats per minute.

• The respiratory rate is more than 20 respiratory cycles per minute, or the partial pressure of carbon dioxide is less than 32 mm Hg.

• Increased leukocyte count of more than 12,000 cells per microlitre of blood.

The major criteria for sepsis are:

• Rapid breathing and increased heart rate.

• Shortness of breath.

• Confusion and disorientation.

• Extreme pain and discomfort.

• Excessive sweating.

What Is the Epidemiology of This Disease?

• The exact incidence of systemic inflammatory response syndrome is unknown.

• It can occur in all populations irrespective of age.

• Systemic inflammatory response syndrome is less common in females. It is due to the action of the estrogen hormone that provides a protective effect against the inflammatory stimulus.

What Are the Clinical Manifestations?

• Fever exceeding 38 degrees Celsius.

• Increased heart rate.

• Rapid breathing.

• Altered mental state with confusion and disorientation.

• Nausea and vomiting.

• Slurred speech.

• Breathlessness.

• Decrease urine output.

What Causes Systemic Inflammatory Response Syndrome?

The causes of systemic inflammatory response syndrome can be divided into two main categories:

Damage- Associated Molecular Pattern:

• Burns, trauma.

• End organ failure.

• Substance abuse.

• Adverse reactions due to medications.

• Hematologic malignancies.

Pathogenic-Associated Molecular Pattern:

• Bacterial infections.

• Viral infections like influenza.

• Toxic shock syndrome due to exotoxins and endotoxins.

What Are the Possible Complications?

Systemic inflammatory response syndrome may progress to other organs resulting in end-organ failures. Some complications that can occur are:

• Acute Encephalopathy: It is a disease affecting the brain and its function.

• Acute Respiratory Distress Syndrome: Fluid accumulation in the lungs causing respiratory distress.

• Tachyarrhythmia: Abnormal heart beats of more than 100 beats per minute.

• Tubular Necrosis: Kidney disorder affecting the tubules.

• Metabolic Acidosis: Presence of high levels of acid contents in the body that may be due to kidney failure or dysfunction.

• Thrombocytopenia: Decreased platelet count in the blood.

• Deep Vein Thrombosis: Formation of a blood clot in the deep veins.

• Disseminated Intravascular Coagulation: A serious medical condition where the proteins that control blood clotting become overactive.

• Hyperglycemia: Increased blood glucose levels.

How to Diagnose This Condition?

The diagnosis is made and confirmed by clinical examinations, and a complete evaluation is required. Therefore, the following tests are performed:

• Complete Blood Count: It evaluates the white blood cells to identify leukocytosis and leukopenia. The white blood cell count is either greater than 12,000 cells per microlitre of blood or less than 4000 cells per microlitre of blood. The criterion for SIRS is identical. More than 10 % of immature bands have a high chance for SIRS.

• Interleukin-6: Patients with increased interleukin-6 levels of more than 300 picograms per microlitre have an increased risk for pneumonia, multiple organ failure, etc.

• Imaging Tests: There are no specific imaging tests for systemic inflammatory response syndrome.

• Other Test Performed are:

  • Blood Culture: A microscopic examination of the blood smear is done to identify the presence of any microorganisms.

  • Cerebrospinal Fluid Analysis: The cerebrospinal fluid is collected through the lumbar puncture and analyzed for any abnormalities.

  • Liver Profile: A blood examination is performed to test the functioning of the liver.

Diagnostic Tests for Sepsis:

• Blood Culture: It is done to assess any infections present in the blood, clotting problems, reduced oxygen concentration in the blood, and electrolyte imbalance.

• Urine Analysis: Detects the presence of any microorganisms in the urine.

• Imaging Test:

  • X-Rays: Chest X-rays are performed to assess any lung infections.

  • Ultrasounds: Abdominal ultrasound of the gall bladder and kidneys to identify the presence of infections

  • Computed Tomography: It produces detailed information and assesses the liver, pancreas, and other abdominal organs.

What Is the Indicated Treatment?

The primary treatment goal for treating systemic inflammatory response syndrome is to stop the progression of the disorder to severe conditions such as shock and multiorgan failure.

• Maintaining Hemodynamic Stability: It is the initial procedure to be followed. In the case of severe sepsis, the electrolyte imbalance should be corrected. Hence administration of isotonic crystalloids at the rate of 30 ml per kilogram per bolus is given.

• Vasopressors and Inotropes: It is indicated to rectify the fluid volume or imbalance in the body due to severe infections.

• Surgical Interventions: In case of severe sepsis and wound infections with abscess, incision and drainage are indicated. Tube drainage of the abscess is also performed.

• Medications:

  • Antibiotic Therapy: In cases of suspected sepsis, empirical antibiotic therapy is initiated. After the test result for the culture, the specimen is obtained, and the empirical regimen is altered accordingly to the microorganism.

  • Antiviral Therapy: It is indicated only in cases of respiratory distress and systemic inflammatory response syndrome occurring during the influenza season.

  • Antifungal Therapy: Similar to antibiotic therapy, empirical fungal therapy is also given in patients with neutropenia (decreased neutrophils, a type of white blood cell).

  • Low-dose Glucocorticoids: Low doses of Hydrocortisone(200 mg to 300 mg) are given to improve the survival rate and reverse shock in the patient.

What Is the Prognosis for Systemic Inflammatory Response Syndrome and Sepsis?

In severe cases of systemic inflammatory response syndrome, there are high chances of developing multiorgan failure in the individual. These patients may require mechanical ventilation, blood transfusions, etc. Hence, the prognosis depends on the severity of the condition.

Conclusion:

Early identification of systemic inflammatory response syndrome and sepsis is crucial. Parents and caregivers should be educated and aware of the condition, the warning signs, etc. As soon as the clinical signs are noticed, they should be taken to the physician for examination. Proper medical history should be given to the doctor for a diagnosis.