eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease
Sepsis: Differential Diagnoses & Workup
Updated: Dec 7, 2007
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Differential Diagnoses
Other Problems to Be Considered
Cardiogenic shock
Coagulase-negative Staphylococcus
Complement deficiency
Congenital heart disease
Fungal infections
Hemophagocytic syndromes
Inborn errors of metabolism
Infections after solid organ transplantation
Macrophage activation syndromes
Neoplasms
Poisoning
Pulmonary embolus
S agalactiae
Workup
Laboratory Studies
- Whenever possible, obtain a blood culture prior to starting antibiotics.
- The yield is clearly correlated to the volume of blood sampled.
- Culture of bone marrow may have a higher yield for certain pathogens (eg, Histoplasma capsulatum).
- Obtain a urine culture unless, in an older child, a genitourinary source of infection can be reliably excluded. Urinalysis may have a role in clarifying the level of risk of urinary tract infection in infants and children.
- Obtain a cerebrospinal fluid (CSF) culture before initiating antibiotic therapy in a child whose condition is stable in whom clinical evaluation cannot exclude CNS infection.
- Many pathogens can be recovered from CSF cultures several hours after a dose of antibiotics; thus, the child whose condition is unstable should receive antibiotics and be stabilized prior to lumbar puncture.
- Once the infant or child's condition is stabilized, the identification of CSF pleocytosis is helpful, even if prolonged antibiotic therapy is likely to have rendered culture results negative.
- Culture of skin lesions, eye drainage, throat, vagina, rectum, cellulitic areas, nasal secretions, sputum, tracheal aspirates, and stool may be helpful in the appropriate clinical context.
- Viral cultures may have a role in certain contexts, although many viral infections are diagnosed serologically.
- Obtain a CBC count.
- In the era of pneumococcal occult bacteremia, the likelihood of a positive blood culture result for pneumococcus increased as the WBC count increased. However, whether an elevated WBC count will continue to be predictive of bacteremia with widespread pneumococcal conjugate vaccination is not clear.
- Elevated band and other immature counts, toxic granulation, toxic vacuolation, Dohle bodies, and, particularly, low white blood cell counts are findings of particular concern
- Hemoconcentration may be present and helpful as a gauge of hydration status.
- Electrolyte level tests, renal and liver function tests, and other chemistry tests may have a role. Serum transaminase levels and other measures of liver dysfunction are often elevated in cases such as disseminated viral and anaerobic infections.
- Measures of clotting function and coagulation parameters may be helpful. Disseminated intravascular coagulopathy, hypercoagulability, and other clotting dysfunctions may be seen in infants and children with systemic inflammatory response syndrome (SIRS).
- Etiology-specific serologies may be helpful.
- The use of inflammatory markers and acute phase reactants (eg, erythrocyte sedimentation rate, C-reactive protein, interleukins 1-b, interleukin-6, interleukin-8, tumor necrosis factor–alpha, leukotriene B4, procalcitonin) in the diagnosis and management of SIRS is unclear.
Imaging Studies
- Obtain a chest radiograph; pneumonia, pleural effusions, adenopathy, and other conditions may be revealed.
- Pursue other imaging modalities as the clinical context dictates.
Other Tests
- Echocardiography may be indicated in certain clinical settings.
Procedures
- Lumbar puncture may be indicated for CSF evaluation.
- Sampling of other fluids or biopsy of various organs or tissues may be necessary.
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 Differential Diagnoses & Workup: Sepsis |
| Treatment & Medication: Sepsis |
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References
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Further Reading
Keywords
sepsis, systemic inflammatory response syndrome, SIRS, septic shock, septicemia, blood infection, bloodstream infection, neonatal sepsis, bacteremia, viremia, fungemia, parasitemia, Streptococcus agalactiae, S agalactiae, Escherichia coli, Haemophilus influenzae, Listeria monocytogenes, Coagulase-negative Staphylococcus, Staphylococcus aureus, E coli, Klebsiella species, Pseudomonas aeruginosa, Enterobacter species, Candida species, Serratia species, Acinetobacter species, Streptococcus pneumoniae, Neisseria meningitidis, H influenzae type b (Hib), S pneumoniae, N meningitidis, Salmonella species, Plasmodium falciparum, pneumococcus, meningococcemia, bacteremia, hyperthermia, hypothermia, tachypnea, tachycardia, hemoglobin SS disease, congenital heart disease, genitourinary anomalies, urosepsis
