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Cited by 63Sepsis Diagnosis and TreatmentInflammation biomarkers and pathwaysinterferon and immune responses

Viral sepsis: diagnosis, clinical features, pathogenesis, and clinical considerations

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Xu, Ji-Qian, Zhang, Wan-Ying, Fu, Jia-Ji, Fang, Xiang-Zhi, Gao, Cheng-Gang, Li, Chang, Yao, Lu, Li, Qi-Lan +10 more·2024·Military Medical Research
DOI 10.1186/s40779-024-00581-0PMC PMC11648306
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Abstract

Sepsis, characterized as life-threatening organ dysfunction resulting from dysregulated host responses to infection, remains a significant challenge in clinical practice. Despite advancements in understanding host-bacterial interactions, molecular responses, and therapeutic approaches, the mortality rate associated with sepsis has consistently ranged between 10 and 16%. This elevated mortality highlights critical gaps in our comprehension of sepsis etiology. Traditionally linked to bacterial and fungal pathogens, recent outbreaks of acute viral infections, including Middle East respiratory syndrome coronavirus (MERS-CoV), influenza virus, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), among other regional epidemics, have underscored the role of viral pathogenesis in sepsis, particularly when critically ill patients exhibit classic symptoms indicative of sepsis. However, many cases of viral-induced sepsis are frequently underdiagnosed because standard evaluations typically exclude viral panels. Moreover, these viruses not only activate conventional pattern recognition receptors (PRRs) and retinoic acid-inducible gene-I (RIG-I)-like receptors (RLRs) but also initiate primary antiviral pathways such as cyclic guanosine monophosphate adenosine monophosphate (GMP-AMP) synthase (cGAS)-stimulator of interferon genes (STING) signaling and interferon response mechanisms. Such activations lead to cellular stress, metabolic disturbances, and extensive cell damage that exacerbate tissue injury while leading to a spectrum of clinical manifestations. This complexity poses substantial challenges for the clinical management of affected cases. In this review, we elucidate the definition and diagnosis criteria for viral sepsis while synthesizing current knowledge regarding its etiology, epidemiology, and pathophysiology, molecular mechanisms involved therein as well as their impact on immune-mediated organ damage. Additionally, we discuss clinical considerations related to both existing therapies and advanced treatment interventions, aiming to enhance the comprehensive understanding surrounding viral sepsis.

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  • The positive rate of blood culture in sepsis is 25% to 40%, mainly caused by bacterial infections.

    “The positive rate of blood culture in sepsis is 25% to 40%, mainly caused by bacterial infections;8”

    From Clinical and Pathogenic Characteristics of 45 Cases of Bloodstream Infection in Obstetrics: A Clinical Analysis (2026) · cites this paper as [8]

    The Background (page unavailable) reports pathogen detection rates of 25–40% in septic cases and says bacterial detection is most prevalent. It does not identify that figure as the positive rate of blood cultures; it describes detection of multiple pathogen types by different methods. (LLM, conf=0.89)

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Authors
Xu, J.-Q., Zhang, W.-Y., Fu, J.-J., Fang, X.-Z., Gao, C.-G., Li, C., Yao, L., Li, Q.-L., Yang, X.-B., Ren, L.-H., Shu, H.-Q., Peng, K., Wu, Y., Zhang, D.-Y., Qiu, Y., Zhou, X., Yao, Y.-M., & Shang, Y.
Affiliations
  • Huazhong University of Science and Technology (CN)
  • Chinese Academy of Sciences (CN)
  • Wuhan University (CN)
  • Chinese PLA General Hospital (CN)
  • Wuhan Union Hospital (CN)
Corresponding author
  • Zhou, Xi
  • Yao, Yong-Ming
  • Shang, You
ORCID
Venue
Military Medical Research
Publisher
Elsevier BV
Published
2024-12-16
Volume
11
Issue
1
Pages
78-78
ISSN
2054-9369 (ISSN-L)
DOI
10.1186/s40779-024-00581-0
PMC
PMC11648306
OpenAlex
W4405409746
Cited by
37
References
283
Citations by year
2026: 19 · 2025: 18
FWCI
2.44
Type
journal article
Language
en
Open access
Licence
Locations
  • Military Medical Research (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
National Natural Science Foundation of China (82372176, 82002026, 82272217, 81971818)
Topics
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
  • Life Sciences › Immunology and Microbiology › Immunology › Inflammation biomarkers and pathways
  • Life Sciences › Immunology and Microbiology › Immunology › interferon and immune responses
Keywords
viral sepsis, sepsis diagnosis, sepsis pathogenesis, pattern recognition receptors, RIG-I-like receptors, cGAS-STING pathway, interferon response, MERS-CoV, influenza virus, SARS-CoV-2, sepsis mortality, antiviral therapy
MeSH terms
COVID-19, SARS-CoV-2, Humans, Influenza A virus, Viremia, Coronavirus, Sepsis, Receptors, Pattern Recognition, Middle East Respiratory Syndrome Coronavirus

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