sepsislike

Sepsislike, often referred to as a sepsis-like syndrome, describes a clinical presentation that resembles sepsis but may not be caused by an identifiable infection, or may reflect an infection that is not proven despite evaluation. It is a descriptive term rather than a single diagnosis and is used when systemic inflammatory responses occur without clear evidence of bacterial sepsis.

Clinical features typically include fever or hypothermia, tachycardia, tachypnea, and leukocytosis or leukopenia. Hypotension and signs of organ dysfunction such as reduced urine output, altered mental status, or elevated lactate can occur. In some populations, such as neonates or the elderly, symptoms may be nonspecific, including poor feeding, lethargy, or malaise.

Etiologies are diverse. True infection with organisms that are difficult to detect can underlie a sepsislike presentation. Noninfectious causes include pancreatitis, major trauma or burns, autoimmune or inflammatory diseases, malignancy, toxin exposure, drug reactions, or transfusion-related inflammatory syndromes. Viral illnesses can also mimic sepsis. Because the distinction between infectious and noninfectious causes is not always clear at presentation, clinicians often pursue broad initial evaluation.

Evaluation centers on identifying infection and assessing organ function. This includes laboratory tests (complete blood count, metabolic panel, lactate, cultures), inflammatory markers, imaging as indicated, and careful hemodynamic and respiratory monitoring. Early recognition of deterioration is crucial.

Management emphasizes supportive care and prudent antimicrobial use. Fluid resuscitation and vasopressors may be needed for shock, along with oxygen therapy or ventilation as required. Broad-spectrum antibiotics are commonly started if infection cannot be excluded, with de-escalation once results are available. Treatment of established noninfectious etiologies is essential, and source control is indicated when applicable. Prognosis depends on the underlying cause and the degree of organ dysfunction.