Global burden work has established that 85% of sepsis cases and deaths occur in low-income and middle-income countries. It reached that figure partly by counting deaths from malaria, leptospirosis, tuberculosis and gastroenteric illness as sepsis — which they are, by the definition of a dysregulated host response causing organ dysfunction. This Personal View argues that the accounting has consequences in both directions.
The gain is visibility: deaths from preventable, treatable endemic infection stop being a separate, lower-priority problem and appear inside a category that attracts research funding and guideline attention. The loss is clinical. Standard sepsis management is built around early recognition, prompt broad-spectrum antimicrobials, organ support and, increasingly, stratification for targeted therapy. Endemic and emerging infections typically have long and complex courses before admission, and their treatment is disease-specific — artesunate, doxycycline, antituberculous therapy — not a bundle.
The authors propose naming the overlap: sepsis from an endemic and emerging infectious disease, stratified within each disease to separate mild cases from those with organ dysfunction. For clinicians in India the practical content is the warning against the reverse error — treating a patient with severe falciparum malaria or leptospirosis as a generic septic patient, and letting the bundle substitute for the specific diagnosis and the specific drug. They also note plainly how little randomised evidence exists for treating these severe forms.
- In a febrile patient with organ dysfunction, name the likely organism before reaching for the bundle
- Send disease-specific tests alongside cultures — malaria smear or rapid test, leptospira serology, sputum for tuberculosis
- Do not let empirical broad-spectrum cover delay artesunate, doxycycline or antituberculous therapy
- Record severity within the specific disease, not only as sepsis or septic shock
- Expect little randomised evidence for the severe forms; the treatment logic comes from the disease, not from sepsis trials
Why it matters
Counting these deaths as sepsis makes them visible in policy, and can make the specific diagnosis invisible at the bedside.
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