Eighty-five per cent of sepsis cases and deaths occur in low-income and middle-income countries. That figure is quoted constantly, and this Personal View argues that it conceals more than it reveals, because the deaths inside it are substantially from malaria, leptospirosis, tuberculosis and gastroenteric illness - diseases whose clinical trajectories look nothing like the sepsis that sepsis guidelines were written for.
The divergence is practical. Sepsis care is built around early recognition, rapid antibiotics, source control and organ support over hours. Endemic and emerging infections typically run a long course before admission and need disease-specific diagnosis and disease-specific drugs; getting an antimalarial or an antitubercular right matters more than the hour at which a broad-spectrum antibiotic was hung. The authors propose naming and stratifying these as sepsis from an endemic and emerging infectious disease, so that the severe forms are recognised early without losing the disease-specific pathway.
For Indian practice this is a description of the medical ward in monsoon season rather than a foreign debate. The usable consequence is in how bundles are written locally: a sepsis protocol that does not prompt a malaria test, a dengue platelet trajectory, a scrub typhus eschar or a tuberculosis consideration will keep producing timely antibiotics for the wrong disease. This is a Personal View, not a guideline, and no randomised evidence supports the proposed stratification yet.
- Check that your local sepsis bundle prompts endemic disease testing, not just cultures and antibiotics.
- Severity stratification and disease-specific diagnosis are separate tasks - do both.
- A long prodrome before admission argues against standard bacterial sepsis.
- Timely antibiotics do not substitute for the right antimalarial, antitubercular or doxycycline.
- Audit whether patients admitted as sepsis in monsoon season had an endemic cause excluded.
Why it matters
A sepsis label brings a protocol with it, and for the majority of the world's sepsis deaths that protocol is not the treatment.
Don't overread it
A Personal View proposing a framework - no trial has tested whether this stratification improves outcomes.
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