Human herpes viruses in burn patients: A systematic review. Issue 1 (February 2017)

• Record Type: Journal Article
• Authors: Wurzer, Paul; Guillory, Ashley; Parvizi, Daryousch; Clayton, Robert P.; Branski, Ludwik K.; Kamolz, Lars-P.; Finnerty, Celeste C.; Herndon, David N.; Lee, Jong O.
• Is Part Of: Burns. Volume 43:Issue 1(2017)
• Page Start: 25
• Page End: 33
• Publication Date: 2017-02
• Subjects: Human herpes virus -- Herpes simplex virus -- Varicella-zoster virus -- Chickenpox -- Cytomegalovirus -- Burns; Burns and scalds -- Periodicals; 617.11
• DOI: 10.1016/j.burns.2016.02.003
• Languages: English
• ISSNs: 0305-4179

Abstract

Highlights: Whether human herpes viruses contribute to morbidity and mortality after burns remains controversial. No direct evidence linked cytomegalovirus and herpes simplex virus infection with increased morbidity and mortality in burns. Cytomegalovirus reactivation is more common than a primary cytomegalovirus infection. Varicella zoster virus infections are rare after burns but have associated severe complications including lethality. The therapeutic effects of antiviral agents after burns warrant further investigation. Abstract: Objective: The contribution of human herpes viruses, including herpes simplex virus (HSV), cytomegalovirus (CMV), and varicella zoster virus (VZV) to morbidity and mortality after burns remains controversial. This systematic review was undertaken to assess evidence of herpes virus-related morbidity and mortality in burns. Materials and methods: PubMed, Ovid, and Web of Science were searched to identify studies of HSV, CMV, or VZV infections in burn patients. Exclusion criteria included: A level of evidence (LoE) of IV or V; nonhuman in vivo studies; and non-English articles. There was no limitation by publication date. Results: Fifty articles were subjected to full-text analysis. Of these, 18 had LoE between I–III and were included in the final review (2 LoE I, 16 LoE II–III). Eight had a prospective study design, 9 had a retrospective study design, and 1 included both. Conclusions: No direct evidence linked CMV and HSV infection with increased morbidity and mortality in burns. Following burn, CMV reactivation was more common than a primary CMV infection. Active HSV infection impaired wound healing but was not directly correlated to mortality. Infections with VZV are rare after burns but when they occur, VZV infections were associated with severe complications including mortality. The therapeutic effect of antiviral agents administered after burns warrants investigation via prospective randomized controlled trials.