Herpesviradae infections in severely burned children. Issue 5 (August 2017)

• Record Type: Journal Article
• Authors: Wurzer, Paul; Cole, Megan R.; Clayton, Robert P.; Hundeshagen, Gabriel; Nunez Lopez, Omar; Cambiaso-Daniel, Janos; Winter, Raimund; Branski, Ludwik K.; Hawkins, Hal K.; Finnerty, Celeste C.; Herndon, David N.; Lee, Jong O.
• Is Part Of: Burns. Volume 43:Issue 5(2017)
• Page Start: 987
• Page End: 992
• Publication Date: 2017-08
• Subjects: Viral cultures -- Cytomegalovirus -- Tzanck smear -- Polymerase chain reaction -- Acyclovir; Burns and scalds -- Periodicals; 617.11
• DOI: 10.1016/j.burns.2017.01.032
• Languages: English
• ISSNs: 0305-4179

Abstract

Highlights: Viruses can cause burn wound and donor site infections, pneumonia, and sepsis. Viral cultures are the most commonly performed viral test at our burn center, followed by PCRs and Tzanck smears. Patients with large full-thickness burns are more likely to have positive viral test results. Herpes simplex virus infections may contribute to mortality. Abstract: Objective: Burn-related immunosuppression can promote human herpesviridae infections. However, the effect of these infections on morbidity and mortality after pediatric burn injuries is unclear. Methods: We retrospectively analyzed pediatric patients with burns ≥10% of the total body surface area (TBSA) who were admitted between 2010 and 2015. On clinical suspicion of a viral infection, antiviral therapy was initiated. Viral infection was confirmed via Tzanck smear, viral culture, and/or PCR. Study endpoints were mortality, days of antiviral agent administration, type of viral test used, type of viral infection, and length of hospitalization. Results: Of the 613 patients were analyzed, 28 presented with clinically diagnosed viral infections. The use of Tzanck smears decreased over the past 5 years, whereas PCR and viral cultures have become standard. Patients with viral infections had significantly larger burns (53 ± 15% vs. 38 ± 18%, p < 0.001); however, length of stay per TBSA burn was comparable (0.5 ± 0.4 vs. 0.6 ± 0.2, p = 0.211). The most commonly detected herpesviridae was herpes simplex virus 1. Two patients died due to sepsis, which was accompanied by HSV infection. The mortality rate among all patients (2.7%) was comparable to that in the infected group (7.1%, p = 0.898). Acyclovir was given systemically for 9 ± 8 days (N = 76) and/or topically for 9 ± 9 days for HSV (N = 39, combination of both N = 33). Ganciclovir was prescribed in three cases for CMV. Conclusions: Viral infections occur more commonly in patients suffering from larger burns, and HSV infections can contribute to mortality.