Herpesviradae infections in severely burned children

Paul Wurzer, Megan R. Cole, Robert P. Clayton, Gabriel Hundeshagen, Omar Nunez Lopez, Janos Cambiaso-Daniel, Raimund Winter, Ludwik Branski, Hal K. Hawkins, Celeste Finnerty, David Herndon, Jong Lee

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.

Original languageEnglish (US)
JournalBurns
DOIs
StateAccepted/In press - 2017

Fingerprint

Virus Diseases
Burns
Infection
Mortality
Body Surface Area
Antiviral Agents
Pediatrics
Herpesviridae Infections
Polymerase Chain Reaction
Ganciclovir
Acyclovir
Herpesviridae
Human Herpesvirus 1
Immunosuppression
Length of Stay
Sepsis
Hospitalization
Morbidity
Wounds and Injuries

Keywords

  • Acyclovir
  • Cytomegalovirus
  • Polymerase chain reaction
  • Tzanck smear
  • Viral cultures

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Wurzer, P., Cole, M. R., Clayton, R. P., Hundeshagen, G., Nunez Lopez, O., Cambiaso-Daniel, J., ... Lee, J. (Accepted/In press). Herpesviradae infections in severely burned children. Burns. https://doi.org/10.1016/j.burns.2017.01.032

Herpesviradae infections in severely burned children. / Wurzer, Paul; Cole, Megan R.; Clayton, Robert P.; Hundeshagen, Gabriel; Nunez Lopez, Omar; Cambiaso-Daniel, Janos; Winter, Raimund; Branski, Ludwik; Hawkins, Hal K.; Finnerty, Celeste; Herndon, David; Lee, Jong.

In: Burns, 2017.

Research output: Contribution to journalArticle

Wurzer, P, Cole, MR, Clayton, RP, Hundeshagen, G, Nunez Lopez, O, Cambiaso-Daniel, J, Winter, R, Branski, L, Hawkins, HK, Finnerty, C, Herndon, D & Lee, J 2017, 'Herpesviradae infections in severely burned children', Burns. https://doi.org/10.1016/j.burns.2017.01.032
Wurzer P, Cole MR, Clayton RP, Hundeshagen G, Nunez Lopez O, Cambiaso-Daniel J et al. Herpesviradae infections in severely burned children. Burns. 2017. https://doi.org/10.1016/j.burns.2017.01.032
Wurzer, Paul ; Cole, Megan R. ; Clayton, Robert P. ; Hundeshagen, Gabriel ; Nunez Lopez, Omar ; Cambiaso-Daniel, Janos ; Winter, Raimund ; Branski, Ludwik ; Hawkins, Hal K. ; Finnerty, Celeste ; Herndon, David ; Lee, Jong. / Herpesviradae infections in severely burned children. In: Burns. 2017.
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title = "Herpesviradae infections in severely burned children",
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.",
keywords = "Acyclovir, Cytomegalovirus, Polymerase chain reaction, Tzanck smear, Viral cultures",
author = "Paul Wurzer and Cole, {Megan R.} and Clayton, {Robert P.} and Gabriel Hundeshagen and {Nunez Lopez}, Omar and Janos Cambiaso-Daniel and Raimund Winter and Ludwik Branski and Hawkins, {Hal K.} and Celeste Finnerty and David Herndon and Jong Lee",
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AU - Wurzer, Paul

AU - Cole, Megan R.

AU - Clayton, Robert P.

AU - Hundeshagen, Gabriel

AU - Nunez Lopez, Omar

AU - Cambiaso-Daniel, Janos

AU - Winter, Raimund

AU - Branski, Ludwik

AU - Hawkins, Hal K.

AU - Finnerty, Celeste

AU - Herndon, David

AU - Lee, Jong

PY - 2017

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N2 - 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.

AB - 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.

KW - Acyclovir

KW - Cytomegalovirus

KW - Polymerase chain reaction

KW - Tzanck smear

KW - Viral cultures

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