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

5 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

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

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    Wurzer, P., Cole, M. R., Clayton, R. P., Hundeshagen, G., Nunez Lopez, O., Cambiaso-Daniel, J., Winter, R., Branski, L., Hawkins, H. K., Finnerty, C., Herndon, D., & Lee, J. (Accepted/In press). Herpesviradae infections in severely burned children. Burns. https://doi.org/10.1016/j.burns.2017.01.032