acyclovir and Burns

Herpes simplex virus (HSV) infection in the burn patient is thought to occur relatively frequently. Most commonly, children with significant burns, particularly involving the head and neck, are affected. Burn related immunosuppression is thought to allow reactivation of latent HSV in most cases, although primary HSV infection has been recognized. Clinical manifestations vary from asymptomatic viral shedding, to prolonged fever with eruption of vesicles, to rare cases of systemic visceral dissemination. Healing partial thickness wounds and donor sites are most prone to infection. Laboratory confirmation of HSV infection relies on direct demonstration of the virus and/or observation of a rise in antibody titer. Treatment of an established HSV infection includes use of IV Acyclovir, meticulous wound care, and efforts to prevent nosocomial spread. The vast majority of cases resolve without sequelae unless complicated by systemic, multiorgan HSV infection.

Topics: Acyclovir; Antibodies, Viral; Antiviral Agents; Burns; Cross Infection; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Infant; Injections, Intravenous; Skin Transplantation; Wound Healing; Wound Infection

A 15-year-old boy with Kaposi's varicelliform eruption complicating healing second degree burns is reported. Clinically, umbilicated vesicles and pustules evolving to extensive erosions appeared over previously burned areas, sparing normal skin. Rapid diagnosis was made on the basis of the presence of multinucleate giant cells in a Tzanck smear. Therapy with intravenous acyclovir was followed by complete epithelialization without scarring. Previous cases of Kaposi's varicelliform eruption in burned patients are reviewed.

Topics: Acyclovir; Adolescent; Antiviral Agents; Burns; Cloxacillin; Drug Therapy, Combination; Herpesvirus 1, Human; Humans; Kaposi Varicelliform Eruption; Male; Penicillins

Fractional photothermolysis was initially introduced by Manstein in 2004 .Fractional CO2 laser technology introduced has allowed physicians to obtain good cosmetic results with a lower rate of complications than non-fractionated ablative laser treatment. However, adverse effects may still occur.Reported cases of HSV infection after fractional photothermolysis are rare. A 48-year-old woman with Fitzpatrick skin type III presented with a scar in her perioral area desiring esthetic improvement of her burn scar. She didn't have a history of recurrent herpes simplex virus (HSV) infection periorally. A fractionated resurfacing laser Quadralase (Candela) was used to treat her perioral burn scar. Two sessions were performed with a month interval. Five days after the second session of laser therapy even after she took antiviral prophylaxis based on valacyclovir 500mg twice daily 24 hours before the laser session and 3 days after, she presented with a rash on the perioral area preceded by pain. Correlation of the history and the clinical presentation was consistent with HSV reactivation. Treatment was initiated with acyclovir 10mg/kg/8h administered intravenously for 10 days with a clearing of her vesicular eruption. Fractional CO2 laser is a very safe procedure when used with accepted parameters. Early recognition, close monitoring and careful wound care will prevent long term sequelae when complications occur.

Topics: Acyclovir; Administration, Intravenous; Antibiotic Prophylaxis; Antiviral Agents; Burns; Cicatrix; Dose Fractionation, Radiation; Female; Follow-Up Studies; Herpes Simplex; Humans; Lasers, Gas; Low-Level Light Therapy; Middle Aged; Mouth; Simplexvirus; Treatment Outcome; Virus Activation

Wound management in burns is a potentially complex issue. Salivary constituents have been shown experimentally to be of benefit in the treatment of thermal injuries. In our clinical experience we have encountered patients who have saliva directly applied to the burn wound prior to presenting to the national burns service. The practice is known as "Licking". We report two cases to illustrate the presentations we have encountered. We believe that these illustrate an isolated phenomenon unique to the Republic of Ireland.

Topics: Acyclovir; Antiviral Agents; Burns; Child; Cultural Characteristics; Female; Herpesviridae Infections; Humans; Infant; Ireland; Male; Patient Acceptance of Health Care; Saliva; Self Care; Skin Transplantation

Increased mortality, extensive visceral involvement, and necrotizing tracheobronchitis associated with herpes viruses have been reported after burns. It is unclear whether herpes presenting as a facial rash results in outcome changes after burns.. A retrospective study characterizing the incidence, presentation, and outcome of 14 patients with facial herpes rashes out of 95 severely burned intubated adults was performed.. Facial rashes attributed to herpetic infections were found in at least 15% of patients. The problem was recognized during the second week after burn. There was no difference in mortality or length of stay noted between patients with or without the infection.. The course of this infection was relatively benign in this group of acyclovir-treated patients. Even so, the lesions clearly contributed to patient discomfort and often produced fevers requiring costly investigations. Early recognition could help prevent diffuse spread of the lesions, decreasing patient discomfort and improving patient care.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Body Surface Area; Boston; Burn Units; Burns; Facial Dermatoses; Herpes Simplex; Herpesvirus 1, Human; Hospitals, General; Humans; Incidence; Intubation, Intratracheal; Length of Stay; Middle Aged; Retrospective Studies; Survival Analysis; Treatment Outcome; Virus Activation

Many people harbor herpes simplex virus, often with a known history of "cold sores". During the relatively immunosuppressed state associated with a serious burn, recrudescence of such infections can occur. We report four adults and two children who developed severe herpetic ulceration, over the face and neck in five patients and in a partial thickness wound in one patient. Herpetic infection was diagnosed by culture and direct immunofluorescence testing and treatment was immediately instituted with systemic and topical Acylovir(R) (Zovirax, Glaxo Wellcome). Ulceration healed under treatment and did not leave visible scarring in any of the patients. Although these infections are rapidly progressive, they respond to prompt treatment with antiviral chemotherapy. Rapidly progressive vesicles and ulceration appearing on the face or in the wounds of burn patients should prompt immediate evaluation for herpetic infection.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Burns; Female; Herpes Simplex; Humans; Infant; Injury Severity Score; Male; Middle Aged; Prognosis; Retrospective Studies; Risk Assessment

Nosocomial transmission of herpes simplex virus (HSV) has been described in intensive care units. A cluster of three patients with HSV wound infections within a 6-week period prompted temporary closure of a burn unit and suggested nosocomial cross infection. However, restriction endonuclease "fingerprint" analysis of the HSV isolates showed them to be genetically and therefore epidemiologically unrelated. This report describes these cases and the use of intravenous acyclovir in the treatment of HSV burn wound infections.

Topics: Acyclovir; Adult; Burns; Cross Infection; Herpes Simplex; Humans; Infant; Male; Risk; Seasons; Virginia; Wound Infection