Cutaneous Herpetic Infection in a Burn Unit-＂Case series＂

Background: Thermal injury renders burned patients susceptible to bacterial infection and sepsis. Pneumonia, wound infection and sepsis accounts for more than 50% of deaths due to severe thermal injury. Although rarer, viral infection should be considered as part of a differential diagnosis. Viral infections are difficult to detect early, especially after antibiotic and anti-fungal use. Viruses are difficult and time-consuming to culture. In addition, systemic symptoms and signs of viral infection are non-specific. Aim and Objectives: This study reviews viral infections in our burn intensive care unit with the aim of establishing the viral epidemiology, early detection of the pathogen, and the differential diagnosis. Materials and Methods: A retrospective chart review of patients admitted to our burn unit from November 2008 to December 2011 was done. The inclusion criterion was a skin lesion suspicious of cutaneous viral infection in a burn patient. Exclusion criteria were chronic wounds and drug eruptions. Results: Overall incidence of viral infection is 0.63% and the male: female ratio is 2:3. Most burns were flame (80%); the remainder were scalds (20%). The mean total body surface area (TBSA) burn was 13.6%, with depths ranging from deep partial thickness to 3rd degree. 70% of patients had concomitant inhalation injury and 10% had pre-existing comorbidities, such as diabetes and hypertension. Conclusion: Early detection of viral infection is difficult, requiring daily assessment of suspicious lesions. A high index of suspicion is appropriate for at-risk individuals with immunocompromise, history of viral infection, pyrexia of unknown origin, endotracheal intubation, and those with suspicious skin lesions that appear 14 days after burn injury. Most cutaneous viral infections have a good outcome when treated early with anti-viral medications.