Herpesvirus infections in burn patients.

erpetic burn wound infection was initially described by Scott and colleagues1 over four decades ago. A 2-year-old girl burned her finger on a cigarette and the area was kissed by her mother, who had a history of orolabial herpes. Although the burn appeared to heal, it became blistered 2 days after the injury, and vesicular lesions developed along the hand and arm, from which herpes simplex virus (HSV) was isolated. This case probably represented a primary herpetic whitlow developing in a thermally injured area, and indeed herpetic lesions occurred several times thereafter at the original site of the burn. Several decades later, the problem of herpesvirus infections in burn victims was noted again, this time by health-care workers at the Brooke Army Medical Center. In a retrospective study, Nash and Foley2 found an approximate 10 percent incidence of necrotizing herpetic lesions involving the larynx or tracheobronchial tree in 97 autopsies of burn patients whose conditions had been undiagnosed antemortem. Lesions were usually focal and associated with superimposed bacterial or fungal infection. Foley et a13 described seven cases of HSV burn wound infection in patients with extensive burns (44 percent to 59 percent body surface area [BSA]), three of whom died during the third week after injury, with visceral HSV involvement manifested principally by necrotizing adrenal and hepatic lesions. The affected burns showed erosive lesions of healing wounds, often complicated by secondary bacterial infection and conversion to full-thickness loss. Nash et a14 also described a case of primary disseminated cytomegalovirus (CMV) infection in a heavily transfused, severely burned 24-year-old man (70 percent BSA) who died 3 months postburn with multiple invasive fungal infections, acute duodenal ulceration and hemorrhage, and histologic evidence of CMV infection involving multiple organs, especially liver and lung. Subsequently, Seeman and Konigova5 found significant rises in CMV antibody titers in 20 percent of severely burned seropositive patients and also reported several fatal cases of disseminated CMV infection in burn patients.6 Such experiences have served to highlight the potential clinical importance of herpesvirus infections in burn patients. Reviewed herein is published information on the frequency, pathogenesis, clinical spectrum, and responses to antiviral therapy for herpesvirus infections in such patients.