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Incidence, Outcome, and Long-Term Consequences of Herpes Simplex Virus Type 1 Reactivation Presenting as a Facial Rash in Intubated Adult Burn Patients Treated with Acyclovir

Fidler, Philip E. MD; Mackool, Bonnie T. MD, MSPH; Schoenfeld, David A. PhD; Malloy, Maryanne RN; Schulz, John T. III, MD, PhD; Sheridan, Robert L. MD; Ryan, Colleen M. MD

Journal of Trauma and Acute Care Surgery: July 2002 - Volume 53 - Issue 1 - p 86-89
Original Articles

Background  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.

Methods  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.

Results  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.

Conclusion  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.

From the Sumner Redstone Burn Center (P.E.F., M.M., J.T.S., R.L.S., C.M.R.), Massachusetts General Hospital Biostatistics Center (D.A.S.), Surgery (P.E.F., M.M., J.T.S., R.L.S., C.M.R.) and Medicine Services (B.T.M., D.A.S.), Massachusetts General Hospital, and Shriners Burns Hospital (P.E.F., J.T.S., R.L.S., C.M.R.), Harvard Medical School, Boston, Massachusetts.

Submitted for publication July 26, 2001.

Accepted for publication December 29, 2001.

Presented at the 33rd Annual Meeting of the American Burn Association, April 18–21, 2001, Boston, Massachusetts.

Address for reprints: Colleen M. Ryan, MD, Bigelow 1302, Surgical Services, Massachusetts General Hospital, Boston, MA 02114; email:

© 2002 Lippincott Williams & Wilkins, Inc.