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

燒燙傷中心之病毒性傷口感染－經驗分享

吳兆明(Chao-Ming Wu) ； 莊秀樹(Shiow-Shuh Chuang) ； 蕭彥彰(Yen-Chang Hsiao) ； 張淑茵(Shu-Ying Chang) ； 楊瑞永(Jui-Yung Yang)

《臺灣整形外科醫學會雜誌》 23卷3期 (2014/09) Pp. 232-239

摘要

背景：燒燙傷病人容易因高溫傷害受到細菌感染，甚至產生敗血症，像是肺炎及傷口感染，都會導致超過一半的嚴重燒燙傷病人死亡。細菌及黴菌的感染經常引起嚴重的併發症，但是病毒感染卻很少被拿來研究討論，此外，大部分的病毒感染通常是一些尋常的症狀，但是要獲得培養結果卻是非常困難，且需要花費較長的培養時間，以致很難去針對病毒感染作治療。目的及目標：本篇文章之目的是回顧本院燒燙傷中心的病毒感染病例，讓我們了解到病毒感染的流行病學資料，使得我們可以做出早期預防及鑑別診斷，特別是針對Herpes 病毒家族的感染會產生終生性的潛伏，容易在免疫性統變差之際造成再度感染進而引起嚴重後果。材料及方法：這篇研究是篇回溯性的研究，收集從2008年11月至2011年12月在本院燒燙傷中心的所有病人中，所有懷疑皮膚性病毒感染的病例，排除的病例包括慢性傷口及藥物引起的紅疹，統計在病歷上所有的資料來做分析研究。結果：全部的發生率約0.63%（10/1582），男性與女性比約2:3，多數的受傷機制為燒傷（80%），其次則為燙傷（20%），傷口幾乎都有達到三度以上的深度，而平均的燒燙傷體表面積為13.6%，這些有病毒感染的病患當中，有70%合併有吸入性灼傷而10%的病患則有其他的慢性疾病（糖尿病及高血壓）。結論：早期發現病毒感染確實相當困難，因此每天檢視傷口變化是必需的，當然我們也了解到當合併有臟器的病毒感染時會有很高的致死率，因此我們必須更小心防範高危險群（免疫抑制及有病毒感染病史）的病患，另外像是不明原因發燒，插管的病患，以及在受傷後兩週左右出現疑似皮膚病灶的患者，我們也都必須注意是否可能有病毒感染，但在高度懷疑之下使用抗病毒藥物後，多數的病毒性傷口感染有不錯的後果。

並列摘要

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.

並列關鍵字

burn ； virus ； viral infection ； critical care