Human herpes viruses in pediatric burns. A common problem for pediatricians and surgeons. A retrospective study

Introduction. Impaired immune status is common in children with burns, which contributes to the reactivation of persistent herpes infections (HI). The clinical presentation of a viral infection does not always fall within the scope of the classical manifestations of an infectious disease. Therefore, pediatricians and surgeons must work closely to ensure adequate treatment and diagnostic approaches in this category of patients.

Aim. A brief review of the literature on this topic and a summary of the results of the retrospective study on the features of the course, diagnosis, and treatment of HI in children with thermal injury.

Materials and methods. We conducted a retrospective review of the medical records of children with burns treated in the specialized department of the Speransky Children’s City Clinical Hospital No. 9, from 2022 to 2024 with a hospital stay of 3 or more days. The study included 718 patients [522 (73%) males and 196 (27%) females] aged 1 to 165 months [median (Me) 16 months]. Of these, 110 (15%) were tested for HI. The indications for the test included fever (>38°C) for two or more days during antibacterial therapy for burn wounds and the absence of any signs of acute respiratory viral infection. The type of viral infection, the need for surgery, and the duration of inpatient treatment were evaluated.

Results. Sixty-seven (9.3%) of 718 patients had laboratory-confirmed HI. The median age of children with burns and confirmed HI was 16 months [interquartile range (ICR): 13–21]. Most children with confirmed HI were males (45 [67.2%]). The average burn area was 6% of the body surface (ICR 5-9). Baseline fever reached 38.7°C (ICR 38.3–39). In patients with thermal injury, the most common were herpes virus type 6 (28 [41.8%] patients) and cytomegalovirus (15 [22.4%] patients). The overall duration of hospital stay of patients was 7 days (ICR 5–9) and 8 days (ICR 6–10) in patients with a confirmed HI, suggesting an extension of the treatment duration (p<0.05). Surgery was performed in 25.9% of patients in the overall group and 31.3% of children with HI activation (p>0.05). Thus, the infection was not associated with a higher rate of surgical interventions for deep skin lesions.

Conclusion. HI in children presented with fever and was detected only during differential diagnosis with other infectious complications. Activation of the infection leads to longer treatment due to slower regeneration; however, it is not considered a risk factor for surgical intervention. The choice of a topical treatment is based on many factors. When managing wounds with a suspected viral and bacterial association, it is recommended to avoid the use of occlusive dressings. Our experience shows that dressings based on an aqueous iodine solution are preferable in such situations.