Cytomegalovirus infection in burns: a review

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Abstract
Sepsis is responsible for significant morbidity and mortality in patients suffering from severe burn injuries. Burn patients are known to be immunocompromised, and it is generally accepted that the immunosuppressed patient may experience human cytomegalovirus (HCMV) infection and disease. Review of the very limited available literature identifies a seroconversion rate of between 18 and 22 % for burn patients who were seronegative for HCMV prior to suffering their burn injury. Furthermore, approximately 50 % of HCMV antibody-positive patients may reactivate. Blood products and allografted skin have clinically been identified as possible sources of HCMV transmission in burn patients. Experience in the treatment of infection or disease in burn patients is very scarce and limited to immunoglobulin therapy. Animal experiments have demonstrated that murine cytomegalovirus (MCMV)-seropositive skin grafts are able to infect immunodeficient mice as well as burned mice. Murine studies have also demonstrated that infection with MCMV enhances susceptibility to secondary bacterial infection and increases mortality in these animals. Burned mice challenged with MCMV have a significantly higher level of bacterial translocation to mesenteric lymph nodes than either control thermally injured mice without MCMV inoculation or non-burned mice injected with MCMV alone. In summary, it remains controversial whether HCMV infection per se alters outcome for the majority of burn patients. Subgroups of severely burned, seronegative patients may benefit from blood products and skin from seronegative donors. Antiviral strategies are not yet evaluated for the burn patient. Further investigations utilizing modern diagnostic techniques seem necessary.