Disseminated zoster in an adult patient with extensive burns: a case report.

BACKGROUND: Shingles (localized zoster) and disseminated zoster are caused by the reactivation of latent varicella zoster virus (VZV). Reactivation of VZV is related to impaired cell-mediated immunity. Extensive burns affecting a patient result in burn-related immunosuppression and cytokine storm. Despite immunosuppression in burn patients, the reactivation of VZV is extremely rare, whereas eczema herpeticum, caused by reactivation of latent herpes simplex virus (HSV), is common. We have found only 1 published case of VZV reactivation during burn treatment in the literature. CASE PRESENTATION: A 51-year-old man was burned in a fire, which affected 60% of his total body surface area (TBSA), and also received inhalation injury (day 0). Despite fluid resuscitation, he showed persistent renal failure. Continuous hemodialysis and filtration (CHDF) combined with polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) therapy was used for cytokine modulation. Autologous and allogeneic skin grafting was performed. On day 15, multiple-drug-resistant Pseudomonas aeruginosa (MDRP) was detected from a blood specimen, and the patient developed multiple organ failure (MOF). On day 31, compact aggregations of small vesicles appeared on the intact skin of his left knee and left buttock. The vesicles were located within the 4th lumbar (L4) spinal dermatome. From day 32 to day 34, similar new vesicles arose on his intact skin and epithelializing skin-graft donor sites. We diagnosed disseminated zoster, based on the patient's age, the characteristic occurrence of the initial vesicles within a limited area of intact skin in the left L4 dermatome, and a positive Tzank smear. Serologic testing on day 36 showed a high level of anti-VZV immunoglobulin (Ig)G with low levels of anti-VZV IgM, anti-HSV IgG, and anti-HSV IgM. The patient was isolated in a negative-pressure room to avoid air-borne spread of VZV. On day 52, the patient died. CONCLUSIONS: To the best of our knowledge, our patient is the second case of reactivation of VZV during burn treatment. It is unclear why reactivation of VZV is rare in patients with burn-related immunosuppression, whereas HSV reactivation is common. Cytokine modulation throughout the treatment period using CHDF combined with PMX-DHP might have been related to the rare reactivation of VZV in our patient. Our case provides an additional information on the relationship between the immune status of a patient with extensive burns and reactivation of latent VZV or HSV.

Awareness of risk of cross-infection and infection-control measures among patients attending University Dental Hospital, Peradeniya, Sri Lanka.

AIM: The aim of the present study was to assess awareness of the risk of cross-infection and infection-control measures practiced in dental clinics for patients attending the outpatient dental department (OPD) at University Dental Hospital, Peradeniya, Sri Lanka. METHODS: A descriptive cross-sectional study was carried out among 427 patients who attended the OPD clinics at University Dental Hospital. An interviewer-administered questionnaire was used to collect data, and chi-squared-test of association was applied where appropriate. RESULTS: Most patients (75.2%) were aware that there was a chance of infection transmission during dental treatments, and nearly 72% stated that wearing gloves and masks by their dentists was important during dental treatment. Awareness was higher among patients with a higher educational level. Participants revealed their fear of potential transmission of blood-borne pathogens in the dental setting. Awareness of sterilization of dental instruments was poor. CONCLUSIONS: The public should be made aware of the possible risks of cross-infection and the importance of infection-control practices in dental clinics. Dental professionals should fill the information gap.