Failure of Local Immunity

Deitch, Edwin A.

doi:10.1001/archsurg.1985.01390250070011

Cited by 28 publications

(4 citation statements)

References 11 publications

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“…However, burn-injured skin may not effectively support hBD4 expression and may require aseptic surgical debridement for normal skin regeneration or replacement surgery [ 30 ]. Also, in severe cases of burn injury, the dermal skin layer can be affected, and destructions in nerves and blood vessels may result in subsequent bacterial colonization in the burn wounds [ 31 ]. Hence, we used an intermediate host, the MDBK cells, to express hBD4 in burn-injured skin layers.…”

Section: Discussionmentioning

confidence: 99%

Inhibition of Pseudomonas aeruginosa with a recombinant RNA-based viral vector expressing human β-defensin 4

et al. 2014

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BackgroundHarassed with extensive epithelial burn wounds, patients can be affected by complications, such as infection, hypovolemic shock, hypothermia, and respiratory failure. Immediate first aid and followed supportive cares are critical for the prevention of severe complications. However, secondary bacterial infection is hard to be controlled in burn patients, and Pseudomonas aeruginosa (P. aeruginosa) is one of the top listed pathogens perturbing burn wounds beyond the antibiotics spectrum.ResultsTo find the way for efficacious protection from the pseudomonas-mediated complications in burn patients, we assessed the in vitro and in vivo inhibitory values of human β-defensin 4 (hBD4), which is known as a member of the cationic, antimicrobial peptides found in human cells of many kinds. The Newcastle disease virus (NDV) was used as a viral vector for the expression of hBD4 in burn wounds. Expressed from the recombinant NDV (rNDV-hBD4), hBD4 effectively inhibited the pseudomonal growths in cell culture media. In a mouse model, severely burn-injured skin was recovered by the direct installation of the rNDV-hBD4 infected cells in the burn wounds whereas that of control mice remained severely damaged.ConclusionsWe suggest that the application of hBD4 may protect burn patients from secondary pseudomonal infection and provide a therapeutic potential for burn wound treatment.

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Section: Discussionmentioning

confidence: 99%

Inhibition of Pseudomonas aeruginosa with a recombinant RNA-based viral vector expressing human β-defensin 4

et al. 2014

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“…[ 10 , 11 ] Finally, blister fluid may impede fibrinolysis and inhibit opsonic activity against Pseudomonas aeruginosa , leading to progressive dermal necrosis. [ 12 , 13 ] Thus, questions about aspiration or deroofing have been discussed for many years as a treatment for burn blisters in different views by the medical literature and medical experts. The choice of treatment is usually based on the clinical impression, preferences, and expertise of the medical team involved in the care and management of the burn patient.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of aspiration or deroofing for blister management in patients with burns

Shin

Sabbagh

et al. 2018

Medicine

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Background:Health care providers commonly encounter blisters when treating burn patients. The question as to whether burn blisters should be drained or deroofed has long been debated. To our knowledge, there has been no controlled, randomized clinical trial to determine which treatment is the best management option.Methods:Between March 2016, and September 2016; 40 patients with burn blisters greater than 6-mm were enrolled in our study. Patients were randomized into 2 groups: aspiration group and deroofing group. The number of days to complete re-epithelialization was noted. Patient and Observer Scar Assessment Scale data were recorded from subjects and investigators at 4 time points. Pain during dressing changes was evaluated using a visual pain scale. Bacterial cultures were also obtained.Results:Average number of days to complete wound healing was 12 days in the aspiration group and 12.55 days in deroofing group. On the Patient and Observer Scar Assessment Scale, investigators found that the aspiration group scars demonstrated improvements in relief and thickness while subjects rated aspiration scars better in terms of pain. Patients with palm/sole blister in the deroofing group scored higher than aspiration group on the visual analogue pain score but it was also not statistically significant (2.66 vs 3.25). The overall incidence of colonization with microorganisms in each group was not significant (15% vs 40%).Conclusion:Neither aspiration nor deroofing is a superior treatment of burn blister. However, some objective indicators suggest that aspiration treatment might be more effective than deroofing treatment.

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“…Luminol-enhanced CL assay is a very sensitive and reliable tool for determining the opsonic activity of serum (2,(9)(10)(11)16 both serum and blister fluid could be corrected in vitro by adding normal serum to the burn patient's serum (4,6). It was reported that treatment with FFP as adjunctive therapy for massive burns was more effective for maintaining the serum opsonins than that of plasma protein derivative (this product is essentially devoid of IgG and functional complement) (1).…”

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confidence: 99%

“…Opsonic activity of blister fluid from severely burned patients on the third to fourth postburn day and the levels of opsonins such as IgG, IgA, IgM, C3 and C4 were lower in the blister fluid than in the patient's own serum or healthy donor's serum. Deitch et al found that blister fluid was not effective in promoting either phagocytosis or intracellular killing of Pseudomonas aeruginosa (6). The decrease in opsonins and opsonic activity in the patient's blister fluid appear to be responsible for the failure of local immunity against invading bacteria.…”

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confidence: 99%

Opsonic Activity of Sera and Blister Fluid from Severely Burned Patients Evaluated by a Chemiluminescence Method

Ono

Kunii

Suzuki

et al. 1994

Microbiology and Immunology

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Burn wound sepsis is the most common and severe complication in the patients with severe burn. To know the systemic and local defect in immunity of burned patients, we measured the luminol-enhanced chemiluminescence (CL) response of normal polymorphonuclear leukocytes (PMNs) upon exposure to zymosan particles, bacteria or Candida albicans that were opsonized with any of patient's serum, blister fluid of burn wound or pooled normal serum (blood type AB). Sera from patients exhibited lower opsonic activities than those of pooled normal serum in the early postburn days. The levels of serum immunoglobulins, complement components and plasma fibronectin were found to correlate well with opsonin-index (OI), which was determined based on the CL response data obtained during the course of infusion therapy with fresh frozen plasma. Furthermore, patient's blister fluid showed much lower opsonic activity against bacteria such as Pseudomonas aeruginosa than patient's own serum. These results indicate that blister fluid is also not effective to opsonize bacteria because of the marked depression of the levels of immunoglobulins and complement components. Destruction of the skin barrier by thermal injury and impairment of systemic or local humoral immunity may predispose these patients to burn wound sepsis.

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Failure of Local Immunity

Cited by 28 publications

References 11 publications

Inhibition of Pseudomonas aeruginosa with a recombinant RNA-based viral vector expressing human β-defensin 4

Inhibition of Pseudomonas aeruginosa with a recombinant RNA-based viral vector expressing human β-defensin 4

Effectiveness of aspiration or deroofing for blister management in patients with burns

Opsonic Activity of Sera and Blister Fluid from Severely Burned Patients Evaluated by a Chemiluminescence Method

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