Treatment of Burn Wound Infection Using Ultraviolet Light: A Case Report

Abstract

A 9 year old girl presented to us with complaints of fever and pain in burn wounds with deteriorating health for one month. According to Lund and Broder's chart, burns spanned the posterior trunk (13%), right arm (1.5%), left arm (1.5%), and buttocks (2.5%). The wounds showed improper healing. She had previously underwent split-thickness skin grafting, using skin harvests from thighs and antimicrobial therapy with vancomycin, fluconazole and colomycin with limited clinical improvement. Analgesia was administered. Blood cultures and tissue cultures from the burns indicated polymicrobial wound infection and sepsis, including methicillin resistant Staphylococcus aureus, Klebsiella pneumoniae and Pseudomonas aeruginosa. Despite broad-spectrum antibiotics, fever persisted and condition deteriorated. Antifungals were also administered with no clinical improvement. Eventually another split-thickness skin grafting was done to provide fresh grafts. In due course, ultraviolet light exposure, of wavelength 32-40 nm/W/cm 2 , was considered for treatment. In prone position, the wounds were exposed to ultraviolet phototherapy 6-8 h daily for 8 days. Eventually, wound healing and sepsis improved. Antibiotics were optimized and high protein diet was started. Eventually the wounds showed fresh margins and visible signs of healing. With remarkable clinical improvement and no further fever spikes, the patient was eventually discharged. She was advised to shower regularly, apply bandages with acetic acid. On her last outpatient follow up, 2 weeks after discharge, she was doing well, with no complaints of pain or fever. Examination of burns showed clean wounds, with clear margins and good graft uptake. She did not require any further grafting or surgical procedures thereafter.

Guidelines for burn rehabilitation in China

“…Burn patients could possibly benefit from all those factors in inflammation reduction, wound healing [ 67 ], edema control, scar maturation and improvement of muscle and soft tissue conditions. The most commonly used are paraffin therapy, hydrotherapy [ 68 ], low-frequency electrotherapy [ 69 , 70 ], medium-frequency electrotherapy, microwave therapy, shortwave therapy, air compression therapy [ 71 ], laser [ 72 , 73 ], ultraviolet therapy [ 74 ], ultrasound [ 75 ], and cold therapy [ 76 ], which can be used alone or in combination according to the specific needs and conditions of the patients.…”

Effect of Low-Level Laser Therapy and Ultraviolet-C Irradiation on Partial-Thickness Burn Wound Healing: A Randomized Controlled Trial

“…Vasodilatation, effective killing of pathogens, and accelerated wound closure have been highlighted [7,18,37]. In vitro studies support using UVC for wound care.…”

“…During the past few years, numerous potential therapies and approaches have been tested in wound care. Light-based therapy is a set of developing modalities in wound care, while low-level laser therapy (LLLT) and ultraviolet-C (UVC) irradiation, both have demonstrated good results and have attracted the attention of the scientific community [5,6,7]. LLLT has evolved as a rapidly growing, noninvasive physical approach to modulate various biological processes.…”

Nanomedicine and advanced technologies for burns: Preventing infection and facilitating wound healing

“…by damaging their DNA) particularly upon prolonged or repeated exposure, several investigations have been conducted that showed that microorganisms are overall much more susceptible to UV inactivation than mammalian cells. Therefore, it has been suggested that UV light could be used as a viable approach for infection therapy [129, 130]. UV irradiation damages microbial nucleic acids, and induces repression of the microorganism replication [131].…”