Oral Presentation Australian Society for Microbiology Annual Scientific Meeting 2014

Was it the Wombat? (#134)

Fleur Francis 1 , Umbreen Hafeez 2 , Syeda Zinat 2 , Robert Norton 1 2
  1. Pathology Queensland - Townsville Hospital, DOUGLAS, QLD, Australia
  2. Townsville Hospital, Townsville, QLD, Australia

We present an unusual case of a 44 year old male who presented with fever, headache, myalgia and drenching night sweats for one week. He described being bitten by wombat few weeks prior. There was no past history of immunosuppression. A physical examination was unremarkable. He was noted to have a hepatitic illness with an ALP of 248, GGT of 92, ALT of 593 and an AST of 545. He was not jaundiced. He remained febrile and clinically unwell. Blood cultures, Q fever, Leptospirosis, Hepatitis A, B and C serologies were negative. EBV IgG and CMV IgG were positive with CMV IgM also positive and EBV IgM negative. CMV avidity was low at 0.12 and CMV DNA was detected in blood by PCR, with a CMV viral load of 8.9X104 copies/ml. There were no other features of CMV disease such as retinitis, colitis or pneumonitis. Given the lack of immunosuppression a conservative approach was taken. The patient recovered fully. CMV infections in immunocompromised patients cause substantial morbidity and mortality, especially among transplant recipients and those infected with HIV. In the immunocompetent host infection is generally asymptomatic or may present as a mononucleosis syndrome. Occasionally primary CMV infection can lead to severe organ specific complications with significant morbidity and mortality. This case highlights the utility of avidity testing to distinguish recent disease from previous infection.