1762. Acute Cytomegalovirus Infection in Combat-Wounded Soldiers
Session: Poster Abstract Session: Viral Infections; Pathogenesis and Epidemiology
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: It is well reported that cytomegalovirus (CMV) is transmissible via blood transfusion and that latent CMV can be reactivated in critically ill and immunosuppressed patients; however the role of CMV in the context of polytrauma is poorly understood.  War trauma patients suffer severe and multiple traumatic injuries requiring massive blood transfusions of non-leukoreduced blood products in the pre-hospital setting and may be at increased risk for acute CMV infection.

Methods: Retrospective chart review of a case series of four acutely ill war trauma patients with fever and active CMV infection treated at Walter Reed National Military Medical Center (WRNMMC) from July 2011 to June 2012.

Results: Twenty-one patients were screened for active CMV via serology or polymerase chain reaction (PCR), and four demonstrated significant CMV viremia (range 26,442 to 385,011 copies/mL). All four patients also had positive CMV IgM. Serologic evaluation of predeployment blood samples of these four patients revealed negative CMV IgG. The four patients were white males between 22 and 23 years of age who suffered blast extremity trauma. The median Sequential Organ Failure Assessment (SOFA) score was 8 (an initial SOFA score of >11 predicts a mortality of >95%). A median of 41.5 units of packed red blood cells and 13 units of whole blood were transfused (total range 24 to 396 units of blood products).  At the time of testing, all patients were febrile with a median temperature of 100.7 and had a median white blood cell count of 3.8, with median lymphocytosis of 45.8%. Two patients also had a diffuse macular rash at the time of diagnosis. Significant transaminitis did not occur; three patients had AST or ALT elevated to 1-1.5 times the upper limit of normal. All patients underwent extensive diagnostic evaluations for fever to include imaging and multiple blood cultures - all were unrevealing except for CMV viremia. One patient was treated for acute CMV with intravenous ganciclovir followed by oral valganciclovir. Within 48 hours, the patient defervesced and the lymphocytosis resolved. 

Conclusion: War trauma patients may be at increased risk of active CMV infection due to massive transfusions and relative immunosuppression.  CMV should be considered in the evaluation of the febrile polytrauma patient.

Lauren Fiske, MD, Walter Reed National Military Medical Center, Bethesda, MD

Disclosures:

L. Fiske, None

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