When should I consider referring a patient with suspected CMV infection to a specialist?

Consider referring a patient with suspected cytomegalovirus (CMV) infection to a specialist if:

• They are immunocompromised or have untreated HIV infection, as CMV can cause severe disease in these populations requiring specialist management.
• There is diagnostic uncertainty or atypical presentation that cannot be managed in primary care.
• There is an inadequate or no response to initial treatment in primary care, suggesting possible complications or resistance.
• The patient is pregnant, as CMV infection during pregnancy may require specialist assessment and management to reduce risks to the fetus.
• There are signs of systemic illness or severe complications that cannot be managed safely in primary care, necessitating emergency hospital admission or specialist input.

In general, patients with suspected CMV infection who have complex clinical features, are at high risk of complications, or require advanced diagnostic or therapeutic interventions should be referred to an infectious diseases specialist, a specialist in immunocompromised patient care, or a relevant specialist such as a hepatologist or obstetrician depending on the clinical context.