Sick after trip abroad

[taltraveler]

Hello,

I spent July and August of 2010 traveling through Europe and the Middle East (U.K., Ireland, Serbia, Macedonia, Greece, Israel, Spain, France, Switzerland). I came down with two flu-like illnesses with fever during the trip. Immediately upon my return, I began having severe headaches and facial pain, neck stiffness, muscle twitching, sporadic loose stools (not severe diarrhea), and a chronic cough. I figured it was viral and would resolve. Five months later, I am still having severe headaches and neck pain, muscle twitching, sharp muscle pain (aching along with shooting pains in face, down legs), coughing, and (rare) low-grade fevers. My CBC was normal along with tests for CMV and hepatitis. I also had a clear chest x-ray. I'm wondering what travel-related infections or parasitic diseases might cause these symptoms as the illness is not resolving on its own and the pain is rather severe. I traveled only to large cities, but spent considerable time outdoors. I ate uncooked beef once in Paris and various cheeses in Serbia, but otherwise nothing out of the ordinary.
Your insight is much appreciated.

Thank you.

[Philip D Parks, MD, MPH, MOccH, FACOEM]

Hello again,

There is no discrete infectious disease that I can attribute your symptoms to based on your postings. It would be in your best interest to ask the infectious disease providers what they tested for (in your blood, urine, and stool) and make sure that there is not any other obscure or common "bug" that could be investigated.

The list of infectious diseases with neurologic symptoms or sequelae is long and includes tropical diseases and non-tropical diseases (e.g. Herpes).

Even though you have temporally correlated your symptoms as beginning during and continuing after your travels, it is important to also rule out metabolic causes of your symptoms. Your visits with the two neurologists should have addressed primary neurologic etiologies that would explain your symptoms. Other organ systems that should be examined include the endocrine system (thyroid gland, hypothalmic-pituitary axis).

I encourage you to be mindful of when your symptoms occur and what seems to be driving increases or decreases in your symptomatology.

Please feel obliged to keep this means of correspondence open.

~ Dr. Parks

This answer is not intended as and does not substitute for medical or legal advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

[taltraveler]

Hello Dr. Parks,

Thank you for your reply. I am a 23 year old female. I worked as a research assistant before my trip and prior to that was a student. My fevers are usually around 99.3 (not especially high). I had night sweats every night for 2 months following the trip, but they have lessened substantially in the past month or so. All other symptoms are present daily (though they seem to wax and wane/migrate over the course of the day or week). None of the routine tests have been abnormal. My travel partner did not contract either of the two flu-like illnesses I acquired while traveling and has had no health problems since our return. The two infectious disease doctors I saw (who ruled out TB, Hepatitis, CMV, and intestinal parasites) recommended that I see a neurologist. Two neurologists suggested that my symptoms sounded like some sort of chronic infection and not a neurological syndrome at all. Prior to my trip, I was very healthy/active. I have no history of any significant health problems, surgeries, or medication use.

Thank you again for your time.

[Philip D Parks, MD, MPH, MOccH, FACOEM]

Hello,

A couple questions about you before I provide an answer...

1. How old are you?
2. Male or female?
3. Do you have any health problems or take any medications?
4. What is your occupation? What types of work have you done in the past?
5. What is your measured temperature with your "rare low grade fevers"? and/or are you having night sweats?
6. How often do you symptoms occur? Daily, weekly, etc?
7. Have any of the medical tests been abnormal?
8. Did you have a travel partner? and, if so, did they experience any problems during your travels or after your return?

Based on your responses, I'll reply with additional comments and thoughts.

~ Dr. Parks

This answer is not intended as and does not substitute for medical or legal advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.