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Possible Malaria or other undiagnosed tropical disease
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Possible Malaria or other undiagnosed tropical disease

Hello I am a 26 year old female always a very well and healthy person, very active with lots of energy. No previous medical history of concern other than scalp Psoriasis since 2 years of age.

July/August 2008 – Travelled to Thailand, stayed at Bangkok and Phuket, travelled extensively outside tourist areas within both areas. Had all required vaccinations before leaving Australia. Malaria tablets not prescribed as low risk area in tourist areas within Thailand.

October 2008 – Presented at local GP with pain under left rib cage, difficulty breathing, dizziness / feeling faint, feeling of hotness in face (most likely a temperature, however my temperature was never measured), tiredness, shaky / tingling in hands and feet, very rapid and strong heart rate, sweaty, nausea, diarrhea, lack of appetite and generally feeling very unwell. An ultrasound of the abdomen did not show any problems other than a slightly irregular shaped left kidney. The GP took a urine sample which was positive for Leukocytes. I was diagnosed with having a Kidney Infection and put on Antibiotics. The urine sample was never sent to pathology for further testing.

23 January 2009 – Presented at the local GP with very simular symptoms to October 2008, have been intermittent on and off for last few months. Diagnosed as having a recurrent Kidney infection and put on antibiotics. The urine sample was positive for Leukocytes and sent of to pathology for testing. There was no bacteria present in the urine sample. I was unable to access these results for many weeks with no phone call from the GP to explain that it was unlikely I had a Kidney infection. Other concerns relayed to the GP was a major flare up of scalp Psoriasis and an unusual acne outbreak on my chin, which was not normal, I also reported getting sore throats with what appeared to be mouth ulcers on my throat and felt like my body was under attack.

29 January 2009 – Presented at the local emergency department with the above symptoms that were not improving with the antibiotics prescribed on the 23 January, the symptoms were actually getting worse. Leukocytes found in the urine sample. Diagnosed with a Pyelonepheritis (Kidney Infection) and put on IV antibiotics and fluids and discharged 8 hours later with oral antibiotics for a week. Subsequent pathology report from urine test taken at the hospital also came back with no bacteria present in the urine. Test for pregnancy negative.

2 February 2009 - Presented at local GP with the same ongoing symptoms outlined above, along with more intense nausea and diarrhea. Mild temperature recorded. Urine sample taken with results reporting Leukocytes but no bacteria present. Blood test taken with no concerns.

18 February 2009 – presented at local GP with ongoing symptoms outlined above on and off, some days and then few days later unwell, with extreme fatigue most of the time. The GP took blood samples to test for suspected Thyroid problems. Blood test revealed elevated Serum Prolactin levels, but no Thyroid abnormalities. I was diagnosed with Hyperprolactinemia. Referred to Endocrinologist to look for possible issues with this Pituitary Gland. All other blood results were normal, including another test for pregnancy which was negative.

23 February 2009 – CT Scan of Brain to look for possible growth on Pituitary Gland. Nothing of concern found on the CT Scan.

2 March 2009 – Appointment with Endocrinologist, sent off for further blood tests and 24 urine test. Endocrinologist could feel nodules on Thyroid. Sent of for MRI of brain to look for any growth on the Pituitary Gland and Ultrasound of the Thyroid gland to confirm any nodules present.

12 March 2009 – MRI of brain and Ultra sound of Thyroid. No concerns found with either of the scans. No issues found with further blood and urine tests looking for Endocrinology Disorders.

18 March 2009 – Presented to GP with ongoing intermittent symptoms outlined above and ongoing fatigue, have not been feeling usual self for several months. Very sore throat last few days with pus on both tonsils, no improvement with scalp Psoriasis and Acne. GP now tests for Cytomegalovirus (CMV). Results come back clear.

21 March 2009 – presented to GP, very concerned about ongoing illness, disrupting normal life and busy job, this cannot go on. Ongoing symptoms as outlined above, extreme tiredness and out of breath very easily just climbing stairs. Referred to Infectious Disease Specialist to look at whether I had contracted a Tropical Disease whilst travelling in Thailand last July/August. I am very susceptible to Mosquito bites, often being bitten alive at barbeques and no one else will even get bitten. Got all the required vaccinations prior to travelling to Thailand and was advised not to take Malaria medication as we were travelling in low risk tourist areas. Despite using repellent, I got bitten many times, particularly at night whilst sleeping without Repellent. I fell very ill in Thailand with food poisoning type illness for around 2-3 days, very sick with Diarrhea and vomiting for at least 48 hours. On 21 March, the GP gave me a referral for a blood test and I was advised to have the blood drawn on a day when feeling particularly unwell with a temperature. Tested for Lyme Disease, Malaria and Dengue Fever.

24 March 2009 – First blood test taken.

27 March 2009 – Second blood test taken.

1 April 2009 – Despite many calls and messages left for the GP, finally informed by receptionist over the phone that all tests to date had come back negative.

Where do I go to from here? I have a referral to an Infectious Diseases Specialist, but he covers 5 hospitals and is very difficult to get an appointment with. I also have another blood test request form to get a third test for Malaria when I get my next fever/ bad patch in the next few days.

Any advice would be wonderful, I can't go on like this! I just want to be well and back to my usual self again!!
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4 Comments
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351246_tn?1379685732
Hi
Thanks for writing to the forum!
With a history of stomach infection to start with, you should explore the possibility of chronic or recurrent typhoid, liver involvement and pancreas involvement. Tests should be run keeping this in mind.
Malaria is often difficult to diagnose by blood test. Diagnosis is generally dependent on clinical presentation.
Another possibility is tuberculosis of the gut and kidney. The culture will not show any bacteria unless special culture is set up. Other indications are a high ESR and positive Montoux Test.
Hope this helps. Please let me know if there is any thing else and do keep me posted. Take care!
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Avatar_f_tn
Hello Dr Nee,
I have consulted with a wonderful GP at a Travel Medicine Clinic, she sent me off for a Mantoux Test which has come back positive with a measurement of 14mm after 3 days. I am off for a chest X ray tomorrow and further imaging of my kidneys. Lets hope we are now getting to the bottom of all this, it has been a whirlwind! Thank you for your advice and support, I will let you know how things end up.
Warmest Regards,
Vanessa :)
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144586_tn?1284669764
As usual Drnee is on the money with the suggestions regarding tuberculosis and malaria.

I have been peripherally involved with malaria for several years, specifically with the use of artimesia treated with supercritical carbon dioxide to extract a substance that has proved helpful in treating the disease. We had a farm set up and were testing the artimesia every year to obtain optimim yields of the substance by selective use of the new seeds under a UN grant for an African nation.  I spent a year researching tuberculosis.

In any event, malaria is not common in America, and difficult to diagnose. I was in Thailand years ago and in certain "belts" it is quite common. I am not a happy camper with the way they tell visitors about protecting themselves.

As Drnee stated mtb infections are usually connected with the lungs, but they could be anywhere.

Please post back on this forum when you find out exactly what they think you have.
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Avatar_f_tn
Hello Dr Nee,

Following further testing, I have also been diagnosed with Glandular Fever, which they think has reactivated dormant TB in my body which has subsequently gone to the Kidneys. My previous GP completely overlooked the blood test results from a few months ago which clearly indicated I had Glanduar Fever (Epstein Barr Virus). I am so happy we are nearly at the bottom of what has been a very long road to coming to a diagnosis. I will hopefully start on medication for TB soon and be on the way to better health.

Hello Care Giver 222, Thank you for your interesting information on Malaria & TB.

Warmest Regards to you both,
Vanessa :)
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