Discussions By Condition: I cannot get a diagnosis.

Fatigue and Chills from last 6 months. Reports Inconclusive

Posted In: I cannot get a diagnosis. 33 Replies
  • Posted By: Anonymous
  • June 5, 2008
  • 00:48 PM

32 year male residing in India.
In the month of July ‘07; had high fever of about 103 degrees with severe body chills, which reduced on medication, but was continuous in nature.
In the month of August ‘07; fever & body chills continued, with severe feeling of tiredness and fatigue, was unable to get up from bed on most days, especially in the morning period after waking up. Towards afternoon, used to feel better, especially after a hot shower.
This continued for a while; at some point was diagnosed with mild Typhoid (1:80) and was advised rest for a week.
Though fever and body chills subsided; fatigue, drowsiness persisted and was unable to concentrate for long hours.
As this continued, got admitted in hospital December ‘07; wherein was diagnosed with relapse of typhoid and leptospirosis and given treatment accordingly.
But till date (June ’08); have not been feeling fine; fatigue and tiredness continues.
General Complaints:

Fatigue or tiredness, all day, in morning, especially
Feeling feverish (body temperature shows normal)
Body Chills
Bowel motions alternating constipation/diarrhoea
Drowsiness
Stomach feels queasy and heavy. Slight burning on occasions in chest area
General body pain (especially shoulders, shin / calves and feet)
Weight loss, up to 6 kgs in last 6 monthsOther Info:

Hunger is there, eat about 4-5 small meals in a day
Feel thirsty, drink about 1-2 litres of water
Stools, been erratic, some occasions have to go 2-3 times in a day, especially on days when I feel the tiredness and some days normal and fine
Urination normal
Sleep normal; about 8-9 hours on a daily basis, but on most mornings, wake up still feeling tired and drained out.

Summary of Results

10th May, '08

Mantoux showed positive : 27 x 22mm
Anti TB IGM : 0.93 units
Anti TB IGG : 225 units
Anti TB IGA : 158 units
Heamoglobin: 12.5 gm/dl
WBC: 8400 cells/cm
ESR (1/2 hr) : 3 mm
ESR (1 hr) : 7mm

3rd June, '08

WBC Count : 4,640 /c.mm
Heamoglobin : 14.5 gm

ANA (Serum/IF Method) : 1:100 Positive
ANTI DS DNA (Serum/IF Method) : Negative
ANTI CCP (Serum/Elisa) : 0.3
Free T4 (Serum/Chemiluminescence) : 1.14 ng/dl
T S H (Serum/Chemiluminescence) : 3.41 ulU/ml
Random Blood Sugar - 78 mg/dl
LDH (Serum / Pyruvate to Lactase SCE) - 296 U/L
Real Time PCR - Mycobacterium TB - Negative
RH Factor - Less than 9.5 IU/ml
ASO (Serum/Nephelometry) - 57.0
CRT - Less than 3.1
Liver Function Test - Normal
Urine & Urine Culture - Normal
Stool & Stool Culture - Normal

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33 Replies:

  • Height : 167 cms & Weight : 54 kgs XRAY PA View - Normal CAT Scan Abdomen - Normal Pl help!!
    Anonymous 42789 Replies Flag this Response
  • Hi, I am so sorry you are not feeling well! My cousin traved to Asia and got something like typhoid (can't remeber exactly so forgive me for that!)...and it took quite a while, years, to fully recover. I know that is not encouraging, so if this is the case, the best you can do is to take very good care of yourself, not to let yourself get run down so that you will not have a relapse. Ok, now for suggestions if it is NOT typhoid taking its time: 1. chronic fatigue 2. thryoid...your TSH looks a little high The American Association of Clinical Endocrinologist recommends a range of 0.3-3.0....and you a bit outside...just a bit...BUT even though, you STILL can have a thryoid problem as it may be autoimmune in nature and you need special testing to find out. This number may be a red flag to check a bit more thoroughly and get also tested for the autoimmune disease of the thryoid one is called Graves and the other Hashimotos. It sounds a bit like Hashimotos as it can give those symptoms you mentioned...or thryoiditis perhaps, which is temporary, but can take a while to get over....DO research thryoid problems. Thyroid problems are also common in India, so you should be able to find a good doctor. 3. Diabetes.....this has recently almost become epidemic in India as Indians become more prosperous and diet changes....there are a lot of wonderful, wonderful, delicious Indian sweets andyou probably have many Indian friends....have you been eating a lot of sweets? Even if you have not, good to check for diabetes. 4. You may also want to look up on other autoimmune diseases...adrenal fatigue (though not autoimmune) also comes to mind.....there are a lot of autoimmune disease and you may find your symptoms there. This is a good site (though for women but I think general infomation for you too! about autoimmune disease at http://www.4woman.gov/faq/autoimmune.htm I am not an expert, but I do have autoimmune thryoid disease, Graves, so I am a bit familiar with thryoid troubles and symptoms. I am not sure, perhaps someone else will jump in, but ANA result may indicated autoimmune disease (?). Hope this helps. Joan
    Joan5555 316 Replies Flag this Response
  • Thanks Joan for the reply; was wondering why everyone else getting a reply expect me! :) 1. Typhoid was 1:80 (which according to docs is not Positive) 2. Chronic Fatigue (any tests to find that?) 3. Thyroid - thanks for the info; will read that up. 4. Auto immune - My ANA test was positive 1:100; but Anti Ds DNA & ANTI CCP negative. Any other suggested tests? 5. India is a wonderful country and people do love sweets; but i am not a great sweet eater, my Random Blood Sugar - is normal 6. I have read about auto-immune in various forums, and thought i was suffering from Lupus - but doctors have rejected that angle. I am at my wits end; as i am possibly in the best professional phase and even personally looking to get married soon; but this chronic fatigue is not letting me move forward!! :confused: Sorry to hear about your health and i hope you recover very soon! Thanks for reply; atleast i know someone is there. :) ;)
    Anonymous 42789 Replies Flag this Response
  • Congratulations on your upcoming marriage! I am sorry you are not feeling well, though! Probably folks did not reply because they just didn't know...I am not sure but I gave it my bet shot! Do not give up on autoimmune tests especially the ones I suggested. Chronic fatigue does sometimes seem to follow and illness and especially Epstein Barr virus...you might try to be tested for that...I am not an expert on chronic fatigue, but if you start a new thread with that in the title there is someone on this board, I think, who seems to know more about it than I do. Don't give up, pursue testing, even if the doctors say no to this blood test and that, you take control and insist...since you have been feeling ill for so long, it is time they started looking for even the "rarer" causes..though autoimmune disease are not all that uncommon...if I can help more, let me know. just curious, where in India are you? Joan
    Joan5555 316 Replies Flag this Response
  • I live in Southern India - city called Chennai (formerly Madras). Marriage is a thought; dependent on recuperation of health. :) Auto-immune - did you suggest some tests? Fatigue is so common to a variety of problems; getting to that diagnosis seems uthopian! I have been driving folks, docs crazy by reading quite a bit (via internet); questioning and maintaining a log for few weeks in the hope that i can get a clue to this mystery. ;)
    Anonymous 42789 Replies Flag this Response
  • I am not sure what particular blood work to suggest for autoimmune diseases. Check out that web site that I mentioned at #4 in my previous post...but probably the best is to look at symptoms and see if you may fit somewhere and then ask your doctor... I understand the problem with the fatigue. Since you also have digestive issues going on as well there (stools etc) that is why I though of autoimmune Hashimotos and it can flare and subside and do different things to your body. You definitely, I think need a bit more blood work, so just keep bugging the doctors until you get more specific testing and all you can do is just start ruling out things one by one. Since you are in India, I am wondering how your diet may have changed? I am wondering if you may be having some reaction to having eating spices or such over the long term. Ok, here I will explain my thinking: I am in Japan and once I moved here I started eating differently.....now perhaps I would have gotten Graves Disease anyway, but a diet, as in Japan, that is high in seafood, and thus high in iodine and a problem for those with sensitive thryoids, well, it is possible it pushed me over the edge and right into full blown Graves Disease. I now avoid overeating anything that may be high in iodine. I notice when I eat it I have a reaction. I have heard of Chennai....have some Indian Students here from there a while back....cashews nuts ...I sometimes get sweets from students...love them! Joan Oh, if not autoimmune: fatigue on waking .....adrenal, cortisol problems...look this up too. Sleeping stage problems as well....
    Joan5555 316 Replies Flag this Response
  • Also have mouth sores (inside of cheeks) one a time; not painful, no bleeding, but are present.
    Anonymous 42789 Replies Flag this Response
  • out posts crossed! :) I added some stuff...
    Joan5555 316 Replies Flag this Response
  • I am vegan and have always avoided spicy & greasy food. Though in my line of work travel about 15-20 days in a month, to remote towns / cities, cannot say have eaten or had water in the most hygenic places. Maintaining the log to see if i can figure whether a particular item / dish is causing flareups, as of now - not been able to identify. If you ever come to India or me to Japan, sweets (if you are allowed are on me) ;) Perhaps, not the right question - are there any other forums like these wherein i can submit my queries - in the hope of getting an answer. :o
    Anonymous 42789 Replies Flag this Response
  • Try Mary Shomon's site at About.com .... if you look there you can get a lot of good info. on thryoid conditions and there is a good forum....but it is commercial so that is a bit anoying with pop ups....but the forum is really good http://forums.about.com/n/pfx/forum.aspx?webtag=ab-thyroid well, that is all for me tonight....would be great to have sweets! will check back again tomorrow :) Joan
    Joan5555 316 Replies Flag this Response
  • gn..take care
    Anonymous 42789 Replies Flag this Response
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  • well i have Pmed you with some queries on another forum that you had posted.that should be know before coming to any diagnosis.You have not mentioned what antibiotics you had taken for typhoid,Now a days we see Ciprofloxacin resistant strains of Typhoid,So if ciprofloxacin was used, it could still be Typhoid which is ciprofloxacin resistant.Another reason might be mis-diagnosis sometimes Typhus is mistakenly treated and taken as Thyphoid due to their similar clinical presentation. But Typhus doesn’t respond to these line of antibiotics which Typhoid responds.Another thing you have not mentioned is about viral markers. I would suggest to go for viral serology if there are any – like retrovirals.I guess you understand what i mean.Since you have weight loss.you should consider about Bone Marrow Aspiration? Its important to know the platelet count,is it normal low.
    010081 5 Replies Flag this Response
  • Frankly; i am not even sure if i had Typhoid in the first place, as my lab report showed 1:80; which is widely considered as not positive. Blood culture in Dec showed i had leptospirosis & had grown salumella typhi; was given the following by doc: T.Doxy 100 mg 1-0-1T.Zanocin 200 mg 1-0-1T.Pan 40 mg 1-0-1T.Dolo 650 mg SOS Regarding TB, blood reports are equivocal and the Xray normal. I am terribly confused, hope can find a solution soon.
    Anonymous 42789 Replies Flag this Response
  • Thyroid Ultrasound is normal!! Wish whatever i am suffering from is diagnosable......
    Anonymous 42789 Replies Flag this Response
  • Report Update: Testosterone : 653 ng/dlSHBG : 32.3 nmo/LCortisol (Morning Sample) : 11/6/ug/dlACTH : 26.65 pg/ml Blood Urea Nitrogen : 8.2 mg/dlCreatinine : 0.7 mg/dl Electrolytes Sodium : 143 mmol/LPotassium : 4.90 mmol/LChloride : 106 mmol/LBicarbonate : 25 mmoll/L Let me know if any of this helps; apart from the other info submitted at start of forum
    Anonymous 42789 Replies Flag this Response
  • Any gastrointestinal upsets, loose stools, stomach upset, sore throat, lymph glands tender? Any stool tests for ova or parasites?
    LINENUP 122 Replies Flag this Response
  • Linen Up: No stomach upsets or loose stools, but more pellet like and tend to float. Stool tests & culture: normal It is the fatigue which is extremely tiring
    Anonymous 42789 Replies Flag this Response
  • 32 year male residing in India.In the month of July ‘07; had high fever of about 103 degrees with severe body chills, which reduced on medication, but was continuous in nature.In the month of August ‘07; fever & body chills continued, with severe feeling of tiredness and fatigue, was unable to get up from bed on most days, especially in the morning period after waking up. Towards afternoon, used to feel better, especially after a hot shower.This continued for a while; at some point was diagnosed with mild Typhoid (1:80) and was advised rest for a week.Though fever and body chills subsided; fatigue, drowsiness persisted and was unable to concentrate for long hours.As this continued, got admitted in hospital December ‘07; wherein was diagnosed with relapse of typhoid and leptospirosis and given treatment accordingly.But till date (June ’08); have not been feeling fine; fatigue and tiredness continues. General Complaints:Fatigue or tiredness, all day, in morning, especially Feeling feverish (body temperature shows normal)Body ChillsBowel motions alternating constipation/diarrhoea DrowsinessStomach feels queasy and heavy. Slight burning on occasions in chest areaGeneral body pain (especially shoulders, shin / calves and feet)Weight loss, up to 6 kgs in last 6 monthsOther Info: Hunger is there, eat about 4-5 small meals in a dayFeel thirsty, drink about 1-2 litres of waterStools, been erratic, some occasions have to go 2-3 times in a day, especially on days when I feel the tiredness and some days normal and fineUrination normalSleep normal; about 8-9 hours on a daily basis, but on most mornings, wake up still feeling tired and drained out. Summary of Results 10th May, '08 Mantoux showed positive : 27 x 22mmAnti TB IGM : 0.93 unitsAnti TB IGG : 225 unitsAnti TB IGA : 158 unitsHeamoglobin: 12.5 gm/dlWBC: 8400 cells/cmESR (1/2 hr) : 3 mm ESR (1 hr) : 7mm 3rd June, '08 WBC Count : 4,640 /c.mmHeamoglobin : 14.5 gm ANA (Serum/IF Method) : 1:100 PositiveANTI DS DNA (Serum/IF Method) : NegativeANTI CCP (Serum/Elisa) : 0.3Free T4 (Serum/Chemiluminescence) : 1.14 ng/dlT S H (Serum/Chemiluminescence) : 3.41 ulU/mlRandom Blood Sugar - 78 mg/dlLDH (Serum / Pyruvate to Lactase SCE) - 296 U/L Real Time PCR - Mycobacterium TB - NegativeRH Factor - Less than 9.5 IU/mlASO (Serum/Nephelometry) - 57.0 CRT - Less than 3.1Liver Function Test - NormalUrine & Urine Culture - NormalStool & Stool Culture - Normal Another here mentioned chronic fatigue.. i think she was refering to "chronic fatigue syndrome" or CFS I myself have CFS and sometimes do come across others on this board who are quite obvious that they probably do have this condition too... in your case thou it isnt obvious but it is possible as maybe you've missed giving all the info to us? CFS can cause your symptoms thou your ANA being positive, may well indicate that it's probably something else... Ones with CFS find their symptoms are brought on by exertion (mental or physical or stress)... you dont mention in your post as things being like that for you and if your symptoms dont worsen or flare up more with exertion.. you should be able to cross possible CFS off your list. Bowel motions alternating constipation/diarrhoea Sounds like irritable bowel syndrome.. that can feature in many different illnesses (autoimmune etc) including in CFS. It's something you can be treated for. Taking probotics and also fibre supplements ..and avoiding any foods which may trigger it can all help this condition.
    taniaaust1 2267 Replies Flag this Response
  • ((Signs of parasite infection from your signs (fatigue, feverish, chills, constipation diarrhea, stomach quesy, general body pain, weight loss)) There is no doubt that the extreme fatigue (CFS) is being caused by a pathogenic bug. It is possible that the culprit could be parasites. Parasites come in quite a few forms and may be causing the underlying problem. Typically they reside in the gastrointestinal tract and can cause both constipation and loose stools and a whole host of other problems. See above. Testing (stool) can be quite tricky. Experts recommend multiple stool testing ... (I tested several times which came back negative... frustrated I treated the parasites and received a visual positive :>) - There are several possibilites of parasites: Nematodes and Cestodes (worms), trematodes (flukes) and protozoa or amoeba infections (giardia, cryptosporidium, b. hominis and numerous others). Some physicians will just treat for parasites without having a positive on a stool test. There are some basic ayurvedic formulas that address all of the parasites from a herbal perspective. It is possible that these may have the strength to remove parasites -instead of pharamcueticals.
    LINENUP 122 Replies Flag this Response
  • Line up: I tried Ayurvedic medicines too; but they have not been helpful. Anything you propose for parasite testing?
    Anonymous 42789 Replies Flag this Response
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