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Vakul Aren
Vakul Aren, Doctor
Category: Medical
Satisfied Customers: 4157
Experience:  MBBS,DTM&H,34 years of experience
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About 3 months ago I got ill while on holiday in Spain. I

Customer Question

Hi there,
About 3 months ago I got ill while on holiday in Spain. I reside in Australia and have had all my immunizations as far as I know. I was originally treated for fevers, night sweats and a single enlarged lymph node in my right groin by a GP in Spain. With a course of antibiotics, anti inflammotories and a declotting agent he put me on the flight back to Sydney telling me I had to do blood tests back home if things didn't change. On the flight back I developed nausea and the other lymph node in my groin swoll up.
I got back and headed straight to a GP for blood tests. The tests showed that I was both infected with a viral and a bacterial infection, (high neutrophils and monocytes) with the test results also showing 'mild mononucleosis' but also my indicators for a bacterial infection being 'through the roof' according to my GP. Glandular fever was suspected but in additional tests I showed antibodies.
I was prescribed another antibiotic agent however the lymph node on the right side of my groin would not go down despite the one on the left side having gone down. An ultrasound was ordered which showed what 'might be an infected node with multiple other reactive nodes' and inflammatory change in the adjacent fat.
On basis of this test I was referred to an infectious disease specialist in the hospital who tested me for everything from an HIV infection to cat scratch disease. I came back with a CMV infection however he was convinced this was not the source of my enlarged lymph node, which had been swollen for 6 weeks by that stage and had now developed a red rash over it too.
A lymph node biopsy was ordered however I never got conclusive results from this. The specialist said that it sometimes takes time for bacteria to develop in a lab and prescribed me Clindacymin which I think he did because he talked about a Staph infection getting stuck in the lymph nodes from day dot. But correct me if I'm wrong. He never followed up saying that a colleague was gonna take care of it as he'd be on holiday but I never received an invitation to a follow up. However the lymph node did go down after the Cleocin so I figured I was better myself.
However I have been perpetually exhausted over the past few months, sometimes sleeping 22 hours a day for no apparent reason and have lost my job in the meantime due to having to call in sick regularly over the past 3 months. I suffer from bouts of nausea regularly to the point of throwing up, however I don't know if this related or due to my bipolar 1/social anxiety and being stressed for not making it into work. I do get nauseated from stress sometimes which in this context would make sense but I have been off any bipolar meds for 2 years and have not had any related episodes or anxiety apart from being stressed not living up to my responsibilities at work lately due to being so exhausted.
I'm afraid to return to the GP as I feel I'm hassling them after exhausting such a huge battery of tests. I would just like a second opinion. Is this CMV mononucleosis due to a CMV infection or an unresolved bacterial infection that is still festering somewhere? Or am I letting my anxieties get the better of me?
Submitted: 11 months ago.
Category: Medical
Expert:  Dr. David replied 11 months ago.

Hello, this is Dr. David. I am reviewing your question now and will be with you momentarily.

Expert:  Dr. David replied 11 months ago.

your testing showed CMV viral infection which can cause severe fatigue

high neutrophils and monocytes can also be from viral infection as well. it doesn't necessarily point to bacterial infection.

Customer: replied 11 months ago.
Could a CMV infection linger for 3 months after original diagnosis? Do I go back to my GP and explain?
Expert:  Dr. David replied 11 months ago.

yes, CMV infections can last for 3 months and can cause fatigue symptoms and severe exhaustion for 3 months

you should follow up with your doctor and let them know

I doubt your symptoms are caused by a bacterial infection.

Expert:  Dr. David replied 11 months ago.

do you have any other questions?

Customer: replied 11 months ago.
Hi David,Maybe the one thing I failed to mention which had Drs stumped is that I had high CPR as well? I'm obviously not familiar with the terms but it seems outrageous that GPs and a infectious disasters specialist would go on a wild goose chase on non excising terms? See attached.
Expert:  Dr. David replied 11 months ago.

a high C reactive protein level can be elevated when you have a viral infection in the body or any sort of inflammation or inflammation of blood vessels in your body.

it is not a specific blood test and can be elevated in several circumstances.

let me know if you have other questions.

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Customer: replied 11 months ago.
Thanks David, I appreciate your answer but would also love for someone to explain it to me in more detail.... Exactly why I enlisted this service. I don't know what the tests mean and that's cool but it'd be even better if I did know! I waited for 10 years for my bipolar diagnosis despite me constantly ringing the alarm bell that something was wrong, excuse me while I try to understand.
Expert:  Vakul Aren replied 11 months ago.

Hello,I am Dr. Aren and i will help with your query.CMV or the CytomegaloVirus is a double strand DNA virus belonging to the herpes family.Its occurrence is wide spread in many countries(upto 60 % exposure in USA).In most it is asymptomatic but can manifest as a flu like syndrome, enlargement of lymph nodes and spleen may occur.A Mononucleosis type piture has been seen in some patients,the problems arise in people who are immuno-compromised or suffering from other illnesses like Rheumatoid Arthritis,SLE,Crohn's Disease and psoriasis among others.Use of steroids or medicines like Tumour necrosis Factor may cuse the disease to be symptomatic.Symptoms include Pneumonia,Uveitis,Hepatitis,Encephalitis,Myelitis,Colitis,Retinitis,neuropathy among others.The disease is often got through blood transfusions and person-to-person contact,having many sex partners ,organ transplant,breast milk and sexual contact.xtreme fatigue is often seen. The disease may resemble Toxoplasmosis,Mononucleosis,Auto-immune and Viral Hepatitis and HIV disease.Work up to differentiate it from these would be required.Since it is an infective process,C-reactive protein (CRP) values are often elevated.Lab tests like PCR and immune assays are used for specific diagnosis,elevation in IgG is often seen.Intracellular inclusions are seen on various stains and a qualitative assay rise is often used for diagnosis.Intravenous Ganciclovir often used for treatment,Vanganciclovir is used to treat moderate infections along with other drugs.These drugs inhibit the DNA synthesis and may be used with immunoglobulins for treating this.The fatigue in acute CMV infections may last upto 18 months.Other drugs used may include Cidofovir and Leflunomide apart from others.The help of an experienced Infectious Disease specialist will help in treating and managing this disease.