Sick with unknown pathogen after Brazil visit

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By Stephanie Oppeneimer ( - on Monday, January 21, 2008 - 11:53 am: Edit Post

I am an RPCV and posting this on behalf of my cousin who has become ill after his stay in Brazil. Please contact me if you or know anyone who has had similar symptoms.

David Cashman Age: 24

Until now, previously healthy man. No family history of related illness. No medications.

One year and a half after graduating college, David travels to Brazil (02/06/2007) He spends a month in Rio and further south in the country, and then travels North to Salvador to settle down. There he lives with a local man in a nice, spacious home. He gets a job teaching English and volunteers in an AIDS orphanage. He is physically very active playing soccer several times a week and running most days. He feels very healthy and strong except for a 2 month bout with what he was told at the time was scabies (but which a US infectious disease physician has said was not likely to have been scabies; it began with a lesion the size of a quarter that appeared one morning on his ankle) that aggravates him many nights. He tries a variety of lotions all to no long term avail. Finally he gets a stronger lotion and an oral drug. He is able to eliminate the infection, but has some strong allergic reactions to the medicine (3 of them), during which he has pronounced reddening of the skin along neck, back, shoulders, and dizziness and nausea. One of the medications he takes is called Sulfira. David is allergic to Sulfa drugs and doesn’t make the connection at this time. Based on the name, Sulfira most likely has Sulfa in it-this probably explains the reaction to this medicine, he is unsure why the other two medicines: Ivermectina and Benzoate de Benzila produced allergic reactions) After the so-called scabies have been eliminated and he has ceased taking the treatments, the after-effects of the medicine are present for 5 or so days. Nothing severe, just some slight dizziness and this thicking of his throat that is difficult to describe. He notices he is often stretching his neck to try to make it better but it doesn’t help much. The entire so-called scabies bout with its after effects ends about mid June. After this, he returns to feeling healthy.

The next event of potential importance is a 5 day hiking trip to the interior of Bahia (northeast Brazil). During the trip he swims in several of the rivers. He also drinks some unfiltered ground water that he is told repeatedly by his guide is safe to drink. The trip goes great. He has no reason to believe the water was contaminated, but because of its proximity to the ensuing events it becomes noteworthy.

The next event which may be of importance occurs during the bus ride back to the city. David gets so dehydrated during the trip, and unable to find anyone with water, that he resorts to drinking 3 handfuls of water from the bus sink. It is very warm in the bathroom as it sits above the engine, and the water comes out hot, because of the engine presumably, as well. He knows it probably not to be the best water but is so desperate he drinks it anyway. In any event, he finally gets some good water at a stop, the rest of the ride is normal and he gets home without issue.

The next night is his last night in Salvador so he goes out for a drink with some friends. During first drink, he notices he is quite dizzy, and his chest feels immensely heavy. His breathing is a little labored and he is scared and doesn’t know what is happening. He manages to get through the night.

The next day (7/18/2007) he travels back to Rio. In general he feels pretty good in Rio, however every day (5 days) at some point during the day he has this heavy chestedness, some dizziness, and the uncomfortable thickening in his throat. He notices it hurts to swallow his food, and he gets out of breath eating. In general though, these episodes last only a couple hours, and most of the day he fells pretty good: able to exercise vigorously, drink alcohol, and whatever else he decides to do. After 5 days in Rio he goes to Chile to meet a friend (07/24/2007) He spends 8 days in Chile biking, hiking, skiing and drinking a good deal of wine. He feels great, no problems whatsoever, and pretty much forgets the troubles he had in Brazil.

Upon coming home he travels to a friend’s wedding in Jackson Hole, Wyoming (8/3/2007). There, his chest and breathing troubles return, this time more severe and for longer duration. He seeks medical advice at the ER and is told all blood work, EKG’s and X-Rays are normal. His problems persist for the next several days. On the trip home back to Boston, his neck is really bothering him. While making the connection in Denver, he has an episode where he gets so light-headed and dizzy that he trips and has to be saved from falling. He goes back to the ER where the same tests are run and once again they all return normal.

The 5 ensuing months can be characterized by:

Chief Complaints:

August: tightness/fullness in chest. Hurt to swallow. Often times felt acutely out of breath—independent of activity. (Since then has been present here and there but would not classify as my chief complaint)

Late August/ September Next chief complaint was a thickening, tightening of muscles in neck around throat, extending up through the jaw and into the ears. No trouble swallowing, just a persistent discomfort. It makes it feel as though air is somehow getting trapped in the throat. While I can breathe, it is awkward, uncomfortable, and often frightening when really acute.

October Next chief complaint is intense pressure in head leading to feelings of instability. Finds that it is hard to concentrate. The headaches are intense to the point of being debilitating. Sometimes he finds he must leave somewhere because he feels so imbalanced

November: Symptoms shift back to throat, back of the mouth region. Same feelings of constriction, tightness. Throat is extremely sensitive to things like coffee and alcohol.

December: First two weeks, starting to feel much better. Not perfect but a lot better

Mid-December: Severe headaches return. Exhaustion is present on a daily basis

Additional complaints include pressure in both ears and at times exhaustion. I also find that I am incessantly thirsty, am urinating much more frequently than normal, am very sensitive to any harsher drinks such as coffee and alcohol, both of which I am now avoiding.

My symptoms usually last all day. They seem to be unrelated to time, place, activity etc. It seems there isn’t much that makes them better when they are happening. It seems traveling exacerbates my symptoms, as does a lack of sleep. I have been sleeping very well, but even 9 hours of good sleep is no guarantee I will feel reasonably ok the next day.

Since going to my friend’s wedding (8/5/2007) I have not had one day of feeling completely normal.

Previous Medications: Prilosec, Zithromax, Prednisone : All failed to produce change

I have also briefly tried Wormwood, Garlic Pills, and CO-Q10—none of which produced any change.

Test Results

EKG’s (5), Echocardiogram, (Doctor at Brigham is of the opinion nothing is wrong with my heart) Stress Tests, blood work, stool samples, test for Lyme’s Disease, tests for Infectious Diseases (STD and travel related: ID at Brigham and BU have said it is most unlikely this situation is the result of an infectious disease) GI Barium Swallow, CT Angiogram of Chest, D-Dimers (tests for pulmonary embolisms), MRI of head, all of have come back normal. I was diagnosed with mild asthma, however the inhalers (albuterol and steroidal) makes my throat and chest feel considerably worse. The asthma also doesn’t explain the head and neck symptoms. I have also had no coughing or wheezing issues. I don’t really think I have asthma and neither do some of the other doctors familiar with my case.

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