Immune System Issues: Symptoms and Diagnostic Insights

Immune system issues

Hello doctor, I started experiencing chills and fever on the night of August 4, 2022.
The next day, I visited an ENT specialist who diagnosed me with a common cold.
I took medication for three days, and while I felt somewhat better, the fever returned.
After that, I occasionally had morning fevers, with a higher likelihood of fever at night, along with a loss of appetite and feelings of nausea.
This continued until August 19, when I saw an infectious disease specialist.
Blood tests revealed elevated liver enzymes: GPT 288 and GOT 71.
I underwent additional screenings that day and was scheduled to review the results on August 24.
However, I checked the results on the National Health Insurance Quick Translation Service and saw the following test results: TOXO IgM Reactive 0.94, CMV-IgM Reactive 14.05, EBEA-Ab Positive 11.3, EB-VCA IgG Positive 750.0, CMV-IgG Reactive 7.0, TOXO-IgG Nonreactive 0.10, HIV Ag/Ab Test Nonreactive 0.238.
I noticed that most of the results were positive, which made me a bit anxious.
I would like to ask for your opinion, as the infectious disease doctor mentioned it might be scrub typhus but still ordered these tests.
Thank you.

Kai, 20~29 year old female. Ask Date: 2022/08/21

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
In your test results, the presence of IgM antibodies indicates an acute infection, so it is important to consider Toxoplasmosis, Cytomegalovirus (CMV), and Epstein-Barr Virus (EBV).
Toxoplasmosis is caused by a parasite known as Toxoplasma, while CMV and EBV are viruses that can lead to pharyngitis and tonsillitis.
These conditions fall under the realm of infectious diseases, and I recommend discussing with your infectious disease specialist to explore the possibility of co-infections and treatment options.
The Allergy, Immunology, and Rheumatology Department at Changhua Hospital, Ministry of Health and Welfare, is concerned about your health.

Reply Date: 2022/08/21

More Info

Based on your detailed description of symptoms and the results from your recent blood tests, it seems that you are experiencing a complex interplay of immune system issues and potential infections. The symptoms you have reported, including recurrent fevers, chills, loss of appetite, and nausea, along with elevated liver enzymes (GPT and GOT), suggest that there may be an underlying infectious process or an immune-mediated condition at play.

The presence of elevated liver enzymes can indicate liver inflammation or damage, which can be caused by various factors, including viral infections, autoimmune diseases, or even medication side effects. The specific tests you mentioned, such as the reactive results for Toxoplasma (TOXO), Cytomegalovirus (CMV), and Epstein-Barr Virus (EBV), indicate that your body has encountered these pathogens. The positive IgM for CMV suggests a recent infection, while the positive IgG for EBV indicates past exposure, which is common as many people are exposed to EBV in childhood or adolescence.

Your doctor’s suspicion of rickettsial infection (such as scrub typhus, commonly referred to as "恙蟲病" in Mandarin) is noteworthy. Rickettsial infections can present with fever, rash, and other systemic symptoms, and they often require specific antibiotic treatment. The fact that your symptoms have persisted despite initial treatment for what was thought to be a common cold suggests that further investigation is warranted.

In terms of your immune system, the recurrent nature of your symptoms and the pattern of fevers could indicate an underlying immunological issue. Conditions such as autoimmune diseases can lead to a dysregulated immune response, causing symptoms like fever, fatigue, and increased susceptibility to infections. It is essential to have a thorough evaluation by an infectious disease specialist or a rheumatologist who can assess your immune function and determine if there are any underlying autoimmune processes.

To further investigate your immune system status, your healthcare provider may recommend a series of tests, including:
1. Complete Blood Count (CBC): To check for any abnormalities in white blood cells, which can indicate infection or immune dysfunction.

2. Immunoglobulin Levels: To assess the levels of different antibodies (IgG, IgA, IgM) in your blood, which can help evaluate your immune response.

3. Autoantibody Tests: Such as ANA (antinuclear antibody) or specific autoantibodies related to autoimmune diseases, to check for any signs of autoimmune disorders.

4. Liver Function Tests: To monitor your liver enzymes and assess liver health over time.

5. Infectious Disease Panels: To rule out other potential infections that may not have been covered in your initial tests.

It is crucial to follow up with your healthcare provider regarding the results of your tests and to discuss the next steps in your diagnosis and treatment plan. Given the complexity of your symptoms and the potential for serious underlying conditions, timely and comprehensive medical evaluation is essential.

In summary, while your symptoms may be concerning, they can often be managed effectively with the right diagnosis and treatment. It is important to remain proactive in seeking medical care and to communicate openly with your healthcare team about your symptoms and any changes you experience.

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