My friend is a 36-year-old male. His height is 170 cm weight is 56 kg. He had some unhealthy sexual exposure seven years back. He said he got sick once and started losing weight beginning that time. In the last seven years, the average of 5 % every year, even though he is eating a lot to gain weight. He thought it was stress and ignored it. But his spouse also started losing weight like him, and then his kids did not gain weight and dropped in percentile. All are eating a lot, but it is not helping. Their family from both sides have good weight and fat. So it does not look generic.
Last two years, he has been talking about slight joint pain, a crawling sensation in his feet, and feeling weak. He is also having locking or pinning pain while trying to squat. His five-year-old kid also has joint clicking sounds and weakness. So he was asked to consult an Infectious disease doctor himself first. So we are looking for your help.
He has recently checked for fourth-generation HIV 1 and 2, HSV 1 and 2, hepatitis A, B, and C, Chlamydia, Gonorrhea, Syphilis, CMV, EBV, urinalysis, and HTLV1. All tests came negative except HSV1 and EBV. He told me his annual check of complete blood count and comprehensive metabolic panel for the last three years looks normal. Upper endoscopy and colonoscopy is normal.
Please help with your input for all questions below, as it is critical for his whole family.
1. Is there any rare blood-borne parasite, bacteria, virus, or infectious disease test he is still missing?
2. Is it reactive or septic arthritis caused by bacteria or viruses?
3. Few tests like Mycoplasma genetalium, HPV, and Lymphogranuloma venereum have not been done so far. Any of this makes sense to get tested for his case now?
4. Will urine analysis or urine culture cover all sexual exposure bacteria?
5. Any infection that could be silently causing pancreatitis, liver, or thyroid damage for him?
6. In the last two years, his TSH went up, signaling hypothyroidism which could have caused weight gain. But for him, it is still weight loss. Any infection that could damage the thyroid and cause hyperthyroid followed by hypothyroid?
7. Is there any advanced diagnosis for rare cases when the basic STD panel does not find and still looks like some infection? If so, what are those?
8. Malabsorption or too much calorie burning is triggered by infection, I guess. Any other chronic or persistent infection you think could spread through blood and cause that?
Welcome to icliniq.com.
I understand your query regarding your friend's weight loss. Since his blood investigation for HIV is negative, we do not have to worry at this point. Rather than the amount of food we take, it is very important to take nutrition-rich food. Sometimes, the weight loss could also be attributed to malabsorption syndromes and parasitic infections involving the gastrointestinal tract. Do get the stool tested for parasites. Other than that, if the weight is within normal BMI, there is no need to worry.
I will suggest eating a small nutritious meal more frequently and staying hydrated. Take at least two boiled eggs daily and two cups of milk daily. I will also suggest two cups of green tea every day. You can take dry fruits and nuts regularly. Over-the-counter B-complex vitamin with calcium can be used for one to two months. More than that, stay stress-free and calm. As EBV (Epstein-Barr virus) panel is positive, we can also think of chronic EBV infection causing weight gain.
I would recommend the blood tested for FT3 (triiodothyronine), FT4 (thyroxine) and TSH (thyroid stimulating factor) - 12 hrs fasting blood test, complete blood count with peripheral smear and ESR (erythrocyte sedimentation rate), serum CRP (C-reactive protein), stool for occult blood and parasites, vitamin and minerals panel. EBV Panel - VCA (viral capsid antigen) IgM and IgG, EA (early antigen) IgG, EBNA (Epstein-Barr virus nuclear antigen) IgG. Do these blood tests if there is no improvement in weight after following diet advice.
I hope my answer clarifies your query.
Thank you for the reply.
He mentioned he had done all these tests mentioned at some point in the last three years. All those results are good. His whole family started losing weight one by one even though they ate more protein and carbohydrates to gain weight.
1. You mentioned chronic EBV impacting weight. Will that cause weight gain or weight loss? Since he is losing weight, he wants to confirm.
2. Are you an infectious disease specialist?
3. You mentioned parasites, can they be sexually transmitted and stay for this many years?
4. Is there any rare blood-borne parasite, bacteria or virus, or infectious disease test he still misses?
5. Is it reactive or septic arthritis caused by bacteria or viruses?
6. A few tests like Mycoplasma genitalia, HPV, and Lymphogranuloma venereum he has not done so far. Any of this makes sense to get tested for his case now?
7. Will urinalysis or urine culture cover all sexual exposure bacteria? Any infection that could be silently causing pancreatitis or liver or thyroid damage for him?
8. Last two years, his TSH went up, signaling hypothyroid, which could cause weight gain. But for him still weight loss. Any infection that could damage the thyroid and cause hyperthyroid followed by hypothyroid.
9. Is there any advanced diagnosis for rare cases when the basic std panel does not find, and still it looks like some infection? If so, what are those?
10. I guess that Malabsorption or too much calorie burning is triggered by infection. Any other chronic or persistent infection you think could spread through blood and cause that?
Welcome back to icliniq.com.
I understand your concern.
With the past history of unhealthy sexual exposure, we should not think only about sexually transmitted diseases. We should not keep only infectious diseases in our minds but also other things like nutrition and other non-infectious etiological conditions. Yes, chronic EBV infections can cause weight loss. I mentioned the parasite, which is spread by eating improperly cooked outside food like Ascaris infection. With only weight loss, I will not suggest testing for infections like Mycoplasma, HPV & Lymphogranuloma. With the history, it does not look like a rare infection. It does not look like septic or reactive arthritis.
Urine analysis or urine culture will not cover all sexually transmitted diseases. It does not look like any silent infection of his organs like the pancreas, liver, or thyroid. Numerous advanced tests are available for sexually transmitted diseases, but the trials are chosen based on history and clinical examination. Malabsorption can happen with intestinal parasites (not sexually transmitted, but due to bad food habits). If your friend is still anxious, I suggest you consult your specialist doctor, discuss with them, and take the medicines with their consent.
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