The Never-Ending Virus

Thursday, March 7, 2012. I’ve experienced something unique this year, both my personal experience and in my medical practice, in my patients. I’ve been calling it the “never ending virus” for two month already. Here is my personal case history:

In mid-December I felt that I was coming down with an upper respiratory infection (URI), with excessive sneezing, a runny nose, and fatigue. Just before Christmas, about a week after the onset of the first symptoms, I developed a terrible dry cough. Five days after that when I arrived in Florida for a golf holiday, I found myself sick in bed with what seemed like the flu, but without fever, and a terrible cough. The malaise was so severe I got out of bed only to go to the bathroom, drink water, eat cereal, or soup. On the third day in bed, I developed right maxillary sinusitis (with fullness and pain in my face and teeth). With effort I made it to the drug store to pick up an antibiotic, and thankfully, the sinusitis resolved within a few days. After four days in bed, and oh yes, drinking Nyquil like it was water, on the last day of my holiday vacation, I got up feeling weak and dizzy, and looking the mirror it looked like I’d lost a significant amount of muscle mass.

The next week (back at work), I was exhausted. The following week the cough got worse again, and it was keeping me from sleeping. The fatigue was difficult and I saw my doctor, who on chest auscultation (examination) thought that I might have pneumonia. So, he put me on Levaquin, a strong antibiotic. My lungs cleared quickly, but I went straight downhill having had a serious side-effect of the Levaquin, one that involved all my muscles and joints. I even got fluid in my knee. Moving and walking was difficult, but I continued to work. I was concerned about the Levaquin complication because I did not know how long it would take for my joints to get better. (Now six weeks later, my joints are fine except for my left knee that remains rather stiff.)

At the end of January I was feeling pretty good except for my joints, when all of a sudden, it began all over again. I developed the same URI with sneezing, copious rhinorrhea (runny nose), and cough.  I thought that one developed immunity from a virus after a URI; nevertheless, I felt that I was starting my fourth recrudescence. It took about ten days for it to subside, and this time no complications. By mid-February I was back to my normal self with good energy. But again one day, I again began coughing with sneezing and runny nose all over again. This came and went in two days. Meanwhile, through the month of February I was using an allergy nasal spray thinking it might be allergies, but it is not allergy, this strange affliction.

To set my illness in perspective: M 29-year-old daughter had this URI with severe cough for six weeks, not unusual for a viral URI. My sister has had a similar on and off again respiratory infection for a three months now; and recently, David Letterman (with apparent nasal congestion) announced, “I’ve had a cold for five months now.”

Now come my patients. Today, I saw a 25-year-old man with symptoms of an on-again-off-again URI for a month. On examination, his entire nose and throat looked like a severe respiratory URI with mucus of varying viscosity everywhere. The watery stuff was dripping down from above, like a waterfall, and there was thick, white, almost Elmer’s-glue-like mucus on the pharynx, and the entire larynx (voice box) was swollen with watery edema. And there was  and mucus everywhere. That is the pattern of an acute upper respiratory infection, but young people don’t get sick for 4-6 weeks. Another strange thing, I have some singers coming in with no real symptoms except for mild hoarseness who appear to have findings of a rip-roaring URI; see below.

Findings: thick and thin mucus, diffuse inflammation (redness and granularity of all the nose/throat tissue)

Furthermore, many of my patients shared my experience of getting well, only to have full blown recrudescences (this terrific word means “breaking out anew”). Different people’s manifestations of this NEVER-ENDING VIRUS tend to remain constant for each individual, meaning that the on-again-off-again-on-again pattern is usually with the same symptom complex in each person. (I was the only person I know who developed typical URI symptoms, then sinusitis, then pneumonia.) Most people with this URI either do or don’t develop cough.

I’ve spoken to colleagues in internal medicine and expressed concern about “the never-ending virus,” but I have not gotten any answers. Here is why I am concerned. Usually after a URI one has immunity; you don’t get the same virus back again just after it’s over. That just doesn’t happen in my experience, but that is what is happening this year. It’s almost as though the virus in our community this year does not confer immunity against itself. Of  concern is the question of why?  Why doesn’t the immune system banish this virus by producing antibodies after the infection? Instead, it comes back again and again like a bad penny. I am posting this because I am interested in other people’s experience, particularly people who work in the fields of infectious disease and immunology.

In conclusion, the URI virus in our community this year does not follow a recognized pattern; the usual post-URI immunity seems to be lacking. Of course the big question is might this NEVER-ENDING VIRUS be different? Could it possibly be altering the immune system in some pernicious way? Would that not explain its bizarre recurring pattern?

Final note: Yesterday I was sneezing and coughing again, and now I must say I’ve had this NEVER-ENDING VIRUS for a full two months. HELP!

The Never-Ending Virus is “SILENT” in Some Patients

Today, a patient with laryngopharyngeal (airway) reflux came in saying that her reflux symptoms (chronic throat clearing, a sensation of a lump in the throat, sore throat and hoarseness) were much worse. When I examined her I found the same evidence of an acute URI that I described above; however, she didn’t think that she was sick. (The photos from her exam are shown below.) This is a “silent: URI? The whole thing here is very odd!

Click on the picture to see it in greater detail: the mucus is like glue!

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