flu-like symptoms two days after diving

[DallasNewbie]

We got back from Cozumel yesterday, and tonight my wife is feeling tired, achy, and has a fever of 100.8. She says it has come on gradually since this morning and she felt fine before that.

Our last dive was on Saturday morning, and we were out at least 26 hours prior to flying home on Sunday. We did have long multi-level dives, but AFAIK, did everything right.

I've read what I could on DAN's website, and it doesn't seem to fit DCI. Everything was normal on the field neuro exam so I do not think it is an emergency and we will call DAN in the morning. I just wanted to see if this could be an unusual presentation of DCI or more likely the flu. TIA.

[flots am]

I'm not a doctor, but have never heard of DCS causing fever, and most DCS symptoms show with 24 hours, so two days is a long time.

On the other hand, getting sick on vacation isn't all that uncommon, so that would be my best guess.

flots.

[Bubbletrubble]

Let me preface this post by saying that I'm not an infectious disease doc...

FYI, neurological symptoms are only present in 10-15% of DCS cases.
The fever is what argues for an infectious cause (flu, dengue fever, malaria, leptospirosis, etc.).
The seasonal flu is relatively uncommon in the summer months because it tends to have problems surviving in hot, humid environments. Swine flu seems to be able to tolerate such conditions better.
Keep an eye on your wife and take her to see a physician if her situation worsens.
After describing her symptoms, one of the first things she should tell the doctor is that she recently traveled outside the U.S., specifically to the Caribbean. Expect some blood samples to be taken.

At least one recent study has shown that the #1 cause of fever in U.S. travelers returning from the Caribbean, South America, south-central Asia, and Southeast Asia is...dengue. There can be an interesting rash that appears shortly after the fever subsides. Fortunately, dengue is usually self-limiting. Infectious disease experts suggest that many travelers infected for the first time with one of the dengue family viruses may show a very mild course but subsequent dengue infections (by a different viral strain) could be more severe.

Here's a link to a recent review on dengue published in Nature Reviews Microbiology.

Mosquitoes suck. *sigh*

I hope that your wife feels better soon.

[DallasNewbie]

Thanks for the replies. There were tons of mosquitoes down there and we were all getting attacked. And her fever is now up to 102, so Dengue is a definite possibility. She will certainly be going to the doctor tomorrow.

[Bubbletrubble]

@DallasNewbie: I'm sorry to hear that your wife's fever is now more elevated.
FYI...

Here's the Treatment section from the CDC webpage on dengue fever:

TREATMENT

No specific therapeutic agents exist for dengue virus infections. Encourage bed rest and maintenance of fluids to prevent dehydration while the patient is febrile. Control fever with acetaminophen. Headache, eye pain, joint pain, and muscle ache may require narcotics. Aspirin, aspirin-containing drugs, and other nonsteroidal anti-inflammatory drugs (such as ibuprofen) should be avoided because of their anticoagulant properties. Aspirin and other salicylates should be especially avoided in children because of the association with Reye syndrome.

Ask patients to watch for warning signs of DHF or DSS as the fever declines, and instruct them to go to the hospital if they develop any of the following warning signs: abrupt change from fever to hypothermia, severe abdominal pain, persistent vomiting, bleeding, difficulties breathing, or altered mental status (such as irritability, confusion, lethargy). Prompt and judicious intravenous administration of isotonic crystalloids and colloids in patients with DHF or DSS can improve outcomes. In patients with DHF or DSS, hospitalization with close monitoring of vital signs, fluid balance, and hematologic parameters (hematocrit, platelet count) is indicated, as well as additional supportive measures.

As noted in the bold-faced text above (which I added), have your wife use Tylenol, not aspirin or NSAIDs, for pain/fever relief.

[Mike]

There have been at least a handful of people reporting coming back sick from Cozumel. I believe the posts are in the Cozumel forum.

What hotel did you stay at, who did you dive with?

[ZenDiver.3D]

I think you are sick, not suffering from a dci. Getting sick on or just after returning from vacation is quite common.