Viruses can have acute or persistent activity in the body. Viruses such as influenza have a limited duration, whereas others such as Epstein Barr Virus (EBV) and Cytomegalovirus (CMV) can remain latent after the initial infection, and become active again at a later stage, causing a recurrence of symptoms. Other viruses have long-term effects without a secondary period of viral activity. Dengue virus is not historically recognised as a chronic virus but can cause persistent symptoms, possibly due to delayed immune system recovery.

Initial Consultation

A 40-year old female presented with a two-day history of fever, headache, fatigue, joint and muscle aches. The patient had previously been well, however, she had recently returned from a trip to South East Asia. The patient was managing her symptoms with ibuprofen 200 mg, 2 to 3 times daily. A case history revealed:

• Frontal headaches, starting in the morning and lasting throughout the day
• A fever of 39.1°C
• Energy 1 to 2/10 (previously 8/10)
• Prickling pain in the soles of her feet

Other relevant history side included:

• Breastfeeding an 11-month old infant
• Diet high in wheat and sugar
• Poor sleep quality (due to infant waking)

Initial Prescription

The initial prescription was aimed at supporting immune function, reducing viral load and reducing inflammation:

• A liquid herbal formula containing Echinacea (Echinacea spp.), high-grade St. John’s Wort (Hypericum perforatum) and high-grade Licorice (Glycyrrhiza glabra). Dosage: 5 ml, 4 to 5 times daily.
• An anti-inflammatory herbal tablet containing Boswellia (Boswellia serrata), Turmeric (Curucma longa), Celery (Apium graveolens), and Ginger (Zingiber officinale). Dosage: 2 tablets, twice daily;
• A nutritional powder containing zinc citrate (25 mg), ascorbic acid (1.0 g), lysine (1.0), and nutritional co-factors to support immune function. Dosage: 5 g, twice daily;

She was referred to her general practitioner for further testing and asked to make the following nutritional and lifestyle changes:

• Include daily fresh vegetable juice containing carrots, ginger, turmeric, and celery;
• Reduce wheat and sugar intake;
• Increase vegetable and bone broths (include into daily food intake);
• Consume garlic daily (preferably fresh); and,
• Rest as much as possible.

2-Week Follow-up

The patient reported that all her symptoms had abated with the exception of fatigue. Her energy remained at 3/10. Blood results revealed:

• Positive Dengue virus via polymerase chain reaction (PCR) test
• Low ferritin 21 ug/L (reference range 25-290)

Her prescription was continued; however, the anti-inflammatory herbal tablet was replaced with:

• A herbal tablet containing Reishi (Ganoderma lucidum), Shiitake (Lentinula edodes) and Maitake (Grifola frondosa). Dosage: 2 tablets, 3 times daily.
• An iron supplement containing iron bisglycinate (24 mg)) and ascorbic acid (120 mg). Dosage: 2 capsules before bed.
• Increase iron-containing foods such as red meat, almonds, apricots, pumpkin seeds, and basil pesto.

6-Week Follow-up

The patient reported an improvement in energy levels rating them 6/10, however, she had not returned to her previous state of good energy and felt run down; which she described as feeling like she was fighting a flu-like virus.

Her prescription was revised and the herbal liquid was replaced with:

• A herbal tablet containing Astragalus (Astragalus membranaceus), Siberian ginseng (Eleuthrococcus senticosus) and Echinacea (Echinacea purpurea). Dosage: 2 tablets, twice daily, taken at breakfast and lunch.
• A probiotic formula containing Bifidobacterium longum BB536, Bifidobacterium breve M-16V , Bifidobacterium infantis M-63, Bifidobacterium lactis BI-04, Bifidobacterum lactis HN019, Lactobacillus rhamnosus HN001, Lactobacillus paracasei Lpc-37, Lactobacillus salivarius spp. salivarius Ls-33, Lactobacillus casei Lc-11. Dosage: 1 capsule daily, with food.
• The patient was also instructed to limit higher intensity physical activity in favour of walking or yoga, and to utilise a sauna once per week.   

12-Week Follow-up

The patient reported a return to good energy, now rating it 8 to 9/10, with an absence of lingering flu-like symptoms for the past 5 weeks. Having discovered she was pregnant, she had ceased herbal treatment 2 weeks prior. Her continuing prescription included:

• Prenatal multivitamin (patient’s own).
• Omega-3 fatty acids providing eicosapentaenoic acid (EPA) [360 mg] and docosahexaenoic acid (DHA) [240 mg]. Dosage: 1 capsule,  twice daily with food.
• Continue with the iron supplement and monitor ferritin levels at each trimester.
• Continue with zinc, vitamin C and lysine powder.
• Continue with probiotic formula until 3 months post-birth.
• Discontinue use of a sauna.

Discussion

While many are self-limiting, some viruses can cause long-term symptoms, which can be seen in this case. While the virus itself may not continue replicating, immune system recovery can take some time, causing a persistent feeling of fatigue. In this case, the co-existence of iron deficiency may have compounded the delayed immune system recovery, as well as the somatic fatigue symptoms. Herbal and nutritional protocols available to naturopaths allow targeted and effective treatment of viruses and post-viral fatigue, even in delicate conditions such as pregnancy and breastfeeding, as was seen here.