By John C. Wolf, D.O.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine
WOMAN'S NIGHT SWEATS MAY BE DUE TO VIRAL PNEUMONIA
Question: I'm a 38-year-old woman. I have been suffering with night sweats for three months. I wake up every night so wet and cold that I have to change my clothes at least two times. They started about the same time I started working in a day care center and became sick with sinus infections, chest infections, asthma and bronchitis. I have been on so many medications that I feel like a drug store, and nothing helps with these night sweats! I don't know what to do. Help!
Answer: Nighttime sweating is a general symptom that can be caused by many problems. I can only give you some general ideas about conditions that may be causing your night sweats because I can't actually examine you -- but you already knew that when you wrote me.
Illness, particularly respiratory illness, can cause night sweats. Working with children in a day care center gives you exposure to many of these. How many times have you had a child cough or sneeze directly into your face? I'll bet it happens several times each day. Hence, you get exposure to almost every respiratory illness that occurs within your community.
Tuberculosis (TB) is certainly a serious respiratory infection to consider even though it isn't that common. I imagine you had a TB test done before you began working in the day care center. These skin tests are positive for 60 to 70 percent of those who have previously been exposed to this infection. Three months of respiratory complaints make me think that it is time for you to have another one. Your doctor will probably also want you to have a chest X-ray taken. This is helpful because in addition to finding signs of both old inactive or new active tuberculosis, it can identify other lung problems.
A common cause of night sweats that usually has accompanying low energy and endurance is an illness commonly called "walking pneumonia." This is actually a mild form of pneumonia that is caused by a viral infection. Although it would be uncommon for the acute infection of viral pneumonia to last for three months, it can happen. More commonly, however, the resulting lung injury that produces these symptoms can take this long to resolve. In addition, these lingering problems are often misdiagnosed as being cases of asthma and bronchitis that are responding poorly to medical treatment.
There are other illnesses that can cause night sweats. Lung infections from common fungal organisms such as histoplasmosis or coccidiomycosis can do it. HIV infection can also cause night sweats as can cancer, particularly lung cancer. Unresolved infection from a "smoldering" sinus infection or dental abscess can cause them. Even high levels of anxiety can cause night sweats.
A common cause of night sweats that needs to be considered in your case is menopause. You see, some women start having night sweats -- a nighttime version of a hot flash -- as much as 10 years before they stop having periods. Your doctor may be able to determine if this is your cause after talking a careful medical history, but it often requires some simple blood tests as well to confirm it. The reason this is important is that relief from hot flashes and night sweats is about the only area involving estrogen replacement therapy over which there is no debate. It works!
I can't accurately tell the cause of your night sweats, but I can make an educated guess. I'd guess you have an infectious cause that originated with a viral illness one of the children unintentionally shared with you. Despite this, I'd suggest that you go see your doctor again to be certain you don't have one of the more readily treatable causes.
"Family Medicine" is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.