CO-INFECTIONS - Chronic infections rarely "travel alone".

That's Dr. Paul Anderson. Sorry, I just had to sign in there. And today we are going to talk about why my chronic infections will not resolve. Well, there's as many answers for that as probably there are hours in the day. But we want to do this in a few chunks and get things going. So we're going to start out today talking about why your infections, if they're chronic, may not resolve. And one of the big areas that that happens in is other infections. And we've talked about this a bit in the sense of a few different other settings. We talked about it with COVID We have talked about it with chronic diseases like Lyme and Epstein-Barr, etc., etc. But a common reason that a person with infections that don't want to let go, that have lingering effects, whether those effects are fully from the infection itself or from other areas such as the effect of the original infection or the immune changes, etc., A big area where a lot of trouble arises for your particular immune system is infections that may have been going on either in the background before you had your chronic infection started, or infections that go on because of treatment that you had for your chronic infections, or infections that kind of come alongside the other infections you have that you may or may not even know that you have. And so there's a few terms that are commonly used. I thought we'd go through those and kind of talk through them first. But the first one is actually called superinfection. And, you know, that sounds really bad. No one wants infection. Certainly nobody wants a superinfection. But basically the definition is an infection following a previous infection, especially when that infection is caused by microbes that have become resistant to the treatment that was used earlier. So one of the side effects of antimicrobial therapy is always listed as superinfection. And technically speaking, that means that the superinfection is other bugs that grew because of resistance to the original drugs or antimicrobials that we gave you in the first place. Now, this could be for a couple of reasons. One can be that the original bug was directly a target of your initial treatment. So like, let's say you had a bacterial infection and you took an antibiotic that was specific for that bacterial infection, and either that infection or one real similar to it that's also specific for that bacterial infection became resistant to the medication that you were given. This is common with antibiotic resistance. So this is one of the reasons why the choice of antibiotic, the length of the prescription antibiotic, and other things become necessary. That's a true superinfection. Now the other thing that can happen with superinfection is that you have your initial treatment and the other infectious agents that maybe you do or don't know that you have were completely not treated by the initial therapy, and that's one that happens quite often as well. Then there's the idea of what we call co-infections, and that's where you have a a parallel, a simultaneous infection by usually multiple types of pathogenic organisms. And so a coinfection can— we commonly hear about this in chronic infections, like in people with chronic Lyme and coinfections. And so there's a couple of ways that coinfections work. One of them is really similar to the superinfection idea where you get treated for one thing and the treatment that you do for that one thing doesn't really transfer over to the other things and the other microbes that you have. And so they just grow, right? The other is that the infection that you have that they found opens up your immune system to more infections coming in. Now, how would your immune system be broken down by an infection that was coming your way and then allowed other things to come in? Well, This happens not infrequently due to the immune system taking all of its— or not all, a lot of its energy, focusing it on the initial or the primary infection that you probably know about or tested for. And then maybe even you're treating that with something that's moderately to highly specific for that. Microbe, and then you go over and the immune system has all its energy going this direction, and then these other microbes just sort of flourish because number one, they're not that impressed with the treatment you're doing for your primary infection. And then number two, your immune system is fighting over here and it leaves the back door open. So with patients, I'd often say things like, you know, imagine yourself or imagine your immune system's like an army. And right now you're in the, you know, the middle of the city and the army is encircling you and it's looking at all sides. And those sides might be bacterial infections of all types, viral infections, fungal infections, parasitic infections, worms, et cetera, et cetera. All the bugs that can give us trouble. And yet you got the army encircling you. And so they sort of keep an eye on what's going on with immune function and immune response. Well, what happens a lot of time when you get a big infection, whether it's the primary one or you get it later on or whatever, is that the immune system rises up and it's sort of like the army, instead of being in a circle, kind of all comes to the front to fight this invader. Because if they don't kind of double and triple and quadruple up on their efforts, the invaders are going to run over the people who were— the army people who were there. And so by doing that, then the rest of your flanks and the rear is open. Everywhere around you is open. So that's another thing that happens. And that can happen, like I said, either in the beginning of an infection or as you're treating. And so let's say, for example, you and your healthcare providers found out you had this nasty chronic infection causing you a lot of symptoms. They give you a really specific treatment for that. They get that going and the immune system is engaged while you're treating. And then other things just sort of come along because they can. And we call those things that come along because they can opportunistic infections. So this is another big factor in the infectious conundrum. So what are some of the things that can help you if the reason you can't get rid of your chronic infectious problem is because of other infections? Now, it's not the only reason. We're going to do one of these on many, many things. But let's say other infections are a big part of it. Well, what you can do is to take a step back. And healthcare providers, sometimes it takes us a while to sort of get up to speed on this till you've seen it a few times. But because you can have more than one infection at a time, and often people do, and like we've said, even with, you know, long COVID and other stuff like that, a lot of people might have COVID, we identify that, but they may also have other infections, opportunistic things like Epstein-Barr virus or a fungus or whatever, and those are going on. If those don't get treated, uh, what you do for COVID is probably not going to take care of them. That's the common thing that happens. So the first thing is if you're kind of stalled, and we see this a lot with people who may, you know, they've identified Lyme disease or they've identified another chronic bacteria or something, they're getting real specific antibiotic therapy for it and they're getting, you know, they just can't seem to get ahead of it. They're getting sicker. And, you know, these real specific antibiotic therapies don't seem to be helping. Well, they might be helping what they're targeted for, but you got all these other co-infections there for many, many reasons. So the first thing is, if it's, you know, if you've got a good therapeutic strategy for what you think is wrong and you're not kind of, you know, resolving in the time that your healthcare provider believes that you should be resolving, the next thing to do is to take a step back and say, well, this might be the fault of other infections that were either there before or have come in because they're opportunistic and I'm fighting over here and they came in over here. And we might need to step back and say, what else is going on? Are there viruses happening? Like I mentioned Epstein-Barr virus, it's in a family called the HHV viral family. And that family loves to be opportunistic. So let's say you're treating away for some bacterial infections or something else, and all the efforts go in there. Well, these HHV family like Epstein-Barr and CMV and stuff, they like to come in and, and they often are already in our bodies, and they just like to reanimate and start dividing and creating their own trouble. Uh, so Epstein-Barr and its whole family, we've seen that with COVID but we see it with Lyme disease patients and all sorts of other things. Another area that happens a lot is because of the treatment, you may be developing either gastrointestinal fungal issues or things like systemic fungal issues, etc. And if the— again, if you're not treating for that type of an organism, that becomes a significant problem. The other thing that we'll see a lot of times, as was sort of talked about in the original, like the standard definition of superinfection, is you got a lot of antibiotics directed in this point of view. So, you know, your healthcare provider thought, well, this is the type of infection, this is the type of drug that helps that infection, so you get that and it probably even knocks down that infection. But in the bacterial world with antibiotics, there's a lot of other Infectious agents that don't care about that antibiotic you got. So again, you have to kind of take a step back and say, did somebody else, you know, rise up because I was focusing everything here? So we're going to wrap up here in just a minute, but just to kind of put a point on this, why often people with chronic infections do not feel that their infections are getting better or they are healing. There are many, many reasons for that. We're going to do separate little videos on them, but one of the reasons can be other infections that are just there. And a lot of these infections are things that we carry with us, a lot of viruses we carry with us, and certain bacteria that are at very low levels. But then we start putting a lot of treatment effort and immune effort into this. one area and the other infections rise up. So we want to look at that. If we're not— we're plateaued, we're not getting better— good to step back and take a look. And you can do that by testing. Again, the HHV family that Epstein-Barr is in is a super common one. The chronic pneumonia organisms that are, uh, very commonly in the air, and if you're sick, you tend to get a Mycoplasma pneumoniae Chlamydia pneumoniae, sometimes even chronic streptococcal, chronic strep issues. There's many other viruses potentially. There's a lot of parasites, helminths or worms, you know, things that you might find in the GI tract. And then as I said, there are other bacteria that may not be being targeted bacteria or parasites that are truly co-infections. Well, we're gonna now take a break and when we come back, we're gonna be talking about the next set of conditions.