THE ROLE OF CHRONIC INFECTIONS IN CHRONIC ILLNESS

Welcome to Medicine and Health with Dr. Paul Anderson. This is a show about opening the often mysterious world of how doctors think and how science works. This program exists to educate and empower you, the listener. Now here's your host, Dr. Paul. Good day and welcome to Medicine and Health. Today we want to talk about the involvement of chronic infections In other chronic illnesses. And so that could be something like a chronic infectious disease. Maybe someone has Lyme complex illness or Lyme disease. That could be something like autoimmunity. It could be something like chronic fatigue syndrome, fibromyalgia. It could even be something that would involve itself in the way cancer plays out. Chronic infections weave their way into chronic health problems, and often they are under the radar enough that we don't know that they're there, so they actually have to be looked for. So the way I want to lay this out today is to speak about the concept and how it happens. Then we want to talk about Why would it be that, you know, you may have this problem and you could live with someone, or it could be your spouse or something, and they don't have that problem? How can you have 2 people in the same family and only, you know, one of them has it? Or 5 people living in the same household, only one of them really has a problem. We want to get into how does it happen. We want to get into the sub-disease areas where this can play itself out, like we talked a little bit about in the intro. And then we also want to talk about, you know, what infections are more common to be chronic and create these problems. So the first thing, which we'll just expand a little bit on the intro, and then I'll kind of weave this story in a little bit later as we're going on, is Where in chronic illness do we see this chronic infection overlay? Now, the first thing I want to be really clear about is it doesn't always mean that the infection is the cause. It might be part of the cause, but often the infection will be aggravating to either the cause or the disease process or both. So when we think about that, then when we talk about things like in autoimmunity, There is a 2-way relationship that goes on between the autoimmune pathology and infectious disease that is chronic. And it's not always that, you know, the infection caused the autoimmunity, but it certainly can aggravate it. Now, as we've talked about before, in autoimmunity, that is where your immune system is actually attacking you. So one of the theories behind how this happens is, uh, a cross-reactivity where the infection will get to a tissue or cells, the immune system goes and cleans up the infection and accidentally makes some memory cells not just against the infection but also against you in whatever area that was in. The other way that infections can aggravate autoimmunity is because the infectious process is actually stimulating to a lot of the chemistry, the immune chemistry in your body. Because if we think about it and we get an infection from the outside, we want to kill it, get rid of it, etc. That's the job of the immune system. Well, the only way the immune system can rise to the occasion, as it were, is through this immune chemistry. So if I've got an autoimmune person on one hand, and then I have an infection that's creating this bump and up and down in immune chemistry, the autoimmune person already has presets where those shifts and changes that go on in the autoimmune person because of the chronic infection will aggravate the autoimmunity. So there's a lot of ways that that can happen. with autoimmunity and chronic infections. Another is, as was mentioned in the intro, fatiguing syndrome. So it could be just fatigue itself, it could be chronic fatigue syndrome, CFS/ME, it could be fibromyalgia, could be any, you know, any mystery fatigue can have an infectious overlay. Now, if you look at just statistically, if you look at enough chronic fatigue fibromyalgia patients, if you check all of them for some of the chronic infections we're going to talk about, just about 100% will come up with them. The degree to which a person with a fatiguing illness has a chronic infection is variable. And what I mean by that is, although most of the patients would come up with something that's chronic, in some people it might be one chronic infection and fairly easy to handle, and their fatigue is contributed to by the infection but a bunch of other stuff. Then in other people, if you look and, uh, they have a, you know, chronic fatigue, fibromyalgia, uh, symptomatology, you may look and there might be a bunch of infections that affect a bunch of the parts of the body. And again, they may not be the cause or the sole cause of the fatiguing illness, but they will be a piece of it. Because one of the things that most people notice with a chronic infectious problem, whether they know they have it or not, is that the most common symptoms include fatigue, include pain, they can include sleep disturbance and other things. Well, those cross over with autoimmunity, cross over with chronic fatigue and fibromyalgia, they cross over with a number of other issues. The next thing, and I'll point these out when we talk about the what or the which infections do this, and that is that we, we have your whole body where the chronic infection can wind up and can create problems. But in people and looking at their symptoms when they're coming in and they don't realize that they have maybe a chronic infection or infections, some of the more common areas that occur after fatigue and energy— we call it constitutional type symptoms— are cardiac symptoms. So you can literally have heart or vascular issues that come up. Neurological issues. So that could be something like headaches. It could be something like aggravation of other neurological disorders like MS or Parkinson's disease, et cetera. It can be an aggravation of a peripheral nerve problem like peripheral neuropathy. So anything that your nervous system does can be aggravated by chronic infection. What's another thing that can happen though that can be aggravated? What does your nervous system do to keep you running? All of the neurochemistry, so the neurotransmitters that occur in your body and in your brain to help operate your brain and your nervous system, those can be directly affected by your chronic infections. And then the other thing is the maintenance and care that your body has for the brain and the spinal cord, etc. Part of that are these membranes that have to work together, and they have to work together in an effort to protect your brain and your spinal cord, but also to keep the neurotransmitters in that are supposed to be in and to keep toxins out and move toxins out. Well, it turns out that these chronic infections can also be a problem for those protective membranes. And so there are many ways the nervous system is affected. Remember I said the heart, the cardiovascular system definitely can be affected. The lungs we're gonna talk about separately 'cause they're sort of one of the bigger ways into the body for a lot of these. And then also your digestive system can be heavily affected by chronic infections. Now, sometimes some of the digestive problems that occur are directly due to a chronic infection or infectious agent. But a lot of times it's just the stress that the infection puts on the body that can throw off the good flora, the good bugs in your digestive tract, that can create a problem. And then another real common area that we see is orthopedic, being joint pain. And the joint pain can be very severe, but it can be inflammatory. And so for instance, if you don't have, say, a trauma where you twisted your ankle or you fell down and maybe broke or hurt a joint or something like that, So there's no history of that. You start to have joint pain. Usually your doctor will do some imaging and they'll look. And if there's not some sort of spontaneous problem or a metastatic disease problem or one of the other kind of big bad reasons for joint pain, a lot of times it will be called inflammatory. So they might do some inflammatory labs, et cetera. Well, in our experience, some of those turn out to be Secondary to these chronic infections as well. Now, so we kind of talked about where in your body these things might show up. How do they get into us? So we want to talk about how these infections get into us, and then secondarily, I want to talk about why is there this paradox where it might happen to me, but everyone else I live with doesn't have any of these problems. Or, you know, if it's, you know, some heritable thing, why am I the only person in my family who's having this problem? So the first thing is that there has to be exposure. So with any infection, the first job to get it into you is to have some sort of exposure. Well, what I would often tell patients is, And I'm, you know, living and practicing in the Northwest, at least for the last, I think, 18 years. Um, and, and so I would say, well, you know, during the winter we have a lot of things in the colder climates, especially the Northwest, that people are coughing and sneezing around on everybody. Now, these are the days pre-COVID. If you're listening live, we're still in COVID. It's, uh, uh, May 12th, uh, 2022. So prior to COVID, though, people might be concerned if the flu was going around, you know, or the office had a bad cold going around. But generally speaking, people weren't— it wasn't on their mind as much, you know, viral or bacterial or fungal transmission. So now that we all think about it, it's that idea of what have I been exposed to? But there are 2 parts. Especially with a chronic infection, there's sort of 2 parts of the puzzle. One is exposure and the other is susceptibility to the infection. So if you look at, you know, kind of the principles of infectious illness, the first thing is you have to have an exposure, you know, so a vector into your body, whether it's someone sneezing or coughing or it's something that's on the doorknobs and you touch your eyes or your mouth or something, or whatever way you got it, then you have to have a combination of susceptibility of your immune system and virulence, or how able to infect you the bug is. So if— and this, this is where a lot of these chronic things come in, uh, where let's say there's a you know, common virus or something, and everybody's pretty much had it by the time they're 20 years old. So take example of like Epstein-Barr virus, uh, you know, the statistics on positive, um, antibodies to Epstein-Barr, you know, in people over 25 years old is like 98% or something like that. High, high, because most people have experienced Epstein-Barr either as a flu-like illness or like mono or or something when they were younger, if you retain all those antibodies and all those T-cell immune fractions that stay in your immune system, the next time you are exposed to Epstein-Barr, those immune factors will rise and either kick you out or sequester you or just kill you. Okay, if it's a T-cell line and you've got T memory cells, You know, a lot of them are cytotoxic. They'll just go kill the virus that invaded. What if you were exposed though, and you are one of those people that chronically reactivate your Epstein-Barr? Well, that is where the exposure part happens, and you don't have the immune system to fight back, and everyone else in your family does. So you all get exposed to Epstein-Barr, but you're the only one who reacts to it. And that is why there's this uneven transmission and, you know, positive symptom picture of chronic infections across humans. Now, usually there's a portal of entry, and the reason why most of the chronic infections have something to do with mucous membranes is that is the way in for the most part. So that's Eyes, ears, nose, throat, and then the lungs. So those are the respiratory mucosa, the ENT mucosa, if you will. There's a digestive system that's got a mucous membrane, set of mucous membranes. And then once in the body, you, uh, can have it just stick around in the area like the lungs or the sinuses or someplace, or it can go systemic. And this is where you get systemic effects such as the fatigue that occurs, pain that can be nonspecific or specific like joint pain, etc., etc. So you have to have entry, you have to have a susceptibility, and usually susceptibility means that, uh, the immune system was not able to see this old bug and push it back out. And so the susceptibility you have then is not having a complete immune response. Now, before we move into some more how, etc., there's another area where infections get involved. I'm going to say I need to be careful talking about this. It's not like anything bad is going to happen to me, but the concept can be misconstrued a little bit. Also, we don't know everything. We don't know everything about it. Everything, so there's probably parts of this story I'm about to tell you that there are holes in because we just don't understand the the immunobiology behind all of it. But I do want to bring it up because a large patient group that that I work with and I do work in and write about etc. are people with cancer, so the oncology world. And so there are associations with some infections. and cellular changes and then cancers that occur, such as the HPV viral strains. Certain of them are associated with more cervical changes in the cells and then cervical cancer. There are other infections like H. pylori in the stomach that is associated with some types of stomach cancers, etc., and other changes that go on. There are definitely direct associations between certain infections and cancers, but there are also secondary associations between the aggressiveness of certain types of cancers and those infections. Then something later in the cancer process we call secondary prevention. In my experience, one of the factors you have to rule out is the presence of chronic infection. Just while we're talking about susceptibility and exposure and all of that, I want you to know that in the world of cancer, there's a couple of routes into the body and the immune system that might allow a chronic infection to be a piece of the cancer picture, either as a trigger like H. pylori or the HPV virus, et cetera, or as an aggravating factor. Like we said, with autoimmunity, your immune system's already not working great. Then you have a chronic infection stimulating a lot of your immune chemistry, and your not working great immune system gets stimulated, and the stimulation isn't a good stimulation. You don't feel as well. And that is very common with autoimmunity. Well, in cancer, you have sort of a different type of immunologic problem that occurs. with cancer. And so, like I said, if it's a direct trigger like H. pylori in the stomach or HPV virus in the cervix and cervical cancer, then that trigger is creating a local response where you get cellular changes that eventually lead to a cancerous progress that goes on. But there are also things such as in advanced prostate cancer. So we're moving way past cause or trigger now to disease process later on. There are more advanced cancers sometimes that have been related in the literature to chronic infections. So prostate cancer is one of them. Now, I did a review about this on my physician continuing education website, and it was about aggressive prostate cancer. And we know that, you know, if you catch breast cancer or prostate cancer early in the process, it's usually very, quote unquote, curable. It's very easy to contain, etc. When you get an aggressive, kind of out-of-control prostate cancer, then you can have problems In regard to it not being as easy to control, the disease state can churn on and get worse, etc.? Well, among many things, one of the things that has been found in the research with advanced prostate cancer is an association with a lot of different types of chronic infections. And the problem that occurs is every time a researcher goes, they normally try and look for one magic bullet bug. But when I did the review and looked into all the different types of infections that can go on, there is probably somewhere around 15 different infectious types that have been identified in the literature that are associated with aggressive advanced prostate cancer. And that includes things from different categories of infection such as virus, parasites, bacteria, etc., fungus. So when we look at cancer, we have a spectrum. There, there are the triggering cause agents, less of those are known. Then there are the aggravating agents, and then there are those that get involved in advanced disease. Now, the other thing I brought up about cancer was there's also this concept of secondary prevention. And that is where your oncologist usually has said you have no evidence of disease or you're in remission or something. And the bottom line is we're done treating you for it right now. We're going to monitor you and watch and wait and see what happens. Well, if you go into no evidence of disease or remission and you're looking for everything you can to stay keep from having the cancer return, we call that secondary prevention. One of the things, and this is more a function of the last decade of people looking for secondary prevention, because before 10 years ago, it was very rare for people to look for secondary prevention medical strategies. It happened, but it was more rare. Now it's more common. What we do with those folks in secondary prevention with cancer is we will look And we will check them for chronic problems that have either occurred because of the cancer that they have, or maybe all of the treatment they had to undergo, chemotherapy and radiation, etc., or other things associated with the cancer, the immune deregulation, etc. So we'll check their hormone function and balance. We will check their digestive function and balance. We will check them for, you know, any number of other things. But one of the things we'll check for are chronic infections. Because if you get to the other end and you've had immune suppressive treatments, especially for your cancer, it's very common. Remember, you— that you need exposure and then some sort of symbiotic relationship with your body where the bug is allowed to get in and stay. Well, cancer treatment can be one of those reasons. So what we find is if we are clearing out, you know, underlying reasons for the cancer to return, Chronic infections become one of those things that we want to clear out. So that kind of goes, you know, where in the body would we see these things and feel them? Um, you know, how do we open the door? Where does it come in usually? And I said a lot of the mucosal membranes— eye, ear, nose, throat, and lung areas— really a big one. Of course, you can get things through needle sticks and other routes of administration as well. But a lot of them are airborne or tactile. So you're touching a fomite and then you rub your eye or someplace and it gets on a mucous membrane and goes in that way. Now, when we're thinking about how do these things create these problems in chronic illness? So when we're thinking about a chronic infection, creating symptoms. One of the things I told you is if you already have an autoimmune disease, and so your immune system is not very well balanced and it's not good at kind of keeping the level that the immune system is supposed to— in autoimmunity, uh, you lose a bit of that— if I then have an immune challenge like an infection that hasn't gone away, my immune system will start to react to that And if I already have autoimmunity, the reaction and the chemistry may cross-react with my autoimmune immune imbalance, and that might make my symptoms worse, or it might make some part of the disease worse. Well, another thing that happens very commonly is, as I said, you know, these constitutional or systemic-like symptoms like fatigue and pain. Now, there's a couple of reasons that this can occur. One of them is simply when your body is fighting, even if you don't know that you have an infection, if your body is fighting heavily the infection, it can take away energy and resources from you and you can feel fatigued. Fatigue is one of the very common, you know, global symptoms that people will get. The other thing that can happen is you wind up with pain secondary to inflammation. And so chronic infections— viruses do this a lot, but others do it as well— can be associated with specific pain like joint pain. And I've had patients where they would say, man, as soon as my knees start hurting, I know maybe I'm flared up, or when my, you know, thumb joints start hurting, things that we would often lay off to— well, you're getting old, maybe you have some osteoarthritis, etc.— sometimes those are literally infectious in nature. When you look at global pain, such as you might see in a fibromyalgia patient or chronic fatigue patient or a chronic pain patient, the same thing happens as would maybe happen with an autoimmune person, but instead of throwing off your autoimmune damaged immune system, the immune chemistry that goes on churning every day because of the chronic infection creates a level of inflammation that rises, and that can either just make you hurt all over peripherally, or it can damage the membranes around your brain and cause your brain chemistry to shift. So you have something called central pain syndrome. Now, are these the only reasons why we might get, you know, specific or nonspecific pain? The only reasons we might get fatigue? No. These are certainly not the only reasons. It's just that once you rule out the other sorts of causes, for example, you've ruled out to the best of your ability, it's not cancer, it's not osteoarthritis, it's not rheumatoid arthritis, it's not secondary to a bad anemia or diabetes or some metabolic disease or something. And when you sort of ruled everything else out and then there's still specific and high-level, say, pain or fatigue, infections are something that you have to back up and take a look at and, you know, turn some rocks over to see what's going on. Now, another thing that happens is immune competition. And this is where your chronic infection is beating away on your immune system and it's drawing resources to fight with the chronic infection, What happens is the competitive ability of your immune system to hold other bugs out goes down. So it is not uncommon in these types of chronic cases where the person might start with one infection and they were kind of handling it, and then they got a little less and a little less able to handle it, and then that opened the door for the next infection to come in. And clinically, we would, you know, talk to people about literally collecting infections. So when you say, well, why would I get it and the other people don't? A lot of it is this immune competition, and they're probably holding all the bugs out with their immune system, and you had something that opened the door. So now you're dealing with 2, and it's easy to go from 2 to 4 and, uh, and on and on and on, you know, more and more and more as you go through. So when we're thinking about it and we're thinking about how do these bugs get in, why would I have it, no one else in my family does, or why am I the only person at work who gets as sick as I do, or whatever, there's a number of reasons when we talk about opening up the door. So I said, you know, just having an infection, having immune competition. The infection drains your immune system's energy, it drains your energy, and then other stuff comes in. Well, there's other things such as aberrant or unusual immune function. So you can be born with a deficit in your immunity, and it doesn't have to be as remarkable as the people with total immune dysfunction like the boy in the plastic bubble or something of that nature. A lot of people are, are, you know, going out and about in the world and they actually have immune dysfunction that maybe, maybe was inherited. Or the other way you can get it is secondary immune dysfunction, and that often goes along with the use of certain drugs, immune treatments that may have wiped out your immune system, such as chemotherapy. radiation, etc. So all of these things that can drag your immune system down can trigger these sorts of problems. The other thing can be, and this is very common when we get people with chronic infections who are, you know, really trying to get to the bottom of it and say, if I don't have a hardwired, you know, genetic immune deficiency, can we get my immune system cleaned up enough where we can get rid of these bugs? And the answer is yes, but sometimes it takes a while. And so the things beyond an immune deficiency and drugs that create an immune deficiency that we're most keen to look at would be resistance factors that we can do something about, we can undo. So How does that work out? If you're born with a genetic immune deficiency, we can only do so much to help protect you. We can do a lot, but we can only do so much because genetically you're born missing either pieces or collateral portions of your immune system. And so those things that are missing just are never going to work normally. support your immune system, do all this stuff. But if you're not born with one of those genetic immune defects and you don't have to be on drugs that are immunosuppressive, which is another topic, then modifiable factors that we look at are resistance factors. So one of the big ones that we've talked about before, and I've done a lot of work with, are called biofilms. And so a biofilm is a very normal part of the biology of microbes. So, you know, bacteria and some other microbes get involved in biofilms, and biofilms are very well known in, you know, aquatic environments, very, very common. Well, they've been known about in humans for a long, long time, and for the longest time we said, well, they're, they're very clearly part of our oropharyngeal health. Biofilms get involved in dental problems and other stuff like that. Well, anywhere where, where it's moist and wet, like your mucous membranes, like your mouth, you create a biofilm. Well, the other thing is that a biofilm then becomes a hive-like place where the bacteria and some viruses and parasites and fungus can all live together. And the hive-like area of the biofilm becomes a resistive barrier against antibiotics and anti-infective drugs and things. So without doing a whole hour on biofilms, just keep in mind that we all have some normal biofilms in our body, in our GI tract. When we've been sick a while, the bugs that can build bigger biofilms that are not normal and are not good for you will start to build and get thicker and thicker walls, you could say, this little hive-like structure. And so what we've identified in the world of the not good biofilms, so the pathological ones, is there are smaller, thinner hives and bigger, thicker hives. And the sicker you've been, the longer you've been sick, the more biofilms build up. And this is why people will find sometimes on a serology, a blood test, positive to this bug and that bug, but it doesn't respond to anti-infective drugs. Or sometimes what will happen is you will be sure that there is some infection there, but you go to test and there's no— nothing comes up in the test. This happens a lot with biofilm agents in the digestive tract, for example. So biofilms are a big resistance factor. Another resistance factor which also messes with your immune system are toxins and the exposure to toxins. Now, if we wanted to stratify between metals and chemicals, the type of chemical toxins that tend to be the most opening of the door to chronic infections are actually called biotoxins or mycotoxins. Mycotoxins are mold toxins, and I'll usually say there's 3 ways that mold could potentially make you sick. One is as a direct infectious agent, and if you're infected with a mold, you're in big trouble. It's usually not compatible with life unless you really are, you know, hot on to treat it. The other would be an allergy to the mold, where you actually have an allergic reaction to the mold. And then the third, which is probably the most deranging of your immune system, would be the, um, the mycotoxin. So the mold, uh, toxin that is released actually is what you're reacting to. So it's— you're not reacting to the mold itself, but the poison that it gives And why is the mycotoxin, which is a biotoxin— so it's a chemical toxin that comes from a biologic, in this case being mold— why is that such a big deal and such a problem? Well, it's such a problem because a lot of the mycotoxins are directly immune inhibitory. As a matter of fact, there are mycotoxins that are made into drugs to be immune suppressive. Wow. Okay, and so if I have mold exposure and I don't know it, that is one of the big ways that we either have a person, you know, who can't ever clear out their Epstein-Barr virus, or who's got Epstein-Barr and 4 other infections and can't seem to get ahead of them. Ruling out mold has to be— or, or mycotoxin exposure has to be one of the first things that you look at with these chronic cases, because it's just like if you were taking an immune suppressive drug, only you're, you know, being exposed to it in the environment. And if you don't know you're being exposed to it, you won't realize how troublesome it is. Now, there are ways to test for mycotoxins. A lot of them are urine screening tests. There's also ways to have your home looked at and tested for mycotoxins or your work or whatever. And then there are ways to remediate it. So when we're looking at opening the door, resistance factors like biofilms and mycotoxins and then other toxins too, so metals and chemicals and things. can also sideline your immune system either directly or indirectly. So the next thing that I said I would talk about would be which infections are the most common. I'm going to go through a list of very common infections, but we're certainly not going to talk about all of them. And what I would normally tell patients is when you're looking at lab testing for chronic infections, it's really a survey test. Okay, so what that means is that we can test for certain, uh, categories and families and infections, etc., but we may not be able to test for all of them. The other thing is that some tests are very sensitive and specific, meaning they're very, you know, likely to find when you do have the disease. and also be negative when you don't have the disease. Other tests are a little more fuzzy and broad, and you have to correlate the answer on the test with your clinical signs and symptoms and things of that nature. So when we talk about these bugs, you know, a lot of them you'll think, well, I've heard of that bug, and I thought you just got that when you were a kid. Well, most of the time, remember, like I said with Epstein-Barr, most of the time that's true. You get it when you're a kid, you develop some immunity and boom, you're, you're fine for the rest of your life, right? Well, when you get things that open the door, whether it's biofilms or immune suppressive drugs or toxins or treatments that you had that were immune suppressive, or just too many infections in your body that's immune suppressive, once you get all that going, then stuff that only would have bothered you when you were a kid now bothers you as an adult. So the first, and these don't go in any particular order, but the first that we'll look at would be virus. And when we think of virus, the, the big family we call the human herpesvirus family, and a lot of people think, oh well, I've heard of herpes, right? So human herpesvirus family, we've identified primarily— there's a lot of them, but we've identified 8 HHV viruses that have a human pathology or pathologies associated. HHV-1 and 2 are also known as herpes simplex virus 1 and 2, and normally type 1 is usually oral, you know, herpetic lesions. Type 2 is usually genital herpetic lesions, although you should know that type 1 and 2 can be in either location. Now, those can be active, as they're certainly chronic infections because they don't like to go away, but they don't usually cause a lot of systemic symptomatology, although they can. The HHV that I'm more concerned with when we get to our chronic patients are HHV number 3. So 1 and 2 are the herpes simplex twins, 1 and 2. Number 3 is called varicella-zoster. This is the chickenpox virus that also can cause shingles in an adult. Number 4 is Epstein-Barr virus, which is the one of the agents of mono, but it's also involved in chronic fatiguing illnesses, etc. Number also some cancers. HHV-5 is cytomegalovirus, and that's another one. It look— it can look exactly like mono or Epstein-Barr, so a lot of times we check them both. And here's the thing, where one of them is, the other one usually isn't far behind. Now we hear about cytomegalovirus, HHV number 5, and we hear about some really bad things like blindness and brain damage and maybe even brain tumors and other stuff, which is true. Um, cytomegalovirus is also, uh, one of those things that's, uh, very bad if you, you know, get it while you're pregnant, etc. So when we think about cytomegalovirus, it's a lot like Epstein-Barr. Its biology is slightly different, and it causes a lot of the same disease states in the younger person. So normally what we teach people is if you have a classic you know, teenager with mono, you do an Epstein-Barr test and it's negative, you can assume it's cytomegalovirus because that causes the same type of disease. Well, in the adult with immune dysregulation, cytomegalovirus HHV-5 and Epstein-Barr HHV-4 create the same type of fatiguing and painful illnesses as well. HHV-6 is in children, roseola, roseola infantum. That's where you have fever and rash and things of that nature. In adults, HHV-6 usually doesn't cause roseola, it usually just makes you fatigued. HHV-7 is very unheard of unless you have an immunodeficiency, and then you see HHV-7 a lot in people, and it causes sort of a nondescript febrile and fatiguing illness. HHV-8 is known as the Kaposi's sarcoma. You hear about that with AIDS patients. Remember, with Kaposi's sarcoma, it was an extremely rare type of cancer sarcoma, and when HIV disease and AIDS came about, people in full-blown AIDS would have Kaposi's sarcoma. Well, turns out it was the HHV number 8 that was being activated, and that was stimulating the Kaposi sarcoma. There's also non-human herpesvirus viruses that we see a lot. One is called the Coxsackievirus. Coxsackievirus is known for hand, foot, and mouth disease in children. It's also a common herding animal type of a virus. There's a Coxsackie A and B. Those tend to like the nervous system or the cardiovascular system. And so a lot of times in the rule-out of somebody with chest pain, when there's no organic problem and their heart isn't the reason for the chest pain, you'll get down to a viral cause. Well, Coxsackie can be one of those reasons. Now, most people will say, well, you know, hand, foot, and mouth is kind of limited to children. Although it's not really. If you have an outbreak in your house, you might get it as an adult. But the chronic Coxsackievirus problems, A, B, or both, those tend to be in your chronically ill patients. So people who've had— and they may not know it, but they've had some immune inhibition or immune competition, etc. Then there's also parvovirus, which we hear about for dogs, but Parvovirus B19. So the B19 strain of parvovirus— in children we hear about Fifth disease, which is the parvovirus exanthem that is in children. But in adults, there's this thing with parvo B19 that happens. And the classic example is you have a mother of a young child comes in and they're presenting with rheumatoid arthritis-like symptoms, usually Paired joint pain above the waist. It's hurting, it's hurting to move the elbows or the wrists or something. You check for rheumatoid arthritis, the RF factor and the ANA and everything, and nothing there. And usually if you see this and it's a mother with a young child, you'll run a parvo B19. It turns out that's positive. The upside is it's infectious and it's not autoimmune like rheumatoid arthritis, so that's good. But the downside is usually what happens, the reason that the classic story is, you know, a mother of a young child, the baby is processing B19 as Fifth disease that you may or may not even know, might have thought they had a cold. And then the mother has an antigenic reaction where their body gets stirred up and their immune system starts to, you know, fight, and it's starts to swell the joints, etc. So in a lot of people where there's not a baby around, so there's not a baby as the trigger, I've seen where people have other reasons for immune suppression, uh, and the parvo B19 will be a reason for their joint pain and other pains that come up. Then there's some fungal, uh, forms. Candida albicans is— and there's a bunch of Candidas, but the Candida family is probably number one. Um, and this again is opportunistic. Uh, you know, I remember, you know, 25, 35 years ago, uh, you know, Candida was blamed for every human ill, uh, and then Epstein-Barr was blamed, etc. And the point of that is not that they're not at fault sometimes, but the point is, is that they are a symptom of the immune system which has been beaten down and attacked and can no longer kind of fight back. And so Candida overgrows naturally. Now, of course, if you're eating a lot of sugar, Candida grows even better. If you've killed off a lot of the good bacteria in your digestive tract, say with antibiotics or something, um, you're gonna have trouble with Candida and other fungus. And there's fungal forms that can be in the gut and elsewhere, like Aspergillus Now, if you have Aspergillus, the fungus growing in your body, and it's you know outside of your digestive tract, you probably have a pretty hardcore immune deficiency because aspergillosis is associated with immune deficiency of a high order. You can also see it though in people who've been on steroids or immune blocking drugs for other diseases. Um, and, and it's one of the things that we will check people for if they're quite ill. Um, the bottom line with things like Candida and aspergillosis and some of these other ones is, uh, if it's there, you really want to kill it. Now, there's good antifungal drugs. There's also, as I said, things you can do with your diet to support the drugs. And there's a lot of antifungal botanical medicines or herb-based medicines. And we usually use these all in combination when it comes to that. Then there are some chronic bacterial things. So talked about these a lot. These are very common with COVID but they're common with other stuff because they get in the respiratory system. And unless you treat them, they just hang out and they can go into a storage form. For example, one of them has a cystic form. The other one can just sort of go into a storage form, and they could last for quite a long time. And like I say, if you don't kill them, they never leave you. So just— they're a little bit viral-like, and that is the pneumoniae organisms. So there is Mycoplasma pneumoniae, and sometimes people confuse that with Mycobacterium. bugs, but the Mycobacterium are other lung bugs like tuberculosis and M. avium and things of that nature. So Mycoplasma are actually the smallest bacteria that we know about. They're atypical in that they don't have a cell wall like most bacteria do, and they're exceedingly common. It's like I say, this is one that gets coughed around on everybody in the winter. And if you've got good robust immune response, you may not let it in. Once it's in though, if you're chronically ill, it'll stay forever. And its cousin you could consider, although they're not really cousins biologically, is Chlamydia pneumoniae. Now, Chlamydia pneumoniae is not the sexually transmitted infection, the STD, STI Chlamydia. That is a different one. This is the one that is inhaled and stays in your lung tissue. And it's a lot like mycoplasma, unless you kill it, it's gonna be a problem. Also strep can do this. So we all think, well, I had strep throat, I shouldn't be getting a whole lot more of those. And that is true, although there are some chronic strep sequelae that come along. The pediatric autoimmune neurological disorder, family, PANS, PANDAS, et cetera. Those are triggered by an immunologic cross-reactivity with the strep bacteria. And so in people who are having that, because it's often in pediatrics, but we now know adults can get a PANS-like syndrome, we're gonna check those guys for not only the presence or activity of the streptococcal bacteria, bacteria, but also for co-infections, these other infections that we see. And then we're going to also look for immune suppressive things like mold, mycotoxins, and stuff. Then there's the infamous Lyme disease family. So Borrelia burgdorferi and all of the Borrelia family are associated— the Borrelia burgdorferi and a few others associated with Lyme disease. from the deer tick. But also there are other infections that almost always go with Lyme. And these are things, you know, such as the Bartonella. And, you know, there's other— a host of other bacteria. Now, just like I've talked about with COVID where I did a review, you know, a couple of months ago, and I put all those papers in the show notes about, you know, COVID and other infections or co-infection, we call them. Lyme disease has co-infections and other infections that tag along. And so a lot of times one of the frustrations in treating— someone's trying to treat their Lyme and they're killing it with the right, you know, anti-Lyme antibiotics and stuff, but they never get better. It's because there's these other infections there keeping the fire going. And Often there's an immunologic deficit either through toxins like mycotoxins or chemicals, metals, etc., or immune suppressive drug treatment present or past, maybe a hardwired immune deficiency that you have that you don't know about, etc. And then the final place, although like I say, this is just the tip of the iceberg of chronic infectious bugs are a lot of things that, that thankfully stay with the digestive tract, but they can create a body-wide problem because, uh, number one, they take away the healthy protective, uh, good bacteria, the good flora in your GI tract. They confuse and inflame your GI immune system, and they confuse and inflame your— GI nervous system as well. So they can cause systemic symptoms in that way. Now, a lot of these are what we call dysbiotic organisms. So they might supposed to be there in tiny amounts but not in big amounts. So you might see things like Candida overgrowth or Aspergillus and fungal elements. You might see, you know, people depending on where you live in the world and also what you've been eating, you might get worms. Helminthic things or parasites, a lot of foodborne things that get in and stay in the digestive tract. And then of course there's a lot of virus. What we're finding out now— we talked about cytomegalovirus, HHV number 5— and that's also associated now with inflammatory bowel disease like colitis and Crohn's and stuff. We're just about out of time here. And so I just want to kind of roll back around and say we're looking at chronic infections. Why would they get in? Why doesn't everyone get them? And what kind of disease problems they stir up. We'll get back here and we'll do some more on this topic as we come up in the future. If you're on a PodBurner, if you're Facebook Live, if you're on YouTube, please like, share, and subscribe. The YouTube channel is growing, and that is where I put the show notes. So if there are show notes for a program, they go right there on YouTube, and our home is CTR Radio Network. All right, well, thank you everybody for Medicine Health, and I will see you all on the radio next week.