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Avatar universal

Frequent Infections

Hello there.

I am a 23 year old who eats well and is very physically active, but I have been experiencing infection after infection lately. It all started two or three months ago with a UTI. I have had a UTI in the past so I wasn't entirely surprised by it, and it quickly resolved with a course of Cipro. However, a few weeks after the UTI I developed a pretty substantial case of diarrhea that lasted for an entire week. I went to the doctor and was told I likely have C. diff due to being on recent antibiotics and because I work in a hospital setting. I was prescribed a course of Flagyl. The Flagyl seemed to work, although I developed some kind of peripheral neuropathy around the same time involving muscle twitching and cramping. Called the doctor about that when it persisted, who told me it could actually be a side effect (albeit a rare one) of the Flagyl or due to an electrolyte imbalance from the diarrhea. I began taking magnesium/calcium supplements and increased my potassium intake, although the symptoms have still persisted somewhat. Then, one week later I developed oral thrush. I returned to the doctor yet again and was prescribed Nystatin, which seems to be working. I was told it was likely the Flagyl, but it still is not common in adults. And then, three days ago, I seemed to develop consistent diarrhea again. I am very worried the C. diff. is recurring.

My question is this: as a young adult with a fairly healthy lifestyle and benign medical history, should I be worried that there is something wrong with my immune system? I am usually rarely sick, and the fact that this has all been happening in such a short period of time worries me. I have been feeling just generally fatigued and shaky lately and my appetite is not the greatest, but I am not sure if that is from the GI symptoms or from some stress I have been under lately. I am really hesitant to return to the doctor again because of how frequently I have been going (although I am not sure if I have a choice if the C. diff. has in fact returned).

Thank you!
14 Responses
1415174 tn?1453246703
COMMUNITY LEADER
Hi and sorry you have been ill. I am not a doctor. These sites do not have doctors for the most part. But I am a microbiologist and will try to explain what is going on.

Actually both Ciprofloxacin and Metronidazole can both cause peripheral neuropathy as a side effect of the drug. This can be temporary if you get off the drug right away or permanent. They can also cause tendon rupture and so forth. So that may be the reason why you felt the nerve problems. The diarrhea
could also have been a side effect of the medication or it could have been from the Clostridium difficile toxin. The mistake the doctor made was to not do a culture on you and to give you another antibiotic (Metronidazole) to make sure you had C. diff instead. Yes the treatment is Metro is you have C.diff but it is best not to treat before you have a true diagnosis. That is why we have increasing drug resistance. So now you have take two antibiotics which have caused an imbalance in your intestinal bacterial  flora which may have caused the C.diff to start with or not and in addition you have yeast over growth. So now you are on Nystatin to control the yeast and probably have the C. diff back again or if you didn't have it to start with you do now. So you will probably have to go back on Metronidazole but then you have the peripheral neuropathy to contend with.  It isn't uncommon to get a recurrance of C. diff with or without another antibiotic. When you have it it tends to contaminate your environment and you have to bleach everything down. So no I don't think there is anything wrong with your immune system. One thing you may want to try are probiotics. Get one that has many types of bacteria like lactobacillus, bifidobacteria and so forth. They usually have live bacteria 10 to the 9th colonies. This is over the counter. It can be taken whether or not you are on antibiotics. You need to be tested for C. difficile toxin A and B and go from there. If you have it they will have to give you Metronidazole again. The thing you have to decide is do  you want to risk getting a permanent peripheral neuropathy since it sounds like the metronidazole (flagyl) triggered it. It could have been the cipro or the flagyl or both. There is another way to treat this. If you are positive for C. diff you could do a fecal transplant. This is going to sound very gross to you. You get a donor (family member who you know has no diseases such as hepatitis, HIV , C.difficile etc.) they have to get tested too for it. Then you do either an endoscopy or an anema and they insert some of their stool into you so that you repopulate your intestines with their bacteria. This is becoming standard treatment if metronidazole doesn't work or you recur.  I have some websites here.
http://www.medscape.com/viewarticle/810905

http://www.mayoclinic.org/medical-professionals/clinical-updates/digestive-diseases/quick-inexpensive-90-percent-cure-rate

I don't know if you are on Facebook but there is a FB site called Cdiff. these people all have it and are knowledgeable about it too because they have gone through alot.

so first get tested and make sure you have it before taking any more antibiotics.
Let me know if you have any more questions.

mkh9
1100598 tn?1413131026
I am not a fan of Cipro. I got C. Diff after a course of Cipro as well. C. Diff is difficult to treat. If Flagyl is not working, you should be on Vancomycin. There are some antibiotics that target only intestinal infections that would be better than Flagyl or Vanco. As Mkh9 said, go on probiotics. I would also add Saccromyces Boulidarii which is a good yeast. You want to take both twice a day for about a year.

1415174 tn?1453246703
COMMUNITY LEADER
I agree that Vancomycin is an option instead of the metronidazole. Although Vancomycin also has it side effects. It is the next drug in line if you want to continue the drug route. It won't cause peripheral neuropathy. It is something to discuss. Yes a "friendly" yeast is a good addition to the probiotics. Since you are being treated right now with Nystatin. It may kill of the yeast for now but after the Nystatin is finished it will be a good addition. Some things to think about.
mkh9
1100598 tn?1413131026
I remembered the name of the antibiotic I took for C. Diff when Vanco and Flagyl didn't work. It was called Xifaxan. I had to fight my insurance to cover it, because it was an off label use for C. Diff.
1415174 tn?1453246703
COMMUNITY LEADER
whisperwolf,
Did you ever get clear of the C.diff?
mkh9
Avatar universal
Thank you for your input, everyone. I really appreciate it.

mkh9 - I do remember reading that Cipro could potentially cause neuropathy, but I would have assumed it would have occurred closer to when I was taking the medication. I am long off the Cipro at this point. I actually returned to the doctor, who had me go for a battery of blood tests to make sure there aren't any other underlying reasons. The muscle twitching and cramping continues. I have also had consistent diarrhea with abdominal pain for the past two weeks now, so my doctor had me provide a sample to test for the C. diff. toxin. I am still awaiting all my test results, but am hoping they come back soon because the abdominal pain and diarrhea are becoming difficult to handle. Also wondering if the twitching is from dehydration/electrolyte balance at this point. My body isn't absorbing much of what I eat. My doctor didn't want to put me on Vancomycin yet unless he knew for sure I test positive for it, but at this point I just need something to make this better. It has been very difficult for me to work long hospital shifts feeling this way.

I have begun to take Probiotics. I'll have to look into the S. boulardii. I'm desperate.
1415174 tn?1453246703
COMMUNITY LEADER
Yes usually the Cipro would be fairly soon during or right after taking the Cipro.  I assume you have been tested for diabetes? Then there is just perhaps tendonitis or carpal tunnel. If you do a lot of repetitive work. Yes you are right probably the muscle twitching is still electrolyte imbalance with all the diarrhea.  The new guidelines are to take 2-3 stool cultures for C. diff to make sure you have it because the toxin test can come up false negative. Also, that if you have more than just diarrhea (cramping and so forth) then you should be on both methronidazole and vancomycin. But then there is the issue with the neuropathy. That is why I brought up the fecal transplant. As an option. But usually they don't do that unless you can't get rid of it through antibiotic means. Glad you are on the probiotics.  Maybe the doctor can give you something to relieve your symptoms. I wouldn't take anything OTC without asking though.  Sorry you are going through this.
mkh9
Avatar universal
mkh9 - Actually, my blood sugar tends to be on the low side. I am prone to hypoglycemic episodes between meals, so I eat smaller but more numerous meals throughout the day. And I would think carpal tunnel as well due to the amount of time I am in front of the computer at work, but the twitching and cramping is pretty widespread. But again, I'm definitely not absorbing much from my food so who knows. I am still waiting back results from a CMP, so I guess I'll see. They also ordered a CBC, TSH, ANA, and Lyme titer.

Hmm. I hope it doesn't come back as a false negative. I don't think this is going to improve unless I am prescribed something at this point. I don't think the doctor wants to risk putting me on Flagyl again. He actually put it under my "allergies" because he was worried about how poorly I reacted to it.

Thanks again for your help and insight! I appreciate it immensely.
1415174 tn?1453246703
COMMUNITY LEADER
Glad to help anyway I can. I was thinking about the neuropathy regarding the tendonitis. Not the muscle twitching and cramping. I do think the muscle twitching and cramping may be due to the electrolyte imbalance. It could be something else too. Yes if you are not absorbing the nutrients from the food that is not good either. Probalbly because it is passing through so fast. The ANA by itself doesn't mean you have Lupus. For Lupus it is the #1 misdiagnosed disease or at least autoimmune disease. There are about 6 tests that have to be positive to have lupus so don't let them diagnose you with it unless you get more testing. A few tests are C3 and C4 (complement) , anti DNA, and there are some others I would have to recheck to be sure. Also, Lyme can cause a false positive ANA titer.  And, if you really suspect Lyme and you come out negative you may want to get retested at IgeneX laboratory. They have a very specific test. So we'll see. Were you bitten by ticks?  Hope things work out ok. Let me know how it goes.
mkh9
Avatar universal
I just wanted to give a quick update.

My lab results came back in, and I found out two things: 1. The C. diff. did in fact come back. And 2. I had a positive Lyme titer. I do live in the northeast area of the country, where ticks are numerous, and I admittedly have spent a lot of time outside the past year (plus, I've spotted ticks on my car a few times and in other places). Although I don't remember a specific incident, I'm not entirely surprised.

Honestly, this was the first time I was "happy" to hear that my lab work showed something positive.

Anyway, thank you again for all your help! Now to hopefully get both of these things in check and move on.
1415174 tn?1453246703
COMMUNITY LEADER
So, did the C.diff come out positive too? How awful. So you will have to take Vancomycin (you still have the fecal transplant option which is now put into a pill form) and is becoming a standard treatment when you don't or can't take antibiotics, plus antibiotics for Lyme. I wouldn't wait long for the Lyme disease treatment.  

How long was it since you were bitten by the ticks? Did you have any target rash (erythemia migrans rash)? That is fine if you didn't as 30% or more more don't get one. I just wanted to know to pinpoint how long it has been since you were infected. The treatment is Doxycycline and should be for about 1-2 months. It depends on your symptoms. About 6 weeks if you have symptoms to 2 months not a couple of weeks. Click on about Lyme, then scroll to treatment. Go to far right of the Welcome to the 16th edition ,Dr. Buscaranos guidelines go to bottom where it says download guidelines. I got the PDF file there. It talks all about the various forms of the disease. I hope you caught it very early on.

http://www.ilads.org/

If your doctor is willing to test you for the co-infections that you can get along with Lymes disease then that is great. Otherwise you may want to find a Lyme literate or LLMD near you at the link I gave you. Coinfections are Ehrlichiosis, Babesiosis, Anaplasmosis, and Bartonella and also you can get Mycoplamsa pneumonia and other Mycoplasmas. There are PCR tests for these coinfections at IgeneX and some other labs have them as well, and usually are treated differently. Babesia is a parasite so that definitely is treated differently if you have it. Hopefully, you won't have any other co-infections but a lot of people do.

I don't know if you can get this link: That I gave you on the website so here it is:

http://www.ilads.org/lyme/B_guidelines_12_17_08.pdf

I wouldn't be happy to have lyme but I sure hope you caught it in the acute or early stage.

mkh9
Avatar universal
I received a fully copy of all my lab results, and the C. diff. did in fact come out positive (not that I am surprised based on my symptoms). Since starting the Vancomycin, I have had at least some improvement of symptoms, which I am very happy about. Still continuing to take probiotics as well.

I also began a one month course of Doxycycline for the Lyme. In all honesty, I do not recall being bitten by a tick at all, but I live in a highly endemic area. All of my symptoms have been limited to the past month, so I can't imagine I was bitten too long ago. I was confused by a few things regarding my lab results, however:

I had my labs processed at LabCorp. My CBC came back normal in every area (I was actually surprised to see the WBC on the lower end of the spectrum with an active C. diff. infection...it was 4.0, which is still normal I realize, but I expected it to be higher. I've seen higher WBCs in patients with UTIs and other infections.) My CMP was also normal. My ANA actually came back positive, which I did not realize because my doctor's office did not mention it when they called me. And also, I noticed that the Lyme IgM/IgG Ab screen came back <0.91 (technically negative)...but they proceeded with the Western Blot anyway. The IgG WB was negative, with only IgG P41 Ab (Flagellin) band noted (five bands required for positive diagnosis), and the IgM WB was positive, with both IgM P41 Ab (Flagellin) and IgM P23 Ab (Osp C). I suppose this could make sense, because my symptoms have been limited to four weeks and perhaps it could not detect seroconversion from IgM to IgG yet. I am just mildly worried about a false-positive. The lab report from LabCorp included a note stating that a false-positive could occur in patients with Antinuclear Antibodies present.

I very much trust my physician (despite not being a LLMD...to be honest, I am not sure where I stand regarding the IDSA vs ILADS conflict), and his decision to prescribe the antibiotics comes from both lab results and clinical symptoms. I am just confused as to why LabCorp, which follows CDC guidelines, proceeded with the WB if my IFA was technically negative (am I missing something here?). Could the presence of only one IgG band mean that seroconversion could be beginning, or just have no relevance whatsoever?
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