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Infections—Bacterial, Viral and Fungal

Many people who are diagnosed with ME/CFS can link their onset to some type of infection and a significant number of these individuals will continue to have recurring infections, such as sinus, respiratory system, cardiac, musculoskeletal and/or bladder. 

Urinary infections

Many of the bladder infections are bacterial in nature and may require repeated courses of antibiotics. Very often, urine will be cultured to determine the specific strain and which medication is the most effective in treating it. Mycoplasma and chlamydia are two types of microorganisms found fairly often in ME/CFS which can cause persistent infections. Many of these infections require more aggressive and extended treatment than one standard course of antibiotics, and some infections respond better to specific types of antibiotics.

General recommendations are not to take magnesium products within 6 hours of an antibiotic (as they can interfere with absorption of the medicine) and not to use antibiotics beyond their expiration date. It may be helpful to be on Nystatin, an antifungal medication, while on antibiotic treatment.

Yeast infections

Yeast infections or yeast overgrowth tend to develop more frequently in patients with ME/CFS and FM which may be partially due to frequent infections requiring treatment with antibiotics (which will kill off both good and bad bacteria). Other factors promoting yeast overgrowth can be a diet high in sugar (sugar feeds yeast) and poor sleep which negatively impacts immune function. 

Yeast infections are often treated with Nystatin and/or Diflucan and Sporanox. The latter two medications are quite expensive and may increase risk of inflammation of the liver. Yeast overgrowth can be brought under control by using acidophilus/probiotic therapy, by avoiding intake of sugar and yeast products, and/or by adhering to a strict anti-Candida diet. There are many books as well as cook books written specifically on this topic.

Viral infections

A number of viruses have been implicated in ME/CFS, particularly from the herpes  and enterovirus families. Antiviral agents, like Acyclovir and Famvir, have been prescribed in the past to treat some strains of herpesvirus infections, but have been found to be ineffective against HHV-6 and HHV-7. 

Valtrex (valacyclovir) was studied in ME/CFS patients with reactivated Epstein-Barr virus (EBV) and improvement of physical function and cardiac function was shown.

Amantadine is another type of antiviral, usually used to treat Type-A influenza virus (at the onset of the flu) and is sometimes used in ME/CFS for its stimulating properties.

A very potent antiviral agent called Valcyte (ganciclovir) is currently being studied in ME/CFS patients to determine if or how it blocks HHV-6, EBV, and other herpesviruses. The majority of the study patients experienced significant improvement. However, it is important to note that Valcyte is considered to be potentially toxic and patients must be very closely monitored while taking this medication. 

Ampligen is an immunomodulatory type of drug, which has remained in an experimental state for ME/CFS in the U.S. since 1988. It acts on double-stranded RNA.  The New Drug Application submitted by the drug manufacturer to the FDA in late 2007 was regarded as incomplete. If /when the FDA approves Ampligen, it may be the first specific treatment for ME/CFS in the U.S. It is already approved by the European Union.