Challenging chronic and recurrent infections now make up a significant proportion of primary care practice. Clinicians must identify and treat a wide range of conditions, including recurrent yeast and urinary tract infections, hepatitis B and C, antibiotic-resistant Clostridium difficile, Helicobacter pylori, and tick-borne infections, among many others. Unfortunately, many of these are difficult to diagnose and manage, often mimicking other conditions and not always having definitive tests available. There are also infections that appear to have important links to chronic disease: for example, the rel ationships between Klebsiella pneumoniae and ankylosing spondylitis, Proteus mirabilis and rheumatoid arthritis, Chlamydia pneumoniae and multiple sclerosis. We are more aware now that infections and the inflammatory response represent the "common soil" of multifactorial diseases, including type 2 diabetes, cardiovascular disease, neurodegenerative diseases, obesity, cancer, and asthma. For these reasons, it is essential that practitioners regularly update their knowledge and clinical skills.
Terrain, Tolerance, and Susceptibility:
Beyond the role of exposure, there exists a complex web of interacting factors that may condition patients to resist (or succumb to) myriad infectious agents. Among the many interesting and useful discussions included in these eLectures are the following clinically relevant topics:
About These eLectures
- Diagnosis of chronic infection can be difficult because our testing is not specific or accurate enough, microbiologists disagree about how to test for and interpret viral, bacterial, and mycoplasma species, and we cannot test for all species or types of infective agents. Even a negative serology may not provide good information because a weakened immune system may be unable to mount a detectable response.
- Immune decision making is extremely complex. Induction of a signal in the immune response may require inhibition of an inhibitor, rather than triggering of an activator (or both). Gene-environment interaction and/or epigenetics may alter the immune response in chronic inflammation.
- Clinicians must understand how the immune system balances tolerance and protection—a complex task. Tolerance, once lost, is tough to recover.
- Key targets for clinical management include local tissues, mucus layer, dendritic cells, commensal flora, micro and macronutrient availability, medications, stress, and hormones.
These eLectures bring the functional medicine perspective on chronic infections front and center, focusing on a systems approach and covering topics such as host immune relationship to microorganisms, the interactions between the host and the microbe, host susceptibility, barrier effects, and immune defenses. Functional medicine recognizes that it is the complex interplay of the infectious agent, the environment or terrain, and the host's innate genetics that together influence our trajectory toward health or disease.
IFM has picked out 10 memorable presentations on this fascinating topic. These will help you wade through the complex topic of chronic infections in the 21st century and develop an effective personalized medicine approach: the right strategy for the right person at the right time.
Lectures were recorded as part of IFM's 2011 International Symposium.