My top six causes of ongoing persistent infections. What are some of the common things that I see in my practice that are the causes of ongoing persistent infections?

Note: If you’ve been struggling with getting sick over and over, and you’re trying to figure out the root cause of what’s underlying all of this, this is something you would need to read so you can talk with your doctor about what possible to look at and investigate as potentially being something that you’ve been dealing with that you just didn’t know about.

In no specific order, lets starting listing the things I see a lot of.

1. Strep

Streptococcus is a very common bacterium. Children get it, adults, get it. Strep throat is sort of the classic presentation of what we think about with strep, particularly in children, but strep can cause skin infections, it can cause gut infections, it can cause urinary tract infections. It’s a common cause of ear infections in young, young children. It can cause meningitis. There are different types of streptococcus.

Group A strep is the one that we mostly associate with causing strep throat and that’s the one that I think probably plagues more people more than others. There is a potential consequence of Group A strep. There are some people that develop what is called rheumatic heart disease or rheumatic fever. We don’t see it as commonly anymore like we used to, but this is a potential consequence where your immune system actually has an auto immune reaction to the strep and so in the effort to fight the strep, it accidentally affects the heart or affects your skin. You can get a skin rash, you can get a fever.

We don’t see it as much anymore. I think a lot of doctors know to test for strep early if kids get sick in particular and it gets treated right away and it typically doesn’t cause those kinds of reactions. I’ve seen one case of rheumatic heart disease actually in a 40 plus year old male.

Strep can be a very common cause of sort of ongoing persistent infection. Strep is also a major cause of PANS, what used to be called PANDAS. This is pediatric autoimmune and neuropsychiatric disease associated with strep. It’s been shortened to PANS because we realize it’s not just strep. Other organisms can trigger this inflammatory reaction in the brain that’s primarily causing acute onset anxiety, OCD, and ticks. There are other symptoms as well with PANS, but these are sort of the hallmark symptoms. We see this in children where literally overnight, they become completely different children; they start experiencing all these symptoms out of nowhere and strep is a common cause of that kind of syndrome.

2. Candida

Candida is a very common cause of yeast infections. You can get yeast infections in the gut, you can get yeast infections on the skin. Women are prone to getting vaginal yeast infection. This is a very common organism, yeast, particularly in the gut. If you’ve been on a lot of antibiotics that killed off a lot of your beneficial bacteria that can dispose you to having an overgrowth of yeast. Yeast is a normal part of our body. Generally, yeast is not bad, but when it overgrows, then it becomes problematic.

Yeast overgrowth in the gut can cause gas and bloating and digestive issues, heartburn, reflux. Of course, vaginal yeast infection is a different kind of syndrome and yeast on the skin can cause itchy skin rashes. If you’re immune suppressed, you can get a thing called oral thrush where the inside of your mouth gets very white and you almost have sort of this curdled cheese odor; a thick coat on your tongue and the inside of your mouth and that’s an overgrowth of yeast. There are different species of yeast. I’m talking about candida specifically, but there are other types of yeast as well that can overgrow and cause problems; a very common chronic persistent kind of infectious agent.

3. Lyme

Lyme is near and dear to my heart as a former Lyme patient. I wrote the book, The Lyme Solution.’ I see a lot of Lyme disease in my practice.

Lyme is the fastest growing tick-borne or even insect-borne infectious agent in the world. Only in the United States, we get over 330,000 new cases a year. Tweet that!

I have many videos where I talk specifically about Lyme disease, in detail. There are over a hundred symptoms associated with Lyme

For people that just haven’t been feeling well for weeks, months, particularly with flu like symptoms, joint pain, headaches, neurological symptoms, balance problems, coordination neuropathy, which is numbness and tingling, all those can be a red flag that it’s Lyme disease or perhaps some other type of tick-borne illness.

I don’t really have a lot of time in this video to go into all the different types of co-infections, but I’ll collectively call them tick-borne illnesses, Lyme really being kind of the dominant one. For people who’ve been experiencing those kinds of ongoing symptoms, I always test for Lyme disease. Unfortunately, Lyme disease testing is not very great, but it is a place to start.

4. Mycoplasma

Mycoplasma is technically a bacteria. It’s what they call an acellular bacteria. Most bacteria have cell walls and so a lot of antibiotics can gear at breaking down the cell wall. Mycoplasma doesn’t have a cell wall; it’s a little bit different. Those types of antibiotics are really not effective for mycoplasma. Classic mycoplasma is what we call walking pneumonia. 

These people are the walking wounded. They cough, they hack, they might run a low grade fever, but they function, they go to work, they do the routine and again, they’ll come off and in and out of being sick, being better, being sick, being better. This could go on for months. The classic walking pneumonia case and mycoplasma is the most common cause of that although there are some other unusual organisms that can cause walking pneumonia.

Mycoplasma can cause other types of symptoms that have absolutely nothing to do with walking pneumonia. I have a book in my library that’s about all the things that mycoplasma can cause that have nothing to do with walking pneumonia. It is a common cause of arthritis. It is a common cause of inflammation in the eyes, particularly in young children, it’s called uveitis. I had a neighbor when I moved to Connecticut that had uveitis and I followed her for three years and her mycoplasma titers were just sky high the whole time. Once she got treated, her eyes actually completely cleared up and that condition went away.

Mycoplasma can cause more systemic problems outside of walking pneumonia. I’ve heard doctors tell patients, who asked “Hey, what do you think about mycoplasma?” “Well, you didn’t get walking pneumonia.” That’s true but there are a lot of other manifestations of mycoplasma. Any kind of chronic arthritic condition, chronic coughing, hacking, again, that kind of comes and goes (you know it’s not really allergy related), you might want to take a look at mycoplasma and just make sure that that’s not part of the underlying issues.

A lot of our gut bugs can cause persistent infection. There are so many, it would be hard to talk about all of it in this video, like Klebsiella. There’s a strong association with Klebsiella causing what’s called ankylosing spondylitis, which is a bone condition particularly affecting the lower back where it becomes very stiff and very painful. That’s an autoimmune reaction from Klebsiella. Proteus is another organism in the gut that we often associate with urinary tract infections, but both Klebsiella and Proteus can cause arthritic conditions.

We have thousands of species, trillions of organisms in our gut. Our body sometimes look at these normal bugs and treat them as if they are foreign. That triggers an autoimmune reaction, which can affect potentially any tissue.Tweet that!

For anyone who’s had persistent gastrointestinal problems, a history of inflammatory bowel disease, irritable bowel syndrome, chronic constipation or even diarrhea, it might be worth having a stool test to take a look at your gut bugs and see if there’s something that’s really out of sorts or something’s overgrown because that could give you some clues that there’s this overgrowth that’s really causing a lot of your symptoms and hopefully easy to correct.

5. Epstein-Barr virus

There are a lot of viruses, right now we’re in the midst of COVID-19 that’s the flavor of the month, but there are many, many other viruses that cause long-term problems. Epstein-Barr virus is a common virus. It’s in the herpes virus class. Herpes viruses are Herpes Simplex, Epstein-BARR virus, CMV, Human Herpes Six, and the Chickenpox virus, Varicella-zoster. They’re all herpes viruses and any one of those can cause various problems for people. 

The Epstein-Barr virus is one I think that probably gets the most attention because we’ve associated it with causing chronic fatigue syndrome.Tweet that!

It’s a known causative agent for multiple sclerosis and other neurological conditions. The Epstein-Barr virus, when it gets out of control can be very problematic. Now, up to 80% of adults have been exposed to Epstein-Barr virus and for most people it’s relatively benign and doesn’t cause a problem. But again, when your immune system’s compromised and it doesn’t keep it in check, it can start to sort of “take off” and create a lot of these symptoms. In children, Epstein-Barr is associated with mononucleosis or what we call mono. These are the swollen glands, the fatigue. Sometimes they get a fever, they can get an enlarged liver or spleen that sort of happens with acute mono and then mono usually lasts about a month. Kids recover and they’re usually fine after that.

However, we do see reactivation sometimes later in life as adults. And it doesn’t look exactly like it does as a kid with mono, but you can get the fatigue, you can get some time still the swollen lymph nodes, you can get intermittent fever; other types of symptoms as well. Don’t just think about Epstein-Barr as just being something you get as a kid and then you don’t get again. Up to 80% of adults have been exposed to this virus so it is possible to get reactivation later in life. With adults, when you get that debilitating fatigue, when that’s the dominant symptom, certainly you want to check out and Epstein-Barr virus and see if there’s any evidence of reactivation.

6. Human herpesvirus 6

Human herpesvirus 6 can cause chronic fatigue. There are reactivations of the Chickenpox virus, that is what causes shingles. And again, if you got Chickenpox when you were a kid and then you get really stressed out later in life, your immune system becomes compromised or perhaps you started taking a medication that’s an immunosuppressant, that can allow that virus that’s been there the whole time, maybe 40, 50 plus years to get reactivated. And it comes out through our nerves and that’s what causes shingles, which is those painful lesions, they look like little blisters and they follow what’s called a dermatome. That is a line of a specific nerve. You can almost trace it on someone’s body where that nerve root is. That is what shingles is.

Viruses that we may have been exposed to earlier in life, can get reactivated later in life. Tweet that!

Often, when our immune system is under duress or compromised that they start to come out. The viruses are a little bit trickier because when you do blood testing, often you will show evidence that you had exposure to the virus, and it’s not necessarily a sign that the virus is causing the problem so diagnosing reactivation of viruses is tricky, unless you get an IgM antibody (IgM is that molecule that we associate with either acute exposure or reactivation). Often those tests come back, and they look sort of normal. We must look at other clues that show that there may be reactivation of the virus. Kasia Kines wrote a really great book on Epstein-Barr virus, you might want to check that out if you think that that’s something you’ve been dealing with.

Mycoplasma, EBV, HHV-6


It is our job as practitioners to do our diligence if we think there’s some sort of underlying virus. Depending on where you think the virus is coming from, sometimes we can do blood tests, sometimes like with the ongoing pandemic we do a nasopharyngeal swab, sometimes it’s a throat swab. Depending on where we think the virus is affecting you, it dictates where we need to look in the body to try and hunt it down. Viruses can be a common cause of chronic infection. These are the things that I see most commonly in my practice.

I hope you found this video helpful.


Thank you,

Dr. Darin Ingels

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