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Remicade causing respiratory infection?

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Ulcerative Colitis
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Posted 4/1/2014 2:11 AM (GMT 0)
My son finished his third infusion of remicade end-March, 3 weeks later he started having a sore throat and some congestion. We thought maybe allergies were kicking in. Then this weekend it got worst at night and came down with 102 fever. Took him to family practice, they started him on zythromycin. Fever is still not gone, need tylenol to control. He's never had such an infection ever before so got me thinking that this could be remicade. I have a call into GI doc, will likely hear tomorrow. I have two questions for forum members with experience on remicade. 1) Will this infection be attended to with regular treatment or should I look out for this getting out of hand 2) Next remicade is due in end-April. What are my options. He seems to be in remission now after diagnosis in Aug (symptoms going back 2 years) and first flare up in Nov - tapered off prednisone (and Apriso) last month. My son is 14. Thanks in advance.

BK
Posted 4/1/2014 2:19 AM (GMT 0)
Unfortunately, nobody can give you a concrete answer. Remicade does weaken the immune system and can bring on infections. This can be very dangerous but I'm wondering if his regular doctor jumped the gun by prescribing antibiotics. They won't do crap if your son doesn't actually have an infection and has maybe a virus or reaction to the Remicade. The antibiotic may put him into a flare. If you haven't already I would load up on megaprobiotics while on the antibiotic and by mega I mean mega.
Posted 4/1/2014 2:58 AM (GMT 0)
Anytime someone has a fever over 100 while on Remicade it is recommended that they see a doc. Because Remi lowers the immune system, it increases our chances of getting infections. I've had 4 sinus infections and 3 UTI's since starting Remi when I very rarely got the sinus infection before (tho I tend to be prone to UTI's). So it's good you took him to the docs. It could be a virus or it could be bacterial...I always sided on the ear of caution and took antibiotics.

How long has he been on the Z-pack?
Posted 4/1/2014 3:12 AM (GMT 0)
Thanks, Sherry. This confirms my suspicion that it is indeed caused by remicade. Did your antibiotic treatment for sinus infections take the normal course for healing, or did it extend and get complicated? How often did you get these sinus infections - once in a year or more often?

Garylouisville, thanks. He has been on VSL3 probiotic (2x daily), I have stepped it up to 3x daily (it is 500 Bill per capsule). I will get to his GI doc tomorrow.

I am considering talking to doc about - reducing remicade dosage for next dose in 4 weeks, or spacing these out further so he doesn't get these sinus infections.

Thank you, really appreciate the input!
Posted 4/1/2014 3:19 AM (GMT 0)
It never got complicated but each one took varying times to get better. 2 of the 4 I've had took a bit longer to go away while the other 2 went away fairly quickly.

In fact I was sick with a sinus infection from hell in February and then to add insult to injury...I got better from the SI in about a 2 weeks (tho it sort of lingered) and 3 weeks later I got my husbands cold! Lol

But yes, I get a sinus infection almost every year....tho I got lucky and never got sick last year. But the first year, I had 3 sinus infections, 2nd year, nothing...3rd year (this year) so far only one and then the cold.
Posted 4/1/2014 3:24 AM (GMT 0)
Btw, it sounds like he's done with his loading doses? If so, I wouldn't recommend spacing the infusions further apart. After the loading doses, it's usually every 8 weeks. Anytime beyond that reduces his chances of fighting the inflammation caused by UC.
Posted 4/1/2014 3:27 AM (GMT 0)
Thanks again, Sherry! So will take this as a side effect of an otherwise effective drug. Any suggestions on probiotics regimen during antibiotic phase of SI?
Posted 4/1/2014 3:47 AM (GMT 0)
Agreed, will stay with 8 weeks for ongoing remicade. Thanks, Sherry!
Posted 4/1/2014 11:25 AM (GMT 0)
Remicade increases ones odds of getting infections, e.g., bronchitis, sinus, urinary tract infections, etc. This is because remi is systematic, and reduces the whole body's natural process of causing inflammation to target and clear out infected cells. Due to a weakened immune system, they can quickly become serious infections. You're best to be vigilant and see your doctor upon first signs of those sorts of infections. Take a course of medication early to treat them.

The risk of dying from a serious infection while on remicade is 40 in 10,000. The odds are still pretty small but it is something to be aware of. Source Slide 22:
http://www.ccfa.org/assets/pdfs/risk-and-benefits-transcript.pdf
Posted 4/1/2014 6:59 PM (GMT 0)
It doesn't cause the infections, it lowers the immune system response and allows colds or flu to become more exacerbated if he's not able to fight it off.

How long has he been on the Zithromax?

Depending on the virus, where it hits and the state of his lungs, please make sure he's monitored to confirm that the infection is being dealt with.

Is he coughing up sputum? and spitting it out rather than swallowing it?
Has he had the sputum cultured?

Sometimes one can have other infections rather than bacterial. Fungal comes to mind...so just ensuring that if he hasn't improved after the course of the Zithromax that he should be checked and other meds given if he needs them.

There are different probiotics that he could take...the vsl#3 should be fine for him during this episode.

If he's having any problems with breathing, there are inhalers that could help during the time he's sick. That can help him expel the mucus too. As well, expectorants are helpful (for me, anyway). He could also steam over a bowl of hot water...caution, however regarding burns from the boiled water steam.

Hope he gets better soon. I've been through bad chest infections, it's very trying physically and emotionally.

Keep us posted how he's doing.

q
Posted 4/2/2014 2:19 AM (GMT 0)
I agree with the previous posters. I have 5 years of experience with Remicade sponsored infections. I wanted to put my D in a bubble at college, but the new strains kept on coming. Pneumonia twice, multiple sinus, streph, mono twice, pink eye, shoot the list is long. I wanted her off the drug, until it failed her...and then I was heartsick by the roaring flare that brought her to her knees.
So, maybe this is an anomaly. Test it well and test appropriately. Do not overuse antibiotics, they are so hard on a colon. Sanitize his world and know that some infections only come once and are not too taxing. Keep the probiotics, digestive enzymes and any other potential helper within reach. Their immune system isn't "gone", just not as reactive. Some bacteria linger, but he can fight it. Their bodies are just fighting on too many fronts.
Posted 4/2/2014 4:17 AM (GMT 0)
Thank you all for your insightful input, helps a lot as we navigate this complex disease. He is stable today, temp under control - only 1 tylenol today - day 3 of zythromax; less cough, sputum has been white and he has been told to not swallow; spoke with GI doc, she wasn't ready to pin it to remicade, I didn't push it either. She said if it recurs then it could be due to reduced immunity from remicade. I think we did the right thing to get him care on Sunday Noon when the fever started.

BV
___________________
Son, 14 diagnosed 08/13 with UC (pancolitis) - symptoms going back 2 years
Rx:Remicade 5mg/kg - loading dose finished end-Feb
Pred -30-60-0 over 4 months. Hospitalized Dec '14 with first flare while on 20 mg pred (diarrhea for a week, no blood - I think it was caused by Ensure 2x daily started 2 weeks earlier for nutrition). Lialda then Apriso did not work
Posted 4/2/2014 4:59 PM (GMT 0)
Absolutely you getting him care early was a good thing.

How's he today?

How long of a course of Zithromax is he on?

q
Posted 4/2/2014 5:09 PM (GMT 0)
I recently posted about this on the Crohn's board. The most common side effect of Remicade is upper respiratory infections:

(From the Infliximab literature): "The more common side effects with REMICADE® are respiratory infections (that may include sinus infections and sore throat), headache, rash, coughing and stomach pain."

In the year I have been on Remicade, I have been dealing with upper respiratory problems for about six months, including sinusitis for the last three months solid. It sucks. My latest blood work shows lowered white & red blood counts, which I assume is because my body is trying to fight off this darn infection. I recently had a CT scan of my sinuses and see my ENT tomorrow to go over results.
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