Brief Answer:
HIV, diabetes, pseudomonas, urologic consultation

Detailed Answer:
Hello,

it's an unusual case, no doubt about it! First of all a LRTI is not supposed to last that long and in most cases it is supposed to respond rapidly to proper antibiotic treatment. Healthy individuals who don't come into contact with hospitals and hospitalized patients, do not usually carry resistant pathogens.

Please let me make clear that I can't obviously provide anything more than some thoughts about your case, which may be useful or not. If you'd like to provide more data (like test reports) it may help me to get a better idea of your condition.

Balanitis is common in diabetes. I guess that your doctors would have detected abnormal blood sugar during treatment.

Is KP keratosis pilaris? If it is, then it's irrelevant to the rest of your symptoms. Folliculitis may sometimes be caused by pseudomonas though. The green discharge from the foreskin raises some suspicions about this pathogen. Monotherapy with quinolones raises suspicions of resistant pseudomonas development. Just an assumption though... The cultures are more important than assumptions! Take into account that pseudomonas balanitis is not common although it may occur.

Persistent balanitis with phimosis may require circumcision (at least partial) so urological consultation is required.

The recently negative HIV eases the mind regarding AIDS. Immunosuppression requires a long time to develop and the tests should have become positive meanwhile. Syphilis and hepatitis are not relevant.

So in conclusion, your current problem seems to be the balanitis only. Phimosis (which is a complication or local infection) makes things worse and favors recurrences and treatment failures. In case of persistent infections, trying to culture the causative agent is important so that proper treatment would be given. Urologic intervention may provide another solution (a more permanent one perhaps), so you'd better seek an opinion soon.

I hope it helps!
Good luck!

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Brief Answer:
your sleep patterns do not affect the immune system significantly

Detailed Answer:
MRSA can be difficult or even impossible to treat in the outpatient setting. These staphylococci are resistant against commonly used antibiotics. Only a culture may prove their presence though, so you'd better try to get a good sample from your balanitis. The lab has to be informed that you take use antibiotics. It will help them to manage the sample accordingly.

I don't believe that tuberculosis is your problem. The negative first test is almost reassuring but the second test is required to be sure. Besides that it's unlikely that pneumonia caused by Mycobacterium tuberculosis would have resolved with common antibiotics, despite the fact that quinolones do have some activity against mycobacteria.

Finally chronic insomnia and the PTSD do not affect the immune system significantly. We don't expect patients with sleep problems to have more serious infections than the others.

Best regards!

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