MEpedia:Non-cytolytic enterovirus

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Acute viral infection plus corticosteroids may cause ME/CFS[edit | edit source]

Dr John Chia has observed that corticosteroids inadvertently prescribed during an acute viral infection substantially increase the risk of developing myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) from that infection. Via his meticulous investigations into patients' medical histories, Dr Chia discovered that hundreds of his ME/CFS patients were given corticosteroids precisely during the time that they came down with a flu-like illness, gastrointestinal upset or other viral infection.[1] Thus there appears to be a causal equation of:

Acute infection + corticosteroids = ME/CFS

Dr Chia says one reason corticosteroids can be inadvertently prescribed during an acute enteroviral infection is because an enterovirus rash can look like hives, so if a doctor questions what the patient ate, and they happened to eat shellfish recently, the doctor may incorrectly assume the rash is a hives rash, resulting from allergy to shellfish. So the doctor may then put the patient on a course of corticosteroids such as prednisone, as this is the normal treatment for hives.

Thus the patient has an acute enterovirus infection, and needs a strong immune response to fight this infection, yet receives immunosuppressing corticosteroids, because the viral rash was misdiagnosed as hives.

Similarly, if a patient comes down with an acute viral infection and its symptoms are suggestive of asthma, they may also be inappropriately prescribed corticosteroids, because that is how asthma is treated.

Immunosuppression by corticosteroids and chronic stress[edit | edit source]

Corticosteroids suppress the Th1 antiviral/intracellular immune response,[2] and suppresses T-cell function.[3]

Interestingly, ME/CFS is usually precipitated by viral infection, and several studies found it is common to experience major psychological chronic stress in the year prior to developing ME/CFS.[4][5][6] Chronic psychological stress elevates cortisol which suppresses the Th1 antiviral/intracellular immune response,[7] and the T-cell response.[8] Thus immonologically, chronic stress has a similar effect to corticosteroid administration, and both these factors appear to increase the risk of development of ME/CFS from viral infection.

See also[edit | edit source]

References[edit | edit source]

  1. "Dr John Chia: Enterovirus Infection in ME/CFS. Presentation at the Invest in ME International ME Conference, London 2010 (available on DVD). Timecodes: 07:31 and 28:00". VIDEO TIMECODE 07:31 — If the patient already had chickenpox before and they then develop flu-like illness with chickenpox-like rashes that's enterovirus until proven otherwise. But the rash could look like measles, German measles, it could look like hives. So very often people travel, eat some shellfish, and develop this hives, all over. Went to the emergency room, the emergency room doctor will say, 'Oh well, you ate lobster, you must be allergic to shellfish.' So what's the next thing they get? They get some prednisone, steroids, and that disease never ended. They develop chronic fatigue syndrome after that. We hear this hundreds of times. VIDEO TIMECODE 28:00 — Glucocorticoids: if the patient developed a viral infection, and with symptoms suggestive of asthma, they are often given steroids, because it's the mainstay of therapy. That can shift the immune response to Th2, not to mention you'll drop the T-lymphocytes down to practically zero. 
  2. Elenkov, Ilia J. (Jun 2004). "Glucocorticoids and the Th1/Th2 balance". Annals of the New York Academy of Sciences. 1024: 138–146. doi:10.1196/annals.1321.010. ISSN 0077-8923. PMID 15265778. 
  3. Davis, Trevor E; Kis-Toth, Katalin; Szanto, Attila; Tsokos, George C. (Jul 2013). "Glucocorticoids suppress T cell function by upregulating microRNA 98". Arthritis and rheumatism. 65 (7): 1882–1890. doi:10.1002/art.37966. ISSN 0004-3591. PMC 3713788Freely accessible. PMID 23575983. 
  4. Hatcher, Simon; House, Allan (Oct 2003). "Life events, difficulties and dilemmas in the onset of chronic fatigue syndrome: a case-control study". Psychological Medicine. 33 (7): 1185–1192. doi:10.1017/s0033291703008274. ISSN 0033-2917. PMID 14580073. 
  5. Theorell, T.; Blomkvist, V.; Lindh, G.; Evengård, B. (May 1999). "Critical life events, infections, and symptoms during the year preceding chronic fatigue syndrome (CFS): an examination of CFS patients and subjects with a nonspecific life crisis". Psychosomatic Medicine. 61 (3): 304–310. ISSN 0033-3174. PMID 10367610. 
  6. Salit, Irving E. (Jan 1, 1997). "Precipitating factors for the chronic fatigue syndrome". Journal of Psychiatric Research. 31 (1): 59–65. doi:10.1016/S0022-3956(96)00050-7. ISSN 0022-3956. 
  7. Dhabhar, Firdaus S (Mar 15, 2008). "Enhancing versus Suppressive Effects of Stress on Immune Function: Implications for Immunoprotection versus Immunopathology". Allergy, Asthma, and Clinical Immunology : Official Journal of the Canadian Society of Allergy and Clinical Immunology. 4 (1): 2–11. doi:10.1186/1710-1492-4-1-2. ISSN 1710-1484. PMC 2869337Freely accessible. PMID 20525121. 
  8. Dhabhar, Firdaus S (Mar 15, 2008). "Enhancing versus Suppressive Effects of Stress on Immune Function: Implications for Immunoprotection versus Immunopathology". Allergy, Asthma, and Clinical Immunology : Official Journal of the Canadian Society of Allergy and Clinical Immunology. 4 (1): 2–11. doi:10.1186/1710-1492-4-1-2. ISSN 1710-1484. PMC 2869337Freely accessible. PMID 20525121. 

ME/CFS - An acronym that combines myalgic encephalomyelitis with chronic fatigue syndrome. Sometimes they are combined because people have trouble distinguishing one from the other. Sometimes they are combined because people see them as synonyms of each other.

myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

chronic fatigue syndrome (CFS) - A fatigue-based illness. The term CFS was invented invented by the U.S. Centers for Disease Control as an replacement for myalgic encephalomyelitis (ME). Some view CFS as a neurological disease, others use the term for any unexplained long-term fatigue. Sometimes used as a the term as a synonym of myalgic encephalomyelitis, despite the different diagnostic criteria.

enterovirus - A genus of RNA viruses which typically enter the body through the respiratory or gastrointestinal systems and sometimes spread to the central nervous system or other parts of the body, causing neurological, cardiac, and other damage. Since the first reports of myalgic encephalomyelitis (ME), enteroviruses have been suspected as a cause of ME. Enteroviruses have also been implicated as the cause of Type I diabetes, congestive heart failure, and other conditions. Enteroviruses include poliovirus, coxsackieviruses, and many others. New enteroviruses and new strains of existing enteroviruses are continuously being discovered. (Learn more: viralzone.expasy.org)

enterovirus - A genus of RNA viruses which typically enter the body through the respiratory or gastrointestinal systems and sometimes spread to the central nervous system or other parts of the body, causing neurological, cardiac, and other damage. Since the first reports of myalgic encephalomyelitis (ME), enteroviruses have been suspected as a cause of ME. Enteroviruses have also been implicated as the cause of Type I diabetes, congestive heart failure, and other conditions. Enteroviruses include poliovirus, coxsackieviruses, and many others. New enteroviruses and new strains of existing enteroviruses are continuously being discovered. (Learn more: viralzone.expasy.org)

T cell - A type of white blood cell which is mostly produced or matured in the thymus gland (hence T-cell) and is involved in the adaptive immune response on a cellular level. Also known as a T lymphocyte. (Learn more: www.youtube.com)

somatic symptom disorder - A psychiatric term to describe an alleged condition whereby a person's thoughts somehow cause physical symptoms. The actual existence of such a condition is highly controversial, due to a lack of scientific evidence. It is related to other psychiatric terms, such as "psychosomatic", "neurasthenia", and "hysteria". Older terms include "somatization", "somatoform disorder", and "conversion disorder". Such terms refer to a scientifically-unsupported theory that claims that a wide range of physical symptoms can be created by the human mind, a theory which has been criticized as "mind over matter" parapsychology, a pseudoscience. Although "Somatic Symptom Disorder" is the term used by DSM-5, the term "Bodily Distress Disorder" has been proposed for ICD-11. (Learn more: www.psychologytoday.com)

The information provided at this site is not intended to diagnose or treat any illness.
From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history.