Enteroviruses, unlike herpesviruses, usually leave the body after an effective immune response. However, they can cause chronic or life-threatening conditions in certain populations, such as in patients with X-linked agammaglobulinemia (XLA).
Role in Myalgic Encephalomyelitis
Enterovirus infection has been posited as a key etiological factor in Myalgic Encephalomyelitis (ME). The evidence for enteroviral persistence in ME patients has been mixed, due in part to different methods of testing and types of tissue samples (for example muscle biopsies, stool samples, stomach biopsies, cerebrospinal fluid).
Research by John Chia and his son, Andrew Chia has looked for enteroviruses in gut biopsies. 82% of samples were positive for viral capsid protein 1 (VP1), compared to 20% of controls. Enteroviral RNA was detected in 37% of biopsy samples, compared to 4.7% of controls. They posit that a subset of Chronic Fatigue Syndrome patients have a chronic enteroviral infection.
Treatment usually involves supporting the immune response particularly in those with documented immune dysfunction. Dr. Chia treats his patients with enteroviral infection with Equilibrant, gammaglobulin and interferon.
- 2016, A study on brain tissue samples from a deceased ME patient found evidence of enterovirus specific genomic sequences and enteroviral protein in the patient's cerebral cortex.
- 2016, A study on stomach tissue samples from CFS patients found that 82% of patients have evidence of chronic enterovirus infection of the stomach.
- 2010, A longitudinal study found that a percentage of patients presenting to emergency care with acute enterovirus infection would go on to develop symptoms of ME and CFS and had demonstrable evidence of viral persistence.
- 1996, A Swedish study using the Fukuda criteria was unable to find evidence of any persistent enteroviral infection in fecal samples, muscle biopsies, or cerebrospinal fluid.
- 1995, In the CFS study group, 42% patients were positive for enteroviral sequences by PCR, compared to only 9% of the comparison group.
- 1994, A second postmortem tissue study found positive enterovirus PCR sequences in the muscle, heart, brain stem, and hypothalamus of a deceased ME patient.
- 1990, Persistence of enteroviral RNA in chronic fatigue syndrome is associated with the abnormal production of equal amounts of positive and negative strands of enteroviral RNA. "This suggests that entrovirus pesistence in muscle is due to a defect in control of viral RNA synthesis."
- 1990, A retrospective cohort study found that 31% of ME patients had elevated enteroviral IgM antibody levels. Sixteen of these patients were retested annually over three years and all showed persistently elevated Coxsackie B neutralizing antibody levels and intermittently positive enteroviral IgM, indicating the possibility of a persistent infection.
- 1988, A study of 76 postviral fatigue patients and 30 controls found significantly higher numbers of positive cultures and IgM responses to enteroviruses.
- 1988, In one study, enterovirus-specific RNA three standard deviations greater than controls was found in muscle biopsies of 20% of ME patients studied.
Talks & interviews
- 2016, - 86. ME and the role of enteroviruses / ME en de rol van enterovirussen - Dr. Byron Hyde, MD
- Rotbart, HA; Webster, AD (15 Jan 2001), "Treatment of Potentially Life-Threatening Enterovirus Infections with Pleconaril", Clinical Infectious Diseases, 32 (2): 228–235, PMID 11170912, doi:10.1086/318452
- McArdle, A; McArdle, F; Jackson, MJ; Page, SF; Fahal, I; Edwards, RH (Apr 1996), "Investigation by polymerase chain reaction of enteroviral infection in patients with chronic fatigue syndrome", Clinical Science (London, England: 1979), 90 (4): 295–300, PMID 8777836, doi:10.1042/cs0900295
- Lindh, G; Samuelson, A; Hedlund, KO; Evengård, B; Lindquist, L; Ehrnst, A (1996), "No findings of enteroviruses in Swedish patients with chronic fatigue syndrome", Scandinavian Journal of Infectious Diseases, 28 (3): 305–307, PMID 8863367
- Archard, LC; Bowles, NE; Behan, PO; Bell, EJ; Doyle, D (Jun 1988), "Postviral fatigue syndrome: persistence of enterovirus RNA in muscle and elevated creatine kinase", Journal of the Royal Society of Medicine, 81 (6): 326–329, PMID 3404526
- Chia, JKS; Chia, AY (1 Jan 2008), "Chronic fatigue syndrome is associated with chronic enterovirus infection of the stomach", Journal of Clinical Pathology, 61 (1): 43–48, PMID 17872383, doi:10.1136/jcp.2007.050054
- Pevear, Daniel C; Tull, Tina M; Seipel, Martin E; Groarke, James M (1 Sep 1999), "Activity of Pleconaril against Enteroviruses", Antimicrobial Agents and Chemotherapy, 43 (9): 2109–2115, PMID 10471549
- Bauer, Sofia; Gottesman, Giora; Sirota, Lea; Litmanovitz, Ita; Ashkenazi, Shay; Levi, Itzhak (23 Jul 2002), "Severe Coxsackie virus B infection in preterm newborns treated with pleconaril", European Journal of Pediatrics, 161 (9): 491–493, doi:10.1007/s00431-002-0929-5
- Groarke, James M; Pevear, Daniel C (1 Jun 1999), "Attenuated Virulence of Pleconaril-Resistant Coxsackievirus B3 Variants", Journal of Infectious Diseases, 179 (6): 1538–1541, PMID 10228078, doi:10.1086/314758
- Abzug, Mark J; Michaels, Marian G; Wald, Ellen; et al. (Mar 2016), "A Randomized, Double-Blind, Placebo-Controlled Trial of Pleconaril for the Treatment of Neonates With Enterovirus Sepsis", Journal of the Pediatric Infectious Diseases Society, 5 (1): 53–62, PMID 26407253, doi:10.1093/jpids/piv015
- "Treatments for Chronic Fatigue Syndrome", EvMed Research (webpage)
- Richardson, J (1 Jan 2001), "Viral Isolation from Brain in Myalgic Encephalomyelitis", Journal of Chronic Fatigue Syndrome, 9 (3-4): 15–19, doi:10.1300/J092v09n03_03
- Chia, JKS; Chia, AY; Voeller, M; Lee, T; Chang, R (Feb 2010), "Acute enterovirus infection followed by myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and viral persistence", Journal of Clinical Pathology, 63 (2): 165–168, PMID 19828908, doi:10.1136/jcp.2009.070466
- McGarry, Frances; Gow, John; Behan, Peter O (1 Jun 1994), "Enterovirus in the Chronic Fatigue Syndrome", Annals of Internal Medicine, 120 (11): 972–973, doi:10.7326/0003-4819-120-11-199406010-00020
- Cunningham, L; Bowles, NE; Lane, RJ; Dubowitz, V; Archard, LC (1990), "Persistence of enteroviral RNA in chronic fatigue syndrome is associated with the abnormal production of equal amounts of positive and negative strands of enteroviral RNA.", Journal of General Virology, 71 (6): 1399-402, PMID 2161907, doi:10.1099/0022-1317-71-6-1399
- Dowsett, EG; Ramsay, AM; McCartney, RA; Bell, EJ (1 Jul 1990), "Myalgic encephalomyelitis--a persistent enteroviral infection?", Postgraduate Medical Journal, 66 (777): 526–530, PMID 2170962, doi:10.1136/pgmj.66.777.526
- | last1 = Colby | first1 = Jane | authorlink1 = Jane Colby | title = Chronic Fatigue Syndrome: A polio by another name (chapter) | journal = ME: The New Plague (book) | date = 1996 }}