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Coxsackie B virus
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===Myalgic Encephalomyelitis=== Some researchers and clinicians [[Enteroviral infection hypothesis|postulate]] that ME is caused by an enteroviral infection. [[Enterovirus infection studies|Several studies]] have found patients with ME to have persistently elevated levels of Coxsackie B IgM or IgG antibodies, circulating immune complexes containing viral antigen, or presence of enterovirus by PCR or culture, all indicating the possible presence of a persistent infection.<ref>{{Cite journal | last = Landay|first = AL | date = September 1991 | title = Chronic fatigue syndrome: clinical condition associated with immune activation | url =https://www.ncbi.nlm.nih.gov/pubmed/1679864|journal=Lancet|volume=| pages=|via=}}</ref><ref name=":0">{{Cite journal | last = Chia | first = John | date = November 2005 | title = The role of enterovirus in chronic fatigue syndrome | url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1770761/|journal=Journal of Clinical Pathology|volume=| pages=|via=}}</ref> Others studies failed to find a difference in rates of positivity between patients and controls. Differences in study outcomes may be due to the criteria used to define study cohorts as well as the techniques used. ====Blood testing==== Elevated Coxsackie B antibodies have been found in patients in at least two ME outbreaks.<ref name="Fegan1983" /><ref name="Calder1984" /> In a retrospective cohort study<ref name="Dowsett1990" /> by [[Melvin Ramsay]] and [[Elizabeth Dowsett]], 31% of the patients were found to have 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, suggesting a persistent infection was present. Similarly, a study of of 76 patients with [[postviral fatigue syndrome]] (PVFS) found that 76% had detectible [[IgM]] responses to enteroviruses. 22% had positive cultures (compared to 7% controls) and [[VP1 antigen]] was detected in 51%, all pointing to a chronic infection in many post-viral patients.<ref>{{Cite journal | last = Yousef|first = G.E. | date = January 1988 | title = CHRONIC ENTEROVIRUS INFECTION IN PATIENTS WITH POSTVIRAL FATIGUE SYNDROME | url = https://www.sciencedirect.com/science/article/pii/S0140673688927225|journal=The Lancet|volume=| pages=|via=}}</ref> However, a larger study in Scotland of 243 PVFS patients and matched controls found no difference in IgM and IgG positivity between patients and controls.<ref>{{Cite journal | last = Miller | first = N A | date = 1991 | title = Antibody to Coxsackie B virus in diagnosing postviral fatigue syndrome | url =https://www.bmj.com/content/302/6769/140.short|journal=The British Medical Journal|volume=| pages=|via=}}</ref> ====PCR==== In a study of serum samples from 100 CFS patients and 100 healthy controls, 42% of patients were positive for Coxsackie B sequences by PCR, compared to only 9% of the comparison group.<ref>{{Cite journal | last = Nairn | first = C | date = August 1995 | title = Comparison of coxsackie B neutralisation and enteroviral PCR in chronic fatigue patients |url =https://www.ncbi.nlm.nih.gov/pubmed/7595406|journal=Journal of Medical Virology|volume=| pages=|via=}}</ref> Also using PCR, a study of 236 patients by [[John Chia]] found enteroviral RNA in 48% of patients as compared to 8% of controls.To date, Chia reports finding enteroviral RNA in 35% of 518 patients.<ref name=":0" /> ====Muscle biopsy==== Several [[muscle biopsy]] studies have also found the presence of Coxsackie B RNA sequences in CFS patients as compared to controls. A study of 60 [[Postviral fatigue syndrome|post-viral fatigue syndrome]] patients found 53% had enteroviral RNA in [[muscle]] compared to 15% of controls.<ref>{{Cite journal | last = Gow|first = JW | date = | title = Enteroviral RNA sequences detected by polymerase chain reaction in muscle of patients with postviral fatigue syndrome | url =https://www.ncbi.nlm.nih.gov/pubmed/1850635|journal=British Medical Journal|volume=| pages=|via=}}</ref> However, a follow-up study comparing CFS patients to patients with other neuromuscular disorders failed to find a statistically significant difference.<ref>{{Cite journal | last = Gow|first = JW | date = 1994 | title = Studies on enterovirus in patients with chronic fatigue syndrome | url =https://www.ncbi.nlm.nih.gov/pubmed/8148439/|journal=Clin Infect Dis|volume=18| pages=|via=|issue=Supp 1}}</ref>
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