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Enterovirus
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== Chronic enterovirus infections == {{Main article| page_name=Non-cytolytic enterovirus}} Like most [[:Category:RNA viruses|RNA viruses]], enterovirus is not capable of assuming a latent state within cells, and enterovirus infections are generally considered to be acute and rapidly cleared by the host immune response.<ref name=":6">{{Cite journal | last = Kim | first = K.-S. | last2 = Tracy | first2 = S. | last3 = Tapprich | first3 = W. | last4 = Bailey | first4 = J. | last5 = Lee | first5 = C.-K. | last6 = Kim | first6 = K. | last7 = Barry | first7 = W.H. | last8 = Chapman | first8 = N.M. | date = Jun 2005 | title = 5'-Terminal deletions occur in coxsackievirus B3 during replication in murine hearts and cardiac myocyte cultures and correlate with encapsidation of negative-strand viral RNA| url = https://www.ncbi.nlm.nih.gov/pubmed/15890942/|journal=Journal of Virology|volume=79|issue=11 | pages = 7024–7041|doi=10.1128/JVI.79.11.7024-7041.2005|issn=0022-538X|pmc=1112132|pmid=15890942|quote=Picornavirus infections are generally considered to be acute and cleared rapidly by the host adaptive immune response.|via=}}</ref><ref name=":7">{{Cite journal | last = Flynn | first = Claudia T. | last2 = Kimura | first2 = Taishi | last3 = Frimpong-Boateng | first3 = Kwesi | last4 = Harkins | first4 = Stephanie | last5 = Whitton | first5 = J. Lindsay | date = Dec 2017 | title = Immunological and pathological consequences of coxsackievirus RNA persistence in the heart| url = http://linkinghub.elsevier.com/retrieve/pii/S0042682217303264|journal=Virology|volume=512 | pages = 104–112|doi=10.1016/j.virol.2017.09.017|issn=0042-6822|pmc=5653433|pmid=28950225|quote=until relatively recently, enteroviruses were thought to cause only acute infections, and to be completely eradicated with ~ 2 weeks of the primary infection.|via=}}</ref> Indeed, [[John Chia]] points out that even today, most physicians are taught that enterovirus does not form chronic infections.<ref>{{Cite web | url = http://www.investinme.org/IIMEC10.shtml | title = Enteroviruses and Myalgic Encephalomyelitis / Chronic Fatigue Syndrome: An Update on Pathogenesis. Presentation at the Invest in ME International ME Conference, London 2015. | last = Chia | first = John | date = 2015 | website = |archive-url=|archive-date=|url-status=|access-date=}}</ref> However, it is now understood that enterovirus B serotypes such as coxsackievirus B and echovirus are capable of mutating during the acute infection into an aberrant viral form called [[non-cytolytic enterovirus]] that can cause persistent low-level infections. These persistent non-cytolytic enterovirus infections deriving from mutated enterovirus B serotypes are found in ME/CFS and several other chronic illnesses, including chronic myocarditis, dilated cardiomyopathy, type 1 diabetes, [[ALS|amytrophic lateral sclerosis]] (motor neuron disease) and [[Parkinson's disease]]. Non-cytolytic enterovirus consists of mutated naked viral RNA which produces persistent [[intracellular infections]] inside host cells, and does not readily kill the cells in which it resides. Although this infection replicates very slowly, it nevertheless produces all the normal [[Viral protein|viral proteins]], and these proteins may have pathological disease-causing effects in the host. Persistent non-cytolytic enterovirus is resistant to immune clearance, and can thus reside inside host cells for very long periods. Non-cytolytic enterovirus infections are characterized by a decreased ratio of positive to negative strand viral RNA: whereas in normal acute enterovirus infections, this ratio is around 100:1, in persistence non-cytolytic infections, the ratio has a value closer to 1:1.
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