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Enterovirus
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== Diagnosis of chronic enterovirus infections == Dr John Chia uses the following tests to detect chronic enterovirus infection in ME/CFS patients:<ref>{{Cite web | url = https://www.enterovirusfoundation.org/treatments-1/ | title = Enterovirus Foundation â Diagnose & Treat | last = | first = | authorlink = | date = | website = |archive-url=|archive-date=|url-status=|access-date=}}</ref> '''ARUP Lab micro-neutralization blood tests for enterovirus antibodies'''. Titers of 1:160 to 1:320 or higher on the ARUP Lab [http://ltd.aruplab.com/tests/pub/0060055 coxsackievirus B test] and [http://ltd.aruplab.com/tests/pub/0060053 echovirus test] suggest chronic active infection. These tests use the very sensitive gold standard neutralization method of measuring antibody levels. The ARUP lab test will indicate which particular enterovirus serotypes are present and active in the patient (out of coxsackievirus B1 to B6, and echovirus 6, 7, 9, 11, and 30). Other methods of antibody levels such as ELISA or IFA are less sensitive, and thus may not be reliable. The CFT method of testing for enterovirus antibodies is insensitive and useless for chronic enterovirus infection.<ref>{{Cite web | url = https://www.youtube.com/watch?v=YSgcNSqssTI&t=27m51s | title = Diagnosis and Treatment of Myalgic Encephalomyelitis / Chronic Fatigue Syndrome Associated with Chronic Enterovirus Infection. Presentation at the Invest in ME International ME Conference, London 2009. | last = Chia | first = John | authorlink = | date = 2009 | website = |archive-url=|archive-date=|url-status=|access-date=|quote=The typical antibody that the laboratory would do is called the complement fixation test, which is neither sensitive nor specific. That means if you get a positive test, it's worthless. And if you get a negative test, it's worthless. Well that's wonderful.}}</ref> '''Stomach biopsy (immunohistochemistry)'''. This test, which requires a sample of stomach tissue obtained by an endoscope and to be sent to [http://www.evmedresearch.com/Immunoperoxidase_Staining_Request_Form250.pdf Dr Chia's lab] for analysis, is the most sensitive for detecting a chronic enteroviral infection, although unlike the ARUP Lab blood tests, the stomach biopsy will not indicate which particular CVB and EV serotypes you have. [[File:Male Torso Showing Tender Spots in Enterovirus Infection.jpg|thumb|Pain or tenderness at the starred points suggest enterovirus infection of the abdomen. Author: Tim44uk, adapted by Hip. License: CC-BY-SA-2.0]] Note that PCR testing of the blood is not considered sensitive for chronic enterovirus infections. Since viruses are cleared quickly from the bloodstream, the chance of finding viral gene or RNA in the blood by reverse transcription-PCR technique is low in chronic infection. Dr Chia found that with special techniques and repeated testing, enterovirus RNA can be found in close to thirty percent of whole blood samples taken from chronically infected EV patients. Dr Chia says that a fairly reliable sign of chronic enterovirus infection of the abdomen in ME/CFS patients is abdominal tenderness or pain in the epigastric area, in the right lower quadrant, and in the left lower quadrant (see the three X's in the abdomen picture). Epigastric pain or tenderness indicates enterovirus infection of the stomach. Right lower quadrant pain or tenderness suggests enterovirus infection of the terminal ileum. Left lower quadrant pain or tenderness suggests enterovirus infection in the small bowel or colon.<ref>{{Cite web | url = https://www.youtube.com/watch?v=WAZ4HiSC_sM&t=19m30s | title = Dr John Chia: Enterovirus Infection in ME/CFS. Presentation at the Invest in ME International ME Conference, London 2010. | last = Chia | first = John | authorlink = | date = | website = |archive-url=|archive-date=|url-status=|access-date=|quote=Here is a young lady's abdomen: you can notice that there's some viral distention, the patient consistently complaining of epigastric pain, nausea, right lower quadrant pain, and left lower quadrant pain. And when I pushed on it, on these X's, can definitely tell me, the tenderness. This is actually a fairly reliable sign to detect enterovirus infection of the abdomen.}}</ref><ref>{{Cite web | url = https://www.youtube.com/watch?v=XBUfUEwyEIA&t=14m35s | title = Clinical and Research Experience of Enteroviral Involvement in ME/CFS. Presentation at the Invest in ME International ME Conference, London 2011. | last = Chia | first = John | authorlink = | date = | website = |archive-url=|archive-date=|url-status=|access-date=|quote=This is actually a very helpful clinical finding. As you know in the definition of ME/CFS, there is sore throat, and ... ... ok, but there is very little attention to the abdominal symptoms, which most patients actually have. Patients often complain of pain up here, here's the rib cage, end of the rib cage, this is where the stomach is. They oftentimes have pain in the right lower quadrant, roughly where the appendix is, and that's the end of the terminal ileum, as I have shown you in the case before. They oftentimes have tenderness in the left lower quadrant, that either the small bowel here, or the colon, which we are actually able to show proteins or viral RNA in these areas.}}</ref>
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