Corticosteroids given during acute viral infection may trigger myalgic encephalomyelitis

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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, up-regulate the antibacterial Th2 response,[2] and suppresses T-cell function.[3] In the international consensus criteria for ME/CFS, under the list of environmental events leading to ME/CFS, it is recognised that "steroids before or during acute respiratory illness can turn immune response to Th2 and suppress T cell numbers".[4]

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.[5][6][7] Chronic psychological stress elevates cortisol which suppresses the Th1 antiviral/intracellular immune response,[8] and the T-cell response.[9] 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. (June 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. (July 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 3713788. PMID 23575983.
  4. ↑ Carruthers, BM; van de Sande, MI; De Meirleir, KL; Klimas, NG; Broderick, G; Mitchell, T; Staines, D; Powles, ACP; Speight, N; Vallings, R; Bateman, L; Bell, DS; Carlo-Stella, N; Chia, J; Darragh, A; Gerken, A; Jo, D; Lewis, DP; Light, AR; Light, KC; Marshall-Gradisnik, S; McLaren-Howard, J; Mena, I; Miwa, K; Murovska, M; Stevens, SR (2012), Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners (PDF), ISBN 978-0-9739335-3-6
  5. ↑ Hatcher, Simon; House, Allan (October 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.
  6. ↑ 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.
  7. ↑ Salit, Irving E. (January 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.
  8. ↑ Dhabhar, Firdaus S (March 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 2869337. PMID 20525121.
  9. ↑ Dhabhar, Firdaus S (March 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 2869337. PMID 20525121.
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