The 12th Invest in ME Conference, Part 1
OverTheHills presents the first article in a series of three about the recent 12th Invest In ME international Conference (IIMEC12) in London.
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Corticosteroids such as prednisone given during an acute viral infection may trigger ME/CFS

Discussion in 'General Symptoms' started by Hip, Dec 13, 2013.

  1. Hip

    Hip Senior Member

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    Dr John Chia has noted that corticosteroids when given during an acute viral infection seems to be a "recipe" that can often precipitate ME/CFS.

    That is to say, quite often: acute infection + corticosteroids = ME/CFS

    In a presentation by Dr John Chia at the Invest in ME Conference, London 2010 (found on the DVD of the conference), Dr Chia talks about the factors and events his patients report just prior to their development of ME/CFS.

    From these meticulous investigations into his ME/CFS patients' medical histories, Dr Chia discovered that literally hundreds of his patients were given corticosteroids such as prednisone exactly at the time that they were acutely ill with a viral infection.

    From hearing this corticosteroids story hundreds of times over in his ME/CFS patients, Dr Chia concluded that taking steroids while fighting an acute viral infection seems to be a recipe for disaster, as it appears to greatly increase the risk that ME/CFS will be precipitated by the infection.



    Why might corticosteroids be inadvertently prescribed for a viral infection? Dr Chia says the skin rash that may be caused by an acute enterovirus infection can look like chicken pox, measles, German measles, or hives.

    Dr Chia says that if, for example, people suddenly become ill and develop a skin rash from an acute enterovirus infection, they may go to the emergency room, and the ER doctor will look at the rash, and might suspect the rash to be hives, since enterovirus rashes can look identical to hives.

    So the ER doctor will question the patient about what he ate beforehand. If the patient just happened to eat some shellfish, then the ER doctor may (incorrectly) assume that the patient's rash is a hives rash, caused by allergy to the shellfish, and so will put the patient on a course of steroids, like prednisone or prednisolone, as this is the normal treatment for hives.

    Thus the patient has an acute enterovirus infection, and needs a strong and robust 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.

    Dr Chia says on the video:


    Why might taking corticosteroids during an acute viral infection lead to ME/CFS?

    It is hard to say, but perhaps if you take immunosuppressive corticosteroids at a critical stage when the body is trying to fight off an acute enterovirus infection, these steroids may weaken the immune response and thereby allow the acute viral infection to spread more deeply into cells or tissues that the virus would not normally get the opportunity to infect when the immune response is strong.

    Once spread more deeply into these cells or tissues, perhaps an enterovirus may more readily set up a non-cytolytic infection; or in the case of Dr Martin Lerner's theory of herpesvirus ME/CFS, more readily set up an abortive infection in non-permissive cells, which like non-cytolytic infections, smolders away but produces no new viral particles.

    And once the virus has gained a foothold in these cells or tissues in this way, it may no longer be possible to eradicate the virus from the body. So this enterovirus infection never resolves, and it becomes a chronic infection (one which produces very few new viral particles, but persists in the tissues). The patient may then come down with ME/CFS a few weeks or months after.

    Dr Chia says on another video:
    So acute infection + corticosteroids = ME/CFS may explain the reason that a subset of patients developed chronic fatigue syndrome.
     
    Last edited: Dec 30, 2017
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  2. cigana

    cigana Senior Member

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    I had gradual onset. I was given steroid eye drops for 2 weeks, a few months before becoming ill. It certainly didn't start at the same time, but I've often wondered if they played a role.
     
  3. lansbergen

    lansbergen Senior Member

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    http://www.fasebj.org/content/16/1/61.full#sec-

    First, at the gene cluster level, our study shows a bidirectional action of GC, which are both immunostimulatory and immunosuppressive at the same time even for the inflammation cluster (12). They seemed to prime and enhance the innate immune response while repressing part of the adaptive immune response in a resting state.
     
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  4. heapsreal

    heapsreal iherb 10% discount code OPA989,

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    Yes, i have been reading up on this of late and GC steroids increase neutrophil counts, this would help certain infections. Maybe it depends on the dose and the duration of treatment, maybe its the very high doses that is the issue. I think about 5mg of prednisone is equal to what our bodies make where when docs give prednisone its usually a much higher dose.

    It might not be related to this but i found interesting was that TNF alpha actually block cortisol receptor sites, this might explain how tnf is inflammatory as its blocking the bodies anti inflammatory mechanisms cortisol. Cortisol seems to be involved in alot of processes.
     
  5. Valentijn

    Valentijn Senior Member

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    I had a couple courses of prednisone for presumed asthma, a month or two after I developed acute symptoms which (retrospectively) looked like bartonella.

    I'd had possible "ME lite" symptoms prior to that, with recurrent difficulties when undertaking step-aerobic classes and tae kwon do. I didn't get full blown ME symptoms until several years later.
     
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  6. Hip

    Hip Senior Member

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    @Valentijn
    I guess that prednisone may have possibly been a factor in your development of ME/CFS, though Dr Chia mentions a timescale of a few weeks to a few months for ME/CFS to appear after prednisone was given during the acute phase of a suspected enterovirus infection.


    I think this corticosteroid etiology for ME/CFS that Dr Chia has observed may be quite similar to mold etiologies: if you are exposed to mold, this can suppress your antiviral Th1 immune response, so if you were unfortunate enough to catch a ME/CFS-associated virus at the same time that you were exposed to mold, this virus will encounter a weakened immune system, and so again, the virus may be able to penetrate deeper into the body, and penetrate into more tissue compartments of the body, thus becoming a chronic, persistent infection that cannot be eradicated.

    So if you take an overview perspective of both the corticosteroid and mold etiologies, they point to this idea that ME/CFS is caused when an acute viral infection meets a temporarily weakened immune system, so that during the acute infection period, the virus is able to insinuate itself deeper into the body, creating a chronic infection, and then precipitating ME/CFS.

    If this idea is correct, then it could explain why some people develop ME/CFS from virus in circulation, but other people who catch the same virus do not: it just comes down to the fact that those who developed ME/CFS had some external factor such as corticosteroids or mold exposure that made their immune system weak at the moment the virus hit them.
     
    Last edited: Oct 18, 2014
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  7. Sherezade

    Sherezade Guest

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    I never thought about it, but now that you mention this, I remember having a really bad tendinitis in my knee and heel, five years ago. It was consequence of overtraining without proper warming before. When i went to the doctor he inyected me something to help with the inflammation, I'm not sure what it was, but now I'm suspecting it could have been corticoids. At that moment I didn't care because the pain was so terrible that the only thing i wanted is relief.

    It took me a couple of months to recover totally from the tendinitis. Then, three years ago, i fell sick with a giardiasis that affected not only me but to all my co workers for drinking contaminated water in the office. i received treatment and I recovered very fast from it, but now I wonder if these situations could have played a part in me getting this illness two years ago.
     
  8. physicsstudent13

    physicsstudent13 Senior Member

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    every so often I read on a forum of an asthma cure like spirulina and azithromycin, but I can't exhale after taking 6 weeks of azithromycin
    I've been on a lot of short/medium courses of prednisone for asthma and take symbicort regularly, does it damage your energy and adrenals? all my doctors are kind of conservative about prednisone and it can destroy your bones.
     
  9. xks201

    xks201 Senior Member

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    Quite interesting but I'm not sure I buy it. It's easy to say everyone gets CFS from corticosteroids but everyone basically is prescribed them nowadays at various times for various things. It's like saying oxygen causes CFS. lol


    If all of these viral stories were true then someone would have been cured by now with an anti viral. You hear tons of people saying they got temporary relief from one but that means nothing.
     
  10. Hip

    Hip Senior Member

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    Nobody is saying that ME/CFS arises purely from corticosteroids, but rather that if corticosteroids are given precisely at the time you happen to come down with an acute enterovirus infection, then this may lead to ME/CFS.

    People have been put into near remission from ME/CFS for periods of 2 to 14 months by taking very potent antiviral treatments that target enteroviruses. If you look at the research done by Dr Chia using interferon treatment, you see that he was able to put ME/CFS into near remission for months. Unfortunately, after several months, the virus would slowly reinstate itself in the body, and the ME/CFS would return.
     
    Last edited: Oct 21, 2014
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  11. xks201

    xks201 Senior Member

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    Oh okay, well that makes sense as a possibility then.
     
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  12. slysaint

    slysaint Senior Member

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    I know this is an old thread but I'm new to the forum and this topic isVERY relevant to my current situation.
    I've had ME for 14 years. I'm currently 10 months into steroid withdrawal(aka tsw). The condition is not yet recognised in the uk . If anyone is currently using steroids, particularly topical steroids I would urge you to check out itsan or the many videos on YouTube. What has brought me back to the ME community is that I now believe steroids( nebuliser and inhaler) could indeed have majorly contributed to my onset of ME. I was prescribed oral steroids last year with disastrous results.
     
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  13. justy

    justy Donate Advocate Demonstrate

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    i currently have a nasty virus. its affecting my chest badly and the Dr just prescribed me prednisone today. I still feel very viral so not sure i want to supress my immune systme further. It may be flu. But on the other hand i want to breathe, and then on the other hand steroids have wrecked my health before and i react with borderline psychosis at low doses....
     
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  14. Hip

    Hip Senior Member

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    That's an awkward dilemma to have, @justy.
     
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  15. ljimbo423

    ljimbo423 Senior Member

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    My guess is your doctor probably prescribed the pred. to bring down your immune response (inflammation) to a more manageable level but not to suppress your immune system too much, so you can still fight off the infection.

    You also say you have reacted badly to steroids in the past, which makes it a difficult decision to make. Whatever you do, I hope you feel better soon.:)

    Jim
     
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  16. justy

    justy Donate Advocate Demonstrate

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    Sure is! The joys of life with severe M.E.
     
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