August 8th, 2016: Understanding and Remembrance Day for Severe Myalgic Encephalomyelitis
Jody Smith joins with other ME voices in honor of Understanding and Remembrance Day for Severe Myalgic Encephalomyelitis.
Discuss the article on the Forums.

How do i test for chronic infections

Discussion in 'Diagnostic Guidelines and Laboratory Testing' started by douglasmich, Mar 5, 2016.

  1. douglasmich

    douglasmich

    Messages:
    311
    Likes:
    120
    There is a lot of talk in the functional medical world about "chronic infections" causing autoimmunity and also other health conditions.

    I think i have one because my WBC is below range but i never get sick.

    How do i test for this?


    thanks
     
  2. Daffodil

    Daffodil Senior Member

    Messages:
    4,802
    Likes:
    4,414
    depends which infection you want to test for. you can ask for antibody testing for: EBV, HHV6, CMV, Parvovirus, Mycoplasmas, etc. For Lyme, I would use the LTT ELISPOT test.
     
  3. MEMum

    MEMum Senior Member

    Messages:
    367
    Likes:
    1,841
    Has anyone had their ASO tested. ASO=Anti-streptolysin factor, ie a measure of recemt/ongoing strep infection.
    I ask for 2 reasons:
    • My daughter had a raised ASO (400 v max 200 = upper range of normal). I/m penicillin shots over 8 weeks led to significant cognitive improvement and better stamina. This was enough for her to study for and pass AS levels in Maths and Geography. She had been unable to study at this level for the previous 14 months or so. The improvement was not sustained, but did return with further courses of Azithromycin/Clarithromycin. Obviously she can't take antibiotics indefinitely due to gut effects etc but nothing seems to get rid of it. She has also tested positive for autoantibodies to the pyruvate kinase receptors in the basal ganglia (BG). The BG are involved in cortico-thalamic loops involved in cognitive function as well as motor function. (cf motor tics seen in PANDAS)
    • Many people with ME have or have a history of sore throats, swollen glands etc.
     
    Valentijn likes this.
  4. Jonathan Edwards

    Jonathan Edwards Senior Member

    Messages:
    5,019
    Likes:
    29,076
    I don't think there has ever been much evidence for a link between chronic infection and autoiimunity. The supposed link was with acute infections like rheumatic fever or the gut infection that may trigger Guillain Barre. The idea is that the acute infection triggers an autoimmune reaction that continues after the infection has gone. Even for that the evidence is pretty weak.

    Chronic infections that continue as infections are just infections as far as I know. They may lead to Reiter's or Poncet's arthritis, which appear to be some sort of overreaction, but not autoimmunity. The trouble is that even the conventional medical community tend to have pretty little idea about these things.
     
    MEMum likes this.
  5. Gingergrrl

    Gingergrrl Senior Member

    Messages:
    8,911
    Likes:
    21,907
    USA
    I truly am confused on this topic and have had one doctor tell me that my chronic IgM+ titers to things like EBV, VZV, HSV 1&2, enteroviruses, etc, show chronic infection versus another doctor tell me the opposite, that they are not evidence of chronic infection and mean that my immune system is in some kind of autoimmune hyper-drive cranking out antibodies to things that are no longer there.

    @Jonathan Edwards In your opinion is one of these theories correct, or neither correct, or could it vary from person to person, etc?
     
    Valentijn and abraxus like this.
  6. Jonathan Edwards

    Jonathan Edwards Senior Member

    Messages:
    5,019
    Likes:
    29,076
    The explanation of antibody levels varies from disease to disease. In Sjogren's disease, for instance, which is autoimmune, your second doctor would be right. But even so there is no indication that the original infections had anything to do with the development of the autoimmunity. The immune system just gets stuck with the antibody loudness knob turned up too high. In true chronic infection IgM stays high because virus is still present.
     
  7. Gingergrrl

    Gingergrrl Senior Member

    Messages:
    8,911
    Likes:
    21,907
    USA
    Is there a list of which diseases or antibodies would fall into which category or would it be a matter of opinion from one doctor to the next?

    This is actually what I suspect is happening to me now with viral titers and with two obscure antibodies found in recent tests via Mayo Clinic. Would this be a case where an immunosuppressant would be appropriate as long as the someone did not have cancer or something contra-indicated?

    This confuses me b/c the viral titers in my case like EBV and VZV are IgM+ (and I am not talking about a few others that have low IgG+ like HHV-6, etc) and am only referring to the ones that remain highly IgM+. Does this mean it is a true infection or even with the IgM+, it could still be that your immune system has gotten stuck with the antibody knob turned up too high?
     
  8. Jonathan Edwards

    Jonathan Edwards Senior Member

    Messages:
    5,019
    Likes:
    29,076
    Dear Gingergrrl,
    I am not going to be able to give more detailed thoughts. Everything depends on all sorts of other factors in an individual case
     
  9. duncan

    duncan Senior Member

    Messages:
    1,927
    Likes:
    4,157
    @Jonathan Edwards , this IgM persistence with chronic infection runs contrary to what mainstreet Lyme experts espouse.

    Their position is that if IgM's remain elevated beyond 60 days, this must be a false positive.

    They insist that titers convert naturally to IgG's, and will evidence elevated IgG's in a Lyme infection after 60 or so days.
     
  10. Jonathan Edwards

    Jonathan Edwards Senior Member

    Messages:
    5,019
    Likes:
    29,076
    I don't think Lyme is a helpful example here since it is so hard to know if antigen is indeed persistent. I would base general rules on situations where we know what is going on. What I was indicating was that IF persistent IgM is indeed due to chronic infection then it is due to persistent presence of antigen (although the rate of fall of IgM may vary a lot). In false positives it isn't due to the infection so this does not apply.
     
  11. duncan

    duncan Senior Member

    Messages:
    1,927
    Likes:
    4,157
    Sorry, but the position of the IDSA is that Borrelia IgM readings will convert to IgG naturally for anyone with a persistent Lyme infection, both before and after abx treatment.

    This is a cornerstone of their philosophy, and a contentious one in an area characterized by polemics. There are many Lyme patients and ILADS doctors who would agree with you.
     
  12. Jonathan Edwards

    Jonathan Edwards Senior Member

    Messages:
    5,019
    Likes:
    29,076
    As I said, it is useless to debate this, since we do not know the level of persistent antigen. I was talking about how you explain persistent high IgM in situations where we know a bit more. If IgM is not high in a persistent infection that is perfectly consistent with what I said - presumably the IgG outcompetes any stimulation of new IgM. You cannot use this as an argument for what 'should be true of Lyme'.
     
  13. duncan

    duncan Senior Member

    Messages:
    1,927
    Likes:
    4,157
    Actually their argument - and they've studies in support of it - is that they do know Bb antigens are present. These would be culture-confirmed cases.

    And it's not my argument. I was merely offering you their perspective in response to "In true chronic infection IgM stays high because virus is still present."

    Sorry, no offense intended.
     
  14. Gingergrrl

    Gingergrrl Senior Member

    Messages:
    8,911
    Likes:
    21,907
    USA
    Thank you and I understand that each case is very unique and there is no standard "rule" that applies to everyone. Thank you anyway!
     
  15. msf

    msf Senior Member

    Messages:
    3,133
    Likes:
    4,316
    So is latent infection not a form of chronic infection? Because most people have latent EBV infections, but not many of them are IgM positive.
     
  16. Gingergrrl

    Gingergrrl Senior Member

    Messages:
    8,911
    Likes:
    21,907
    USA
    @msf, I know you are not asking me but I am still trying to understand this. If someone does test IgM+ for EBV four years after their infection, would this be considered latent infection, active infection, or a chronic infection? Or would the answer vary greatly on each doctor's interpretation?
     
  17. Groggy Doggy

    Groggy Doggy Mutiny!

    Messages:
    886
    Likes:
    2,641
    Hi @Gingergrrl

    I think the answer may depend on the values for the other EBV tests. If you scroll down to the table, you will see the different interpretations:

    https://labtestsonline.org/understanding/analytes/ebv/tab/test/
     
  18. Gingergrrl

    Gingergrrl Senior Member

    Messages:
    8,911
    Likes:
    21,907
    USA
    Thanks, GD, and I looked at the chart and wonder what it means if I test positive for all four of the tests?!! It must mean my body is just cranking out these antibodies in some kind of autoimmune/hyper state? It's all I can think of since I had mono/EBV in 2012.
     
  19. msf

    msf Senior Member

    Messages:
    3,133
    Likes:
    4,316
    I´m not an expert, but I think some doctors would say it´s evidence for reactivation.
     
  20. msf

    msf Senior Member

    Messages:
    3,133
    Likes:
    4,316
    If you make a distinction between latent and chronic infection with EBV, then chronic would have to refer to CAEBV, I think.
     

See more popular forum discussions.

Share This Page