Laboratory/Investigative Protocol: Diagnose by criteria. Confirm by laboratory and other investigations. A broad panel of tests provides a more robust basis to identify symptom patterns, abnormalities and orient treatment.
Routine laboratory investigation: □ CBC, □ ESR, □ CA, □ P, □ RBC Mg, □ vitamin D3, □B12 & folate, □ ferritin,
□ zinc, □ FBS, □ PC, □ Hb A1C, □ serum electrolytes, □ TSH, □ protein electrophoresis screen, □ CRP,
□ creatinine, □ ECG (U+ T wave notching), □ CPK and liver function, □ rheumatoid factor, □ antinuclear antibodies, □ urinalysis, □ essential fatty acids, □ CoEnzyme Q10, □ immunoglobulins, □ diurnal cortisol levels, □ TTG,
□ serotonin
Additional laboratory investigation: (as indicated by symptoms, history, clinical evaluation, lab findings, risk factors)
□ 24 hour urine free cortisol, □ DHEA sulphate, □ ACTH, □ chest x-ray, □ hormones including free testosterone,
□ panoramic x-ray of dental roots, □ amino acid profile, □ abdominal ultra sound, □ lactose/fructose breath test
Further testing with specificity to ME,if and as indicated. Some tests are in the research stage but can identify abnormalities and focus treatment. Viral tests should be interpreted by a physician experienced in these infections.
Pathogen: □ Enterovirus; Tests: RT-PCR, serology, stomach biopsy
Pathogen: □ mycoplasma; Tests: DNA-PCR, serology
Pathogen: □ EBV, □ CMV, □ HHV-6; Tests: DNA-PCR, serology, antigenemia
Pathogen: □ Borrelia burgdorferi; Tests: DNA-PCR,serology, Western Blot
Pathogen: □ Clamydia pneumonia; Tests: DNA PCR, serology
Pathogen: □ Parvovirus B19; Tests: DNA-PCR,IgG, IgM,
Immune system profiles: □ *↓NK cell function & ↑cytotoxicity; □ B & T-cell function: □ IgG, □ IgG subclasses 1-4; □ IgA, □ IgM (shift from T1 to T2), □ cytokine/chemokine profile panel (94% accuracy): IL-8, IL-13, MIP-1β, MCP-1, IL4, □ flow cytometry for ↑ lymphocyte activity, □ ↑37 kDa 2-5A RNase L immunoassay – defect/ratio & bioactivity,
□ food sensitivity panel, □ chemical sensitivities, □ stool for WCB - D-lactic acid bacteria balance, ova & parasites,
□ autoimmune profile, Intestinal dysbiosis: □ IgA & IgM for intestinal aerobic bacteria in serum, □ ↑ leukocyte elastase activity in PBMCs, □ IgG food intolerance test, □ toxoplasmosis
Neurological & static testing: □ *SPECT scan with contrast - ↓ cortical/cerebellar region cerebral blood flow (rCBF) in the frontal, parietal, temporal and occipital & brain stem regions - more brain involvement indicates increased illness severity, □ MRI of brain – (increased T2-weighted images in high white matter tracts & loss of GM volume) & rule out MS, □ MRI of spine (dynamic disc bulges/herniation , stenosis), □ sleep study (↓ stage 4 sleep, sleep pattern & rule out treatable sleep dysfunctions – upper airway resistance syndrome, sleep apnea, etc.)
PENE: A 2 consecutive day comprehensive 8-12 minute cardiopulmonary exercise stress test (measuring heart, lung, and metabolic function) - only ME patients have significantly worse scores the second day & abnormal recovery from exertion. * Exercise tolerance test with expired gas exchange - (2 consecutive days) – measure cardiovascular, pulmonary & metabolic responses at rest & during exercise: □ peak oxygen consumption VO2 or VO2 at anaerobic threshold (AT) - decline of 8% or greater on test 2 indicates metabolic dysfunction, □ post-exercise blood analysis - increase in sensory, adrenergic and immune genes - increase in metabolite receptors unique to ME
Energy metabolism/ion transport: □ ATP profile – identifies insufficient energy due to cellular respiration dysfunction □ further ATP related parameters, superoxide dismutase and cell-free DNA Respiratory:
□ pulmonary function test Cardiovascular: □ Tilt table test to confirm OI (70 -80% tilt, measure HR continuously, BP periodically – 30 min or presyncope); □ Cardiac output decreases - left ventricular dysfunction in the heart;
□ 24-Hour Monitor for suspected arrhythmia, NMH/POTS, myocarditis (Note: Repetitively oscillating T-wave inversions &/or T-wave flats, typical of ME, may be subsumed under non-specific T-wave changes.)
