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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Proof of enterovirus : biopsy or blood work ?

Discussion in 'Diagnostic Guidelines and Laboratory Testing' started by Dechi, Mar 27, 2017.

  1. Dechi

    Dechi Senior Member

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    My doctor wants me to have a gastric biopsy to find traces of an enterovirus he suspects. I read a lot about people who had blood work done that found evidence of enterovirus or other infectious agents. I am wondering why would someone choose one method over the other ? Blood work seems a lot faster. But where can it be done, and what do you ask for ?

    I am getting impatient. I know there is no cure but there is a way to try sensible treatments if you know what you are fighting with. A gastric biopsy will take months to do and more months to get the results. I think my doc sends it to be analyzed somewhere in the US, maybe with Dr Chia even.

    If anyone can explain this for me, I will be really grateful.
     
  2. Gingergrrl

    Gingergrrl Senior Member

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    This question is definitely for @Hip or @halcyon. I know for blood tests for EV, that ARUP labs is supposed to be the best. I am not sure what the advantage of stomach biopsy is b/c even if it tests positive, I am not sure how it would change the treatment beyond if your ARUP testing was positive. And even then, there is no targeted anti-viral for EV yet (unless I am mistaken). This is why I tagged the two experts on this topic...
     
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  3. Dechi

    Dechi Senior Member

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    @Gingergrrl thank you ! We'll wait for the experts... :)
     
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  4. halcyon

    halcyon Senior Member

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    The advantage of the gastric biopsy test is that it is not serotype specific. It can detect the VP1 protein produced by all known enterovirus serotypes. In the US, proper serology tests (using a microneutralization method) only exist for all 6 serotypes of Coxsackie B and only 5 of the more common echovirus serotypes (there are 28 known echovirus serotypes in total). This leaves close to 100 known serotypes of enterovirus that cannot be tested for by commercially available serology testing. The disadvantage of the gastric biopsy test is that there is always the chance, if positive, that you were just carrying a transient enterovirus gut infection at the time of the biopsy, as all people will over time. Dr. Chia's lab does additionally test the samples for the presence of double stranded RNA, the preponderance of which has been associated with chronic enterovirus infections in ME, but I don't think it's been proven that dsRNA isn't also present in transient infections.

    So, if you are chronically infected with an enterovirus, the ideal scenario would be that it's one of the common serotypes that can be tested for via microneutralization serology, and you would repeat this testing over the span of many months to see if the titer remains at a level consistent with active infection, to rule out the possibility of transient infection.

    With all that said, I don't even know if these serology tests are available in Canada and I don't know what it would entail to get them sent to the lab that does this testing in the US (ARUP Laboratories in Utah).
     
  5. Dechi

    Dechi Senior Member

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    @halcyon thank you for this detailed answer ! From what I understand, one part of the analysis is done by Life Lab in Ontario and another part of the biopsy is sent to Dr Chia. Dr Chia and Dr Hyde work together.

    What about blood work, is it worthwhile ? Once Dr Hyde told me you could send some blood to Pasteur Institute in France and have results in 3 weeks. I don't know why we're not going this route, though.
     
  6. halcyon

    halcyon Senior Member

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    I'm not sure what testing they have available. I know you've mentioned that Dr. Hyde suspects you might have been infected with enterovirus D68, perhaps they don't have a test available for that (which is likely). I assume he suspects this due to your onset corresponding to one of the D68 outbreaks in Canada? This is where the gastric biopsy test would come in handy because it should be able to detect VP1 from enterovirus D68, but it wouldn't be able to tell you that it was D68, and again it wouldn't prove that it's a chronic infection necessarily.
     
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  7. Mij

    Mij Senior Member

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    I had PCR RNA test in Ottawa virology lab at CHEO years ago. Not sure if the lab still exists though because I'm sure Dr. Hyde would have it sent there?
     
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  8. Dechi

    Dechi Senior Member

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    @Mij I'll ask him if I get a chance. What does CHEO stand for ?
     
  9. Mij

    Mij Senior Member

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    Children Hospital of Eastern Ontario.
     
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  10. kangaSue

    kangaSue Senior Member

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  11. trishrhymes

    trishrhymes Senior Member

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    I know nothing about how to test for enteroviruses, but have read this thread and other mentioning enteraoviruses with interest, and have a question:

    If there is chronic enterovirus infection, what is the recommended treatment, how effective is it, and does treating it help with ME/CFS symptoms?

    And if the treatment is drug based, is there any alternative over the counter (herbal or dietary) treatment?

    I ask because, being housebound and in the UK, I have a snowball's chance in hell of getting any tests, so any treatment is based on guesswork. Which is probably why I haven't really tried any in 27 years apart from pacing, and my health continues to decline.

    Sorry, being lazy - I realise I should do a search and/or start a new thread with my questions. Can anyone point me in the right direction, and I'll get out of your thread.
     
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  12. alex3619

    alex3619 Senior Member

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    There are to my knowledge no official treatments for enteroviruses aside from palliative treatment. Chia has some experimental methods and reports some success, and this includes antiviral herbal extracts I think.
     
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  13. JES

    JES Senior Member

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    You can find a good list of enterovirus antiviral medications/herb in this forum post. The problem is that only a limited number of these supplements pass the blood brain barrier. Dr. Chia uses Oxymatrine mostly, which unfortunately all it did was to cause dizziness when I increased the dosage, no improvement.

    Fluoxetine is an interesting drug that would pass the BBB and is antiviral against both CVB3 and CVB4. Unfortunately, it doesn't do anything from my experience at the standard dosage of 20 mg, the concentration is probably not high enough to reach EC50 levels of antiviral response. I may trial it at 40+ mg sometimes this year, though the side effects are such that I wouldn't be very happy taking it at that dosage for the rest of my life, even assuming that it worked.
     
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