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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, he discovered a causal equation: acute infection + corticosteroids = ME/CFS

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

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

    After hearing this corticosteroids story hundreds of times over from 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 that acute infection.



    Why might corticosteroids be inadvertently prescribed for an acute 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 just like hives.

    So the ER doctor may question the patient about what he ate recently, and if the patient happened to eat shellfish, then the ER doctor might (incorrectly) assume that the patient's rash is a hives rash caused by allergy to the shellfish, and will thus put the patient on a course of corticosteroids like prednisone, 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 DVD from the Invest in ME Conference:



    Mechanism of Action in Triggering ME/CFS

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

    It is hard to say, but since corticosteroids suppress the Th1 antiviral immune response (and increase the Th2 response) and suppresses T-cell function, one possibility is that when given at a critical point when the body is struggling against an acute enterovirus infection, corticosteroids may allow the virus to penetrate more deeply into cells or tissue compartments such as the brain that it would not normally get the opportunity to infect (three autospies found enterovirus in the brains of ME/CFS patients).

    Once in these tissue compartments, enterovirus may set up a chronic non-cytolytic infection; or in the case of Dr Martin Lerner's theory of herpesvirus ME/CFS, set up an abortive infection in non-permissive cells. In both cases, the infection smolders away, but produces no new viral particles.

    If the virus gets a chance to enter immune-privileged tissue compartments like the brain, it may no longer be possible to eradicate the virus from the body. So this enterovirus infection never resolves, and this may be how the patient then comes down with ME/CFS.

    Dr Chia says on another video:
    So acute infection + corticosteroids = ME/CFS appears to be the causal equation for some patients.



    Psychological Stress Connection to ME/CFS

    Dr Chia's discovery might also help explain the psychological stress connection to ME/CFS:

    Several studies found major life stressors (eg divorce, bereavement) in the months preceding the onset of ME/CFS. Refs: 1, 2, 3.

    Since chronic psychological stress elevates cortisol which suppresses the antiviral Th1 immune response (ref: 1) and T-cell response (ref: 1 ), if someone were unlucky enough to catch an ME/CFS-associated virus like enterovirus precisely during a period of chronic major life stress, this acute infection + elevated cortisol from stress combination might precipitate ME/CFS much in the way as the acute infection + corticosteroids combination does.

    So in this way, Dr Chia's discovery could explain how chronic psychological stress increases the risk of ME/CFS.
     
    Last edited: Jun 12, 2018
  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 says that in his patient histories, when prednisone was given during the acute phase of a viral infection, ME/CFS would be precipitated a few weeks to a few months later. So that is the timescale of the triggering of ME/CFS after an acute infection + corticosteroids event.


    I think possibly this corticosteroid etiology for ME/CFS that Dr Chia has observed may be quite similar to mold etiologies: if you are exposed to mycotoxins from mold, this can suppress your antiviral Th1 immune response (ref: 1) and T-cell response (ref: 1), so if you were unfortunate enough to catch a ME/CFS-associated virus during some chronic exposure to mold, the virus would encounter a weakened immune system, and so again, the virus may be able to penetrate into more tissue compartments like the brain, and then set up a chronic infection that cannot be eradicated.

    So if you take an overview 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 phase, 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, stress or mold exposure that made their immune system weak at the moment the virus hit them.
     
    Last edited: Jun 12, 2018
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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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    Dr Chia is not 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.


    If you look at Dr Chia's research, you see that he was able to get severe ME/CFS back to work using interferon therapy to fight off enteroviral infection. Unfortunately, after several months, the virus would slowly reinstate itself in the body, and the ME/CFS would return. And some ME/CFS patients with chronic herpesvirus infections have greatly improved or gone into remission using the potent antiviral Valcyte.
     
    Last edited: Jun 12, 2018
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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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  17. tooth

    tooth

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    Sorry to drag up an old thread, but I saw @Hip referencing this study in another post. I think I probably had moderate ME since a teenager before the big crash. I do think mine is somewhat virally related (perhaps not exclusively a virus itself but more that there's an inherited chink in the armour of my immune system that let them in and can't get them out). A few years before Big Crash, I was put on months of oral steroids (can't remember if it was prednisolone or prednisone) for a horrible skin infection that turned me into a crusty balloon. I just googled "enterovirus rash" and it certainly could have been that. I had to take three months out of school I was so exhausted.

    The year after that, I got eczema hepeticum which was almost the end of me, I can't remember if I got oral steroids (lots of antibiotics and antivirals though) but certainly plenty of topical steroids (remember walking out of the pharmacy with two plastic carrier bags full!!!).


    Thanks again @Hip - I've been looking into (and just started) doing some immune modulating stuff with herbs targeted at Herpes viruses as I have a problem with shingles. Remember you mentioned Sophia Flavescencs for enterovirus and it's on my list of things to add in at one point. Certainly makes sense after reading this thread!
     
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  18. adambeyoncelowe

    adambeyoncelowe

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    I've been taking corticosteroid inhalers since I was a kid. Would those count?
     
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  19. Hip

    Hip Senior Member

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    It would depend on dosage. The prednisone dose for allergy is in the order of 40 mg daily, so if you were inhaling that dosage daily from your inhaler, and if you happened to catch an infection from an ME/CFS-triggering virus like coxsackievirus B while you were using the inhaler, then I think it would count.
     
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  20. adambeyoncelowe

    adambeyoncelowe

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    I checked. Only 0.5mg per day. So it's likely safe at that dose. However, the side-effects are interesting:

    Common side effects of budesonide include:
    • Nausea, vomiting, diarrhea, and constipation
    • Dizziness and headache
    • Upset stomach or stomach pain, gas, and bloating
    • General or joint pain
    • Fatigue
    • Low blood levels of potassium
    • Acne
    • Weakened immune system
    • Bladder or kidney infection
    Serious side effects of budesonide include but are not limited to:
    • Cushing's syndrome (more likely with long-term use)
    • Decreased function of adrenal glands (more likely with long-term use and higher doses)
    • Pressure in the space between the skull and the brain
    • Life-threatening allergic reaction called anaphylaxis in which you may have trouble breathing, the throat closes up, and your skin breaks out into hives
     
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