1:16 titer for Coxsackie B; should I be concerned?

Hip

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Thank you for your clarifications,just for the record i totally disagree on your last statement as Enterovirus being the "singular cause" of ME/CFS
Sorry, I meant to say a singular cause, meaning that it is possible just the chronic viral infection alone is capable of causing ME/CFS.

But that's not to deny there may be other causes, such EBV. Several studies have shown that around 10% of patients who get mononucleosis will go on to develop ME/CFS. So that seems to link EBV to ME/CFS quite convincingly.

Incidentally, one study found EBV can also form a non-cytolytic infection.
 
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AlwaysTired

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My results are finally in from ARUP-

Coxsackie B2- 1:40
All other Coxsackie B (1-6)- <1:10

Echovirus 9- 1:20
Echo. 6 & 7- <1:10
(Echo 8 must not have been done???)

Parvovirus B19 IgG- 4.18 IV
Parvovirus B19 IgM- 0.15 IV

HHV-6-

HHV6 By PCR Source Plasma
HHV6 By PCR Type Not Determined
Sample is negative for HHV6 nucleic acid therefore, viral
type cannot be determined.
HHV6 Quant By PCR (Copy/mL) <1000 cpy/mL cpy/mL
HHV6 Quant By PCR (Log copy mL) <3.0 log log

Are my coxsackie B2, Echovirus 9 or Parvovirus IgG titers of any significance?
 

Hip

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Are my coxsackie B2, Echovirus 9 or Parvovirus IgG titers of any significance?
Your CVB and echovirus titers are well below the 1:320 threshold that Dr Chia uses to diagnose chronic active infection. So I think you can rule out these enteroviruses.

I don't know how to interpret your parvovirus B19 titers; you'd need to see an ME/CFS specialist. If the IgG is very high, then you might assume an active infection.

I think Dr Chia and Prof Montoya use PCR to diagnose parvovirus B19 infection in ME/CFS patients.
 

AlwaysTired

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Your CVB and echovirus titers are well below the 1:320 threshold that Dr Chia uses to diagnose chronic active infection. So I think you can rule out these enteroviruses.

I don't know how to interpret your parvovirus B19 titers; you'd need to see an ME/CFS specialist. If the IgG is very high, then you might assume an active infection.

I think Dr Chia and Prof Montoya use PCR to diagnose parvovirus B19 infection in ME/CFS patients.
It is my dream to some day see an ME specialist, especially because all my tests come up with unremarkable results, leaving other specialists as well as my GP to not be able to do anything for me...
 

Hip

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It is my dream to some day see an ME specialist, especially because all my tests come up with unremarkable results, leaving other specialists as well as my GP to not be able to do anything for me...
Have you done the right tests for the common viruses and bacteria linked to ME/CFS?

You've done the right tests for coxsackievirus B and echovirus at ARUP Lab.

But what about EBV, HHV-6 and cytomegalovirus? ME/CFS doctors usually use antibody tests for these (not PCR tests). Did you get antibody tests for these three herpesviruses?

Another pathogen to consider testing for is Chlamydia pneumoniae, which is an intracellular bacterium.

You can see an overview of the tests ME/CFS doctors use in the "1st Round Tests" section of this roadmap document.



For the your parvovirus B19 IgG of 4.18 IV, does your lab results report specify the value for a positive infection?
 
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Hip

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It is my dream to some day see an ME specialist, especially because all my tests come up with unremarkable results, leaving other specialists as well as my GP to not be able to do anything for me...
Have you done the right tests for the common viruses and bacteria linked to ME/CFS?

You've done the right tests for coxsackievirus B and echovirus at ARUP Lab.

But what about EBV, HHV-6 and cytomegalovirus? ME/CFS doctors usually use antibody tests for these (not PCR tests). PCR will often miss herpesvirus infection in ME/CFS, because these infections may be in the tissues rather than the blood. Did you get antibody tests for these three herpesviruses?

Another pathogen to consider testing for is Chlamydia pneumoniae, which is an intracellular bacterium.

You can see an overview of the tests ME/CFS doctors use in the "1st Round Tests" section of this roadmap document.



For the your parvovirus B19 IgG of 4.18 IV, does your lab results report specify the value for a positive infection?
 
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Hip

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My results are finally in from ARUP-
By the way, do check that your lab results page says ARUP Lab on in somewhere. This is because if you order ARUP Lab tests through Quest or LabCorp, they often don't actually sent your blood sample to ARUP, even if you ask them to.
 

AlwaysTired

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Have you done the right tests for the common viruses and bacteria linked to ME/CFS?

You've done the right tests for coxsackievirus B and echovirus at ARUP Lab.

But what about EBV, HHV-6 and cytomegalovirus? ME/CFS doctors usually use antibody tests for these (not PCR tests). PCR will often miss herpesvirus infection in ME/CFS, because these infections may be in the tissues rather than the blood. Did you get antibody tests for these three herpesviruses?

Another pathogen to consider testing for is Chlamydia pneumoniae, which is an intracellular bacterium.

You can see an overview of the tests ME/CFS doctors use in the "1st Round Tests" section of this roadmap document.



For the your parvovirus B19 IgG of 4.18 IV, does your lab results report specify the value for a positive infection?
I've had the antibody tests for EBV several times, since I had mono when my ME began, and the titers are always <1:10 which means no virus detected. I don't think I've had cmv or hhv-6 antibody done since I initially got sick (with mono) cause they weren't near as high as EBV. I had thought the hhv-6 that I just got was going to be antibodies so I was surprised when I got my results


Honestly though I don't even know how much stock to put in these results since viruses can hang out in organs and tissues without giving themselves away


Regarding Parvovirus, above 1.11 meanspast or recentinfection, but that's all it says...



I am moving back to Utah tomorrow so i may not be able to get any more tests unless they decide to fully expand Medicaid, which is unlikely since the plan right now is to include a work requirement.
 
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Hip

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Honestly though I don't even know how much stock to put in these results since viruses can hang out in organs and tissues without giving themselves away
That's why antibody tests are used: they don't detect the virus directly, but measure the degree of immune response to it.
 

halcyon

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Echovirus 9- 1:20
Echo. 6 & 7- <1:10
(Echo 8 must not have been done???)
The ARUP echovirus test panel should include results for 5 echovirus serotypes: 6, 7, 9, 11, and 30. What were your titers for 11 and 30?

As Hip said, make sure that the results indicate somewhere that ARUP performed the testing.
 

AlwaysTired

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The ARUP echovirus test panel should include results for 5 echovirus serotypes: 6, 7, 9, 11, and 30. What were your titers for 11 and 30?

As Hip said, make sure that the results indicate somewhere that ARUP performed the testing.
The ARUP echovirus test panel should include results for 5 echovirus serotypes: 6, 7, 9, 11, and 30. What were your titers for 11 and 30?

As Hip said, make sure that the results indicate somewhere that ARUP performed the testing.
Tests were done at ARUP. I bypassed having to go through LabCorp or Quest by seeing my rheumatologist, who was able to order them from there and it is ARUP whose name and info is on the results so 100% they were done there.

Regarding 11 and 30...I went back to my results pages to check again and can't access the echovirus test results now so I will have to call and find out later
 
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Can anyone in the US advise on how to get the testing done by ARUP and the test order number I should reference?

I asked my doc for the Coxsackie test from ARUP and I got a lab order for Lab Corp which stated that the sample should be sent to ARUP. However when I went to Lab Corp for the blood draw they told me that the "system" recognized the order code and that Lab Corp do that test in house and never send it out.

Lab Corp test came back negative but after re-reading this thread I'd like to try again, just don't know how.
 

Hip

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Apparently it is very common for ARUP tests ordered through LabCorp to be done in error through LabCorp's own test. I've heard this story many times.

You need to contact LabCorp, and explain the situation, and ensure that they send your second test to ARUP. You might even tell them that this problem happens all the time, as they need pull their socks up on this. I am not in the US, so don't know any more details, but someone needs to email their headquarters and alert them to this problem in their computer system.
 

halcyon

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Can anyone in the US advise on how to get the testing done by ARUP and the test order number I should reference?
These should be the Lapcorp codes for the ARUP send outs:
  • 816869 - Coxsackie B Virus Abs
  • 823361 - Echovirus (Frozen) Serum Ab Panel
Failing that, I recommend calling around to the labs in your area hospitals and find out which ones have an ARUP account and can do a send out. If you go this route, the ARUP test codes are here and here. Print these out, get a new requisition form from your doctor, and take them in to the lab.
 

Wolfcub

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Numerous studies in the UK in 1980s and 90s, as well as more recent studies by John Chia, indicate that coxsackievirus B and echovirus can exist as a chronic low-level active non-cytolytic infection in the muscle tissues, intestinal tissues and brain tissues of ME/CFS patients.

If you perform enterovirus PCR testing on the blood, you often will get a negative result in ME/CFS; but if you perform PCR on infected tissues via biopsy (as the British researchers did), then it will often be positive. The high titers found on antibody neutralization tests are likely caused by these tissue infections.
So @Hip ....does that mean that in order to detect a chronic enterovirus infection, a tissue biopsy is mandatory? (rather than a blood test?)
 
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You need to contact LabCorp, and explain the situation, and ensure that they send your second test to ARUP. You might even tell them that this problem happens all the time, as they need pull their socks up on this. I am not in the US, so don't know any more details, but someone needs to email their headquarters and alert them to this problem in their computer system.
Thanks @Hip for the response. I submitted a question to Labcorp via their consumer service portal.

These should be the Lapcorp codes for the ARUP send outs:
  • 816869 - Coxsackie B Virus Abs
  • 823361 - Echovirus (Frozen) Serum Ab Panel
Thanks @halcyon . Is it also useful to do tests for Coxsackie A?
 
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Hip

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So @Hip ....does that mean that in order to detect a chronic enterovirus infection, a tissue biopsy is mandatory? (rather than a blood test?)
No, the ARUP lab coxsackievirus B and echovirus antibody tests, which use a very sensitive method (called the plaque reduction neutralization test) are also good for detecting chronic enterovirus infection.



Is it also useful to do an IgG and IgM tests and do you know if there is an useful ARUP test for Coxsackie A?
Coxsackievirus A is not linked to ME/CFS, so for ME/CFS purposes there is no reason to test for CVA.

Regarding IgM and IgG: I am not entirely sure, but I think the plaque reduction neutralization test method used at ARUP may simultaneously detect both IgM and IgG (and not distinguish between them).

At least when I was in contact with the lab director at the Hellenic Pasteur Institute in Greece, which also offers coxsackievirus B testing by the plaque reduction neutralization test (at a great price of €68), he told me that their test combines IgM, IgG and IgA.
 
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These should be the Lapcorp codes for the ARUP send outs:
  • 816869 - Coxsackie B Virus Abs
  • 823361 - Echovirus (Frozen) Serum Ab Panel
@Hip @halcyon I called Lab Corp Customer service (1-888-522-2677) and they confirmed that 816869 is sent to ARUP but that 823361 is sent to Cambridge Biomedical. Rep confirmed 823361 is performed using Serum Neutralization Assay. I'd appreciate your thoughts if this is acceptable.

FYI - I did call ARUP (1-800-522-2787) but they could not give me any Lab Corp codes. They said that Lab Corp could use manual requisition or Electronic Requisition but the Lab Corp rep I talked to confirmed what the local Lab Corp office told me is that they need a specific Lab Corp order code to order a test.

FYI - Lab Corp website does not recognize these codes.
 

Hip

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I called Lab Corp Customer service (1-888-522-2677) and they confirmed that 816869 is sent to ARUP but that 823361 is sent to Cambridge Biomedical. Rep confirmed 823361 is performed using Serum Neutralization Assay. I'd appreciate your thoughts if this is acceptable.
I think I read that Dr Chia also uses the Cambridge Biomedical test for echovirus, which is also an antibody neutralization like ARUPs, so it is the same sort of test. So it probably would be OK to get your echovirus tested at Cambridge Biomedical. But it would be good to have the right code for the ARUP echovirus test.

I found some alternative code numbers for the ARUP tests given in this post; I am not sure what those codes are, possibly the Quest codes for these ARUP tests?



@Ema might be able to offer some suggestions here, as she recently had the same issues with trying to order the ARUP tests through LabCorp and Quest.
 
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