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CMV reactivation diagnosis

SunMoonsStars

Senior Member
Messages
159
Trying to get a feel for how CMV is diagnosed as reactivated.

Any insight appreciated.
My List of tests

Herpesvirus 6 (HHV6) IgG 1:1280
Reference Range < 1:80 >= 1:320 Positive (HHV6 Foundation)

Cytomegalovirus Antibody IgG 19.3 H
Cytomegalovirus Antibody IgM 0.7
Cytomegalovirus IgG and IgM Reference Range: <=0.8 Nonreactive 0.9- 1.0 Indeterminate >=1.1 Reactive

EBV Ab VCA, IgM 41.9 High
Negative <36.0. Equivocal 36.0 - 43.9 Positive >43.9
EBV Early Antigen Ab, IgG 49.3 High
U/mL 0.0 - 8.9
EBV Ab VCA, IgG. >600.0 High
EBV Nuclear Antigen Ab, IgG 519.0 High

Parvovirus B19 Antibody, IgG 7.2 H *
Parvovirus B19 Antibody, IgM 0.2*
IgM and IgG Interpret <0.9 Negative 0.9 - 1.1 Equivocal>1.1 Positive

Adenovirus Antibody 1:8 Detected
<1:8 Antibody Not Detected
> or = 1:8 Antibody Detected

Streptozyme Screen with Reflex to Titer POSITIVE
Reference Range: Negative
Streptozyme Titer (Reflexed) 1:200
Reference Range: <1:100

Mycoplasma Pneumoniae (IgG) 2.39 H
Mycoplasma pneumoniae (IgM) 265*
IgG Interpretive criteria:
<=0.90 Negative 0.91-1.09 Equivocal >=1.10 Positive
IgM Interpretive criteria:
<770 U/mL Negative 770-950 U/mL Low positive >950 U/mL Positive

Chlamydia pneumoniae IgG 1:64 H <1:16
Chlamydia pneumoniae IgM <1:10*
< 1:10
 
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Learner1

Senior Member
Messages
6,305
Location
Pacific Northwest
My doctors also ran CMV and EBV PCR tests.

They also ran IgA on all of the above.

Have you had immunoglobulins measured?

What did your doctor say? Are you getting treatment for any of these?
 

ljimbo423

Senior Member
Messages
4,705
Location
United States, New Hampshire
Hi @SunMoonsStars - This what Dr. Robert Naviaux says about high antibody titers in CFS. Robert Naviuax is virologist and a leading CFS reaseacher.

He is a Salk-trained virologist, and molecular and cell biologist, the inventor of the popular pCL retroviral gene transfer vectors, and was trained at NIH in tumor immunology and natural killer cell biology.
http://naviauxlab.ucsd.edu/team/
latent and reactivated viral and bacterial infections can occur, but in the case of ME/CFS that has lasted for more than 6 months, this may be the exception rather than the rule.

Some doctors and scientists have not done a good job at educating patients and other scientists about the difference between serological evidence of infection in the form of antibodies like IgM and IgG, and physical evidence of viral replication like PCR amplification of viral RNA or DNA, or bacterial DNA.

We have learned in our autism studies with Dr. Judy Van de Water that supertiters of antibodies do not mean new or reactivated viral replication. Supertiters of IgG antibodies mean that the balancing T-cell and NK cell mediated immune activity is decreased.

This is a functional kind of immune deficiency that causes an unbalanced increase in antibodies.
[
/QUOTE]
https://www.omf.ngo/2016/09/09/upda...-fatigue-syndrome-q-a-with-robert-naviaux-md/
 

SunMoonsStars

Senior Member
Messages
159
Supertiters of IgG antibodies mean that the balancing T-cell and NK cell mediated immune activity is decreased.

This is a functional kind of immune deficiency that causes an unbalanced increase in antibodies.”

This makes sense.
But the fact is with the big increases titers comes huge acute attacks of Meningoencephalitis and Mono symptoms both.
Whether it’s immune disfunction only or not it’s very painful and scary!
 

SunMoonsStars

Senior Member
Messages
159
My doctors also ran CMV and EBV PCR tests.

They also ran IgA on all of the above.

Have you had immunoglobulins measured?

What did your doctor say? Are you getting treatment for any of these?

I’ve been given ivig a couple years ago but they only saw ebv active IGM for years assuming that was the cause Finally a European doc ran more tests as my symptoms were so odd with organ and CNS involvement. She didn’t know how to interpret and I’ve been chasing down info and getting expert opinions now. Hoping to get on appropriate meds and protocol as Valtrex was only thing given. This has been horrid 3 plus years as I had sudden attack of Meningoencephalitis type symptoms plus momo type at once few years ago suddenly. But was prior to that a typical cfids person without proper treatment really though. But was nothing crazy like this ever.

Do you know if CMV result means reactivated along with HHV6 and EBV which are. ?
 

Hip

Senior Member
Messages
17,795
This what Dr. Robert Naviaux says about high antibody titers in CFS.

From the Naviaux article you quoted, Naviaux says this:
Increased IgG antibodies to CMV, EBV, HHV6, Coxsackie, etc. are not good evidence of a reactivated viral infection. While Coxsackie is an RNA virus related to poliovirus, antibody titers can increase to this virus too, even though it cannot establish a chronic or latent infection. This can be proven in most cases by trying to measure viral DNA or RNA by PCR in the blood or swollen lymph nodes.

The above bolded statement by Naviaux is not correct; it does not take into account the research on enteroviruses published in the last 20 years. Coxsackievirus B can and does form chronic infections. These chronic CVB infections have been proven to exist not only in the tissues of ME/CFS patients, but also in the heart muscle of chronic CVB myocarditis patients. They are called non-cytolytic enterovirus infections.



in this article it states in CMV reactivation at acute stage IGG titers rise to Four Fold.

Can we use this for diagnosing our CMV reactivation?

Rising titers occur in acute infections, but they are not relevant for chronic infections. In ME/CFS, there are thought to be chronic active infections.

Your best bet is to go by the criteria that the ME/CFS specialist doctors use for diagnosing chronic active infections.

What lab(s) did you get your above tests from, by the way?
 
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SunMoonsStars

Senior Member
Messages
159
“Your best bet is to go by the criteria that the ME/CFS specialist doctors use fordiagnosing chronic active infections.”

This is my question. What criteria do they use for CMV. The article I posted seems quite good and quotes HHV-6 is diagnosed as reactivated if above 4x.

The tests above are all Sonora Quest besides EBV one which is Labcorp.
Which has been IGM positive for my fourth year.

Looking for CMV test criteria ME doctors use yes. I can’t seem to find anything specific.

Thanks for your reply and feedback.
 

Hip

Senior Member
Messages
17,795
Looking for CMV test criteria ME doctors use yes. I can’t seem to find anything specific.

If you look at the mini roadmap document, that's where I complied the various diagnostic criteria used by ME/CFS doctors for diagnosing a chronic active infection (which once diagnosed they will treat with antivirals or immunomodulators).

In the case of CMV, I have not been able to find much information, except the criteria which Dr Lerner used, which was that elevated IgG titers to CMV indicate active infection. He unfortunately did not say exactly what the threshold was for a high titer. But if your test results indicate high (I take it the "H" in your CMV results means high, is that correct?) then you might well have an active infection.

By Lerner's criteria you might also be diagnosed for chronic active EBV, given that your lab report say your EBV IgM VCA is high, and EBV Early Antigen is high.
 
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Hip

Senior Member
Messages
17,795
@SunMoonsStars, I think your HHV6 IgG titers of 1:1280 would indicate an active infection by Dr Montoya's criteria. But ideally you would want to see an ME/CFS specialist doctor to get a diagnosis of active infection in these 3 viruses.

Valcyte is an antiviral which targets EBV, HHV-6 and CMV.
 

SunMoonsStars

Senior Member
Messages
159
@SunMoonsStars, I think your HHV6 IgG titers of 1:1280 would indicate an active infection by Dr Montoya's criteria. But ideally you would want to see an ME/CFS specialist doctor to get a diagnosis of active infection in these 3 viruses.

Valcyte is an antiviral which targets EBV, HHV-6 and CMV.
Thank you. Yes it’s adding up to all three it seems which the more I learn the more I am told ther ride together. Am in middle of evaluation with ME doctor but that CMV I wanted to research. Like you said Dr L wasn’t clear on threshold. Yes it’s quite positively H High.
 

SunMoonsStars

Senior Member
Messages
159
In reality looks like they ride together but should calm too. I guess for some of us they won’t calm for years and yesrs.
Hope Valcyte will help with all three like your indicated.
Thanks for help.

If anyone knows titer limits for reactivated CMV I’m still wanting to learn more and learn what the goal would be to calm it as we know IGG isn’t supposed to go negative either once exposed.
 

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ljimbo423

Senior Member
Messages
4,705
Location
United States, New Hampshire
@Hip

Ron Davis says the same thing as Naviaux about not using antibody titers for detecting viral infections-

Ron Davis-
Also, there is a common misunderstanding about viral infection among some patients and even some doctors. Most viral assays used by doctors test for the presence of antibodies to viruses, not the viruses themselves.

The presence of antibodies shows that the person had a viral infection in the past, but does not constitute evidence that it is still present.

A direct assay for a virus is needed in order to find out if any virus is present. The current state-of-the-art assay is a PCR test for DNA or RNA from a virus. (Serology tests are tests for antibodies, not viruses.)

We are conducting these direct PCR assays in the Severely Ill Patient Study, as well as extensive DNA sequencing for any as-yet-undiscovered viruses.

https://www.omf.ngo/2016/09/09/viruses-and-cfs-statement-by-ron-davis-and-bob-naviaux/

Although I do think it's possible that some people with CFS/ME have problems with viruses stemming from immune system dysfunction. I think PCR testing is the way to determine that, as Robert Naviaux and Ron Davis say.

Jim
 

Hip

Senior Member
Messages
17,795
We are conducting these direct PCR assays in the Severely Ill Patient Study, as well as extensive DNA sequencing for any as-yet-undiscovered viruses.

If they are conducting PCR on the blood of ME/CFS patients, they will not tend to find any virus present in the blood. However, that does not mean there is no infection in the body.

In the case of enterovirus, we know that the virus is in the tissues, and studies performing PCR tests of ME/CFS patients' tissues have proven this to be the case. This was known in the early 1990s.

So if they are conducting PCR on the blood, then don't expect to find much. It's in the tissues that you need to look.
 
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