Hip
Senior Member
- Messages
- 18,109
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.
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:
