Coxsackievirus test by ArminLabs

[frederic83]

I was tested at ArminLabs with the coxsackievirus test. With the information I gathered, I explained here how the test is supposed to work:

Armin lab is not testing, actually, every coxsackievirus Bs. It tests for B1 and A7 antigens, and if it is positive, because B1 and A7 antigens should match for almost all Bs and As viruses, and considering how the test is designed, you are considered positive for coxsackievirus B (one of them) if the B1 antigen is positive and A (one of them) if the A7 antigen is positive.
But you won't know which virus subtypes exactly you are positive. That's what I understood through my e-mail conversation with Armin.
In the report, they says positive for B1 and/or A7, but it means you are positive for one or more CVB1-6 and/or one or more A subtypes.
So, if you want to know with which coxsackievirus subtypes you are infected (B1 to 6 or As), I don't recommend this test.
For the tests done before 2016 (or late 2015I guess), the reports just said positive/negative for coxsackievirus, without the B1 or A7 antigens precision.

The test use the immunofluorescence assay and the cost is 64 euros.
They use the test from Euroimmun Lübeck Germany and they "insert" A7 and B1 antigens in the test system.

My report, high titers for CVA and CVB:

I was also tested at the Utrecht Lab in the Netherlands, which offered (they stop the test at the end of april 2016) a microneutralization test and I was negative for all the CVB except for CVB5 but with a low titer (1:8) that is probably from a past infection, not an active one.

In CFS, we know that the microneutralization test is the only one that showed a real correlation with an enterovirus infection in a non-cytolytic form.

I don't understand why I'm positive for the CVB and CVA. Moreover, the CVA types are not linked to CFS. I was thinking that the result are due to a cross-reaction with several enterovirus types.

Who was tested with the coxsackievirus at ArminLabs? What are your result?
Who was positive for the CVA with the ArminLabs test?
If we can compare with a microneutralization test (Arup Lab for example), maybe we can find if the ArminLabs test is reliable about the detection of non-cytolytic coxsackievirus infection.

 

[Hip]

UPDATE: The info in this post is not correct, so I have struck it out. Please see this post below for the correct info.

What appears to be the case with the ArminLabs coxsackievirus test is that they only use two coxsackievirus antigens for testing, namely CVB1 and CVA7 antigens; but ArminLabs say there is cross-reactivity between these two antigens and all the other coxsackieviruses (CVB1 to CVB6, and CVA1 to CVA24).

So according to ArminLabs, these two CVB1 and CVA7 antigens can be used to detect the whole range of coxsackieviruses.

However, the way ArminLabs present their results does not clearly indicate this. Anyone reading their ArminLabs coxsackievirus test results, which will always only show the results for CVB1 and CVA7, might assume that they have infections with CVB1 or CVA7.

But this is not the case. Your ArminLabs test results may show positive for CVB1, but this may be because you have an infection with CVB4, for example, which shows up as CVB1 due to the cross-reactivity.

Likewise, your test results may show positive for CVA7, but this may be because you have an infection with for example CVA16.



So the way ArminLabs present their coxsackievirus test results is confusing, as nowhere do ArminLabs state what is explained above, not in their test results, nor on their website which details their coxsackievirus test.

@frederic83 only found this out by contacting ArminLabs and asking for an explanation.

So there are likely many patients who got tested privately at ArminLabs, and think they have a CVB1 or CVA7 infection after seeing their ArminLabs test results, but in fact don't; they have a completely different coxsackievirus infection.

 

[msf]

I was tested at ArminLabs with the coxsackievirus test. With the information I gathered, I explained here how the test is supposed to work:



The test use the immunofluorescence assay and the cost is 64 euros.
They use the test from Euroimmun Lübeck Germany and they "insert" A7 and B1 antigens in the test system.

My report, high titers for CVA and CVB:

View attachment 15410

I was also tested at the Utrecht Lab in the Netherlands, which offered (they stop the test at the end of april 2016) a microneutralization test and I was negative for all the CVB except for CVB5 but with a low titer (1:8) that is probably from a past infection, not an active one.

In CFS, we know that the microneutralization test is the only one that showed a real correlation with an enterovirus infection in a non-cytolytic form.

I don't understand why I'm positive for the CVB and CVA. Moreover, the CVA types are not linked to CFS. I was thinking that the result are due to a cross-reaction with several enterovirus types.

Who was tested with the coxsackievirus at ArminLabs? What are your result?
Who was positive for the CVA with the ArminLabs test?
If we can compare with a microneutralization test (Arup Lab for example), maybe we can find if the ArminLabs test is reliable about the detection of non-cytolytic coxsackievirus infection.

I don´t know much about Cocksackie testing, sorry, but I´m curious as to whether you asked Armin (I´m too tired to spell his surname) if your problems could be caused by either Cocksackie A or B. It seems to me that there a few logical possibilities: you are not infected with either virus; you are infected with one or both kinds of viruses and one or both are responsible for your illness; you are infected with one or both kinds viruses and they aren´t responsible for your illness. The first and the third possibilities are similar in that if they are true you will need to look for another cause of your present illness. Not sure if this helps at all, but it just seemed to me that you might have already made some assumptions about what you may or may not have and what may or may not be causing your illness, and I just wanted to make sure you are considering ALL the possibilities.

 

[Hip]

@msf
I think @frederic83's post is not so much about what's causing his ME/CFS (although that is of course of interest), but about the interpretation of the ArminLab results.

UPDATE: The info in this post is not correct, so I have struck it out. Please see this post below for the correct info.

There is the confusion that anyone who takes an ArminLab test will only show CVB1 and CVB7 in their results (see my above post).

 

[frederic83]

I don´t know much about Cocksackie testing, sorry, but I´m curious as to whether you asked Armin (I´m too tired to spell his surname) if your problems could be caused by either Cocksackie A or B.

The question I try to answer is: what does this test detect? A titer 1:3200 is high, I don't think it is a false positive. But in CFS, the detection of the enterovirus type is tricky, and the IFT is not designed for CFS. So I would like to compare with others that took this test and the Arup test. I think it should be stated on their website what the test really detects or just say it detects coxsackievirus in general but the way the test is done won't provide more specific information.

In 2015, the reports from ArminLabs mentioned "coxsackievirus" alone, without specifying the B1 or A7 subtypes. Now, someone that take that test and does not have the information could think he is infected with B1 and A7 subtypes, that is what I thought at the beginning. We need a clear diagnostic, just knowing we have some random coxsackievirus virus in our body is not enough.
Is it a cross-reaction between coxsackie A, B or even echovirus? We don't know. But What I can say is that it is highly unlikely that I'm positive for CVB.

 

[ScottTriGuy]

the reports from ArminLabs mentioned "coxsackievirus" alone, without specifying the B1 or A7 subtypes. Now, someone that take that test and does not have the information could think he is infected with B1 and A7 subtypes, that is what I thought at the beginning.

I just got my Armin results today and B1 and A7 and assumed I was positive for those two specifically...until I read this thread.

My B1 IgG was 1:10,000 (ref: < 1:100) but B1 IgA was only 1:10 (ref: < 1:10).

1:10,000 seems like a rather high number.

 

[Hip]

I just got my Armin results today and B1 and A7 and assumed I was positive for those two specifically...until I read this thread.

UPDATE: The info in this post is not correct, so I have struck it out. Please see this post below for the correct info.

Yes, Armin Labs do a poor job in explaining their coxsackievirus test results, as I think many people will see coxsackievirus B1 and A7 on their test results, and erroneously assume they are infected with specifically these viruses.

 

[bertiedog]

1:10,000 seems like a rather high number.

This is the same result I got about 3 years ago when tested by the other German Lab he used to work for (cannot remember the name at this moment).

It didn't specify any particular type just Coxsackievirus and to be honest I have never really understood what it means exactly. In other tests I have had I also had 6 Herpes Type viruses above the range but nothing like as high as this result.

I benefited hugely from a 20 month course of a herbal protocol for Lyme Disease and co-infections (Cowdon Protocol) and wondered if the various herbs helped with these issues but I don't really know.

Pam

 

[frederic83]

I just got my Armin results today and B1 and A7 and assumed I was positive for those two specifically...until I read this thread.

My B1 IgG was 1:10,000 (ref: < 1:100) but B1 IgA was only 1:10 (ref: < 1:10).

1:10,000 seems like a rather high number.

My IgGs for CVB1 et CVA7 are 1:3200. Then, the neutralization assay from the university of Utrecht showed no titers at all for CVB (barely 1:8 for one CVB, don't remember which one exactly). I think a high IgG only in the ArminLabs test is not really relevant. IgA is probably more a clue. KDM prescribe me a blood PCR for coxsackievirus when he saw the high IgG, the PCR was negative.

 

[Hip]

Three weeks ago I sent the following email to Armin Labs:

Dear Sir

On online forums, I sometimes encounter patients who took your coxsackievirus test, and who say they are positive for CVB1 and CVA7. However, I understand that your test uses CVB1 and CVA7 antigens to detect the whole range of Coxsackie A and Coxsackie B viruses. So for example, someone might have an infection with CVB4, but in your test, their results would always show CVB1.

So when people see the results of your test, they may think they have a CVB1 infection, but in fact have a CVB4 infection, in this example.

May I suggest that you consider making it clearer on your test results page that being positive for CVB1 does not necessarily mean that you have CVB1, and that you may have any of the CVB1 to 6 viruses. Likewise, you may want to make it clearer that being positive for CVA7 on your test does not necessarily mean you have CVA7, but might be infected with any one of the CVA1 to 24 viruses.

However, I have not yet received a reply from Armin Labs.

 

[frederic83]

@Hip You should e-mail to Armin directly and not the lab, more chance to get an answer.

 

[pcmenten]

@Hip or anybody who can answer, a question; where do I get tested for coxsackie/enterovirus? What other advice relating to this testing can you offer?

I've done a little searching on this forum, and I'll do more, but, of course, I'm feeling a little brain-foggy at the moment.

Thanks,
Paul

 

[Hip]

where do I get tested for coxsackie/enterovirus?

ARUP Lab in Utah: they provide neutralization antibody tests for coxsackievirus B and echovirus which are sensitive enough to detect the chronic low level "smoldering" infections found in ME/CFS patients.

Dr John Chia, who specializes in enterovirus-associated ME/CFS, found that other forms of enterovirus blood test are not sensitive or reliable enough to detect chronic enterovirus infections in ME/CFS patients.

ARUP Lab tests for all 6 serotypes of coxsackievirus B (CVB1 to CVB6), and tests for the more common serotypes of echovirus (namely EV6, EV7, EV9, EV11 and EV30). Coxsackievirus B and echovirus are the two types of enterovirus linked to ME/CFS.

So these ARUP tests will tell you exactly which coxsackievirus B and echovirus serotypes you have in your body, and will tell you whether each serotype your have in your body is active or not. If it is an active infection (meaning your antibody titers are 1:320 or higher), then this may be the cause of your ME/CFS.


More info here:

Who's Had Their Coxsackie B virus And Echovirus Antibody Titers Tested at ARUP Lab?

Info on enteroviruses in this post.

Dr Chia's treatment for enterovirus-associated ME/CFS in this post.

 

[pcmenten]

Thank you, Hip. I knew you had posted this elsewhere and I did a few quick searches, but bailed out and resorted to a direct question. I truly appreciate all the information you provide on these forums.

 

[Hip]

I wrote to Dr Armin recently to ask him about his coxsackievirus test, and he told me the following:

This antibody testing is nearly 100% specific for B1 or A7 and NOT all other subspecies.

During our international accreditation process the well known virologist Professor Schnitzler from German accreditation authorities has told us, that we have the duty to write this onto each comment for each testing as he said, this test is highly subspecies specific and NOT covering all other subspecies, e.g. your mentioned B6.
If you want to discuss this, plesae contact the Professor and virologist directly:

https://www.klinikum.uni-heidelberg.de/Schnitzler.6549.0.html

So please correct your advise into the right way.
All the best
Armin

So Armin's coxsackievirus test only tests for coxsackievirus B1 (and coxsackievirus A7), and does not test for any of the other serotypes of coxsackievirus B (ie, it does not test for CVB2 to CVB6).

This is stated on this page on the ArminLabs site (see under: Virology > Ligand Assays).

Given that the coxsackievirus serotypes most frequently associated with ME/CFS are CVB3 and CVB4 first and foremost, then CVB2, EV6, EV7 and EV9, and much less EV11, according to Dr Chia (see this blog article), I can't see that Armin's coxsackievirus test would be of any use to ME/CFS patients.

Indeed, I can't see how a test for just CVB1 and CVA7 could be of use to anybody. For a coxsackievirus B test, you would want it to cover the whole range of the six Coxsackie B viruses.


It is confusing and misleading that it does not mention on Armin's website that his coxsackievirus test only detects CVB1 and CVA7. Patients will assume the test covers all Coxsackie viruses, which it does not.

 

[ScottTriGuy]

This is the same result I got about 3 years ago when tested by the other German Lab he used to work for (cannot remember the name at this moment).

It didn't specify any particular type just Coxsackievirus and to be honest I have never really understood what it means exactly. In other tests I have had I also had 6 Herpes Type viruses above the range but nothing like as high as this result.

I benefited hugely from a 20 month course of a herbal protocol for Lyme Disease and co-infections (Cowdon Protocol) and wondered if the various herbs helped with these issues but I don't really know.

Pam

I started the Cowden Protocol about 8 - 10 weeks ago, have not noticed any difference, but its good to hear you improved. How long before you noticed some improvements?

 

[bertiedog]

I think it was just a gradual process over a period of several months. However last winter when a stupid NHS Endocrinologist said I was on too much thyroid medication and asked me to stop 25 mcg thyroxine it pushed me right back with many old, troubling symptoms returning and my immune system suffered terribly. I began to think I had lost all those positive improvements for good, it was a very depressing time.

It took me nearly 5 months to get over this once the thyroxine was restarted because he was completely wrong and I did need the dose I have been taking since 2003 so it goes to show the importance of balancing one's hormones too which I am positive get affected by this illness. (I had stayed on the 2 grains of dessicated thyroid throughout but my body needs that small daily added amount of thyroxine too).

This summer I again average around 8800 steps daily but of course there are some bad days but many good ones too.

Pam

 

[ScottTriGuy]

Sounds like you've been sick with ME a long time, since at least 2003, so that's also encouraging that you responded.

I'm also on dessicated thyroid having replaced the synthroid by the functional medicine doc. I haven't worm my fitbit in over a year, it was too depressing to be reminded of how little I was able to move but may pull it out of storage to see if I can ascertain some progress. Thanks for the motivation.

 

[bertiedog]

I'm also on dessicated thyroid having replaced the synthroid by the functional medicine doc

This is where it would seem I am rather individual in that the 2 grains just doesn't quite "do it for me" whereas the tiny bit extra of T4 makes a big difference to my energy level. I know that everybody seems to say that T4 is the inactive hormone and has to be converted but I could feel the difference or rather the lack of it from the 2nd day of stopping it. When I was out in the park, walking my dog I just didn't have the same stamina and as the week's went by it became so noticeable that within 4 weeks I started actually running out of energy on my walks, even experiencing panic attacks on a couple of occasions. I had to stop going to my favourite places and find smaller parks so that I could sit down and generally do a lot less.

I had also by 6 weeks of stopping it started getting frequent throat infections which went on for months so basically everything was falling apart.

The symptoms of panic attacks whilst out on walks were the ones I first experienced way back in the mid 90s before I had any treatment but when I think the autoimmune stuff started. Because of everything I had read, for many years I thought they were psychological but of course this time I knew exactly why I was getting them and couldn't wait for the blood test on my thyroid function to prove what was going on and I am pleased to say it did. The free T4 had dropped from 15.8 to 7.6 in just 7 weeks off that tiny bit of thyroxine (UK range).

Pam

 

[sometexan84]

I wrote to Dr Armin recently to ask him about his coxsackievirus test, and he told me the following:


So Armin's coxsackievirus test only tests for coxsackievirus B1 (and coxsackievirus A7), and does not test for any of the other serotypes of coxsackievirus B (ie, it does not test for CVB2 to CVB6).

This is stated on this page on the ArminLabs site (see under: Virology > Ligand Assays).

Given that the coxsackievirus serotypes most frequently associated with ME/CFS are CVB3 and CVB4 first and foremost, then CVB2, EV6, EV7 and EV9, and much less EV11, according to Dr Chia (see this blog article), I can't see that Armin's coxsackievirus test would be of any use to ME/CFS patients.

Indeed, I can't see how a test for just CVB1 and CVA7 could be of use to anybody. For a coxsackievirus B test, you would want it to cover the whole range of the six Coxsackie B viruses.


It is confusing and misleading that it does not mention on Armin's website that his coxsackievirus test only detects CVB1 and CVA7. Patients will assume the test covers all Coxsackie viruses, which it does not.

I see that Armin is targeting just CVB1 and CVA7....


But are these 2 from Armin even being done properly?


If they're not using neutralization, and instead doing IFA... wouldn't this mean that these Armin tests are as useless as the ones at LabCorp, who also use IFA for their CVB tests?