Got lab results - help me with interpretation please

[Hip]

@Hip, it is amazing that you know all of these statistics re: the different viruses!

I don't know them off by heart; I just copied them from a page on my website.

This still confuses me (IgG+ vs. IgM+ for enteroviruses).

I believe (but am not entirely sure) that in some antibody tests by the neutralization method (the method used by ARUP), these tests do not differentiate between IgM and IgG. So I believe your titers represent the sum total of your IgM and IgG antibodies combined together.

In chronic infections, though, you will not have IgM, just IgG; so when the ARUP tests are used in ME/CFS patients with chronic enterovirus infections, I think your results will just represent the IgG levels (unless you just happened to pick up a new acute enterovirus infection in the same week that you were tested, which will cause high IgM).

 

[Wonkmonk]

Around 1 in 10 are seronegative for EBV; the prevalence of EBV in adults is something like 90%.

Sorry, this is of course, correct for the whole population. I was referring to those around age 40 for which I think I've seen studies that found 98% had previous infection with EBV.

EDIT:

I think this is the study:

http://cvi.asm.org/content/11/1/123.full

"The positivity rate for EBNA-2 IgG rose in the 1- to 2-year age group, increased and remained at a plateau (∼45%) between 3 and 29 years of age (3- to 4-, 5- to 9-, 10- to 14-, and 15- to 29-year age groups), and then reached 98% by age 40 (≥40-year age group)."

 

[Hip]

I was referring to those around age 40 for which I think I've seen studies that found 98% had previous infection with EBV.

You get slightly different results from study to study, depending when and where they were conducted. That one is was in Japan.

 

[Markus83]

Sorry, this is of course, correct for the whole population. I was referring to those around age 40 for which I think I've seen studies that found 98% had previous infection with EBV.

This doesn't sound good because it means that I will develop nearly 100% an EBV infection in the future. I think this would completely knock me out.

 

[Hip]

Parvo came back IgM negative and IgG positve (Elisa 7.9, normal < 0.9). Wester blot IgG bands found: VP-2p, VP-N, VP-1S, VP-2r, NS1. The lab states: "NS1 band positive. Chronic persistent or past infection. To rule out chronic persistend infection PCR of blood serum recommended."

I don't know what to do with that either. 2015 I had also very high IgG-titer against parvo in another lab (144 U, normal < 3 U).

These high parvovirus B19 IgG titers are worth pursing further: there are several studies (see: 1 2 3 4) that show parvovirus can cause ME/CFS, and what's more, the parvovirus B19 form of ME/CFS is quite treatable, using intravenous immunoglobulin (IVIG).

Which means that if parvovirus was the cause of your ME/CFS, IVIG could completely cure you.

 

[Markus83]

Yes Hip, I know, but my insurance would cover IVIG only if Parvo DNA could be shown in blood. I'll let it test, but I have little hope that something will show up.

Do you know if Parvo can cause neurological problems like tingling in extremities and face, headache, brain fog?

 

[Hip]

Do you know if Parvo can cause neurological problems like tingling in extremities and face, headache, brain fog?

Many infections can cause tingling (paresthesias). Headache and brain fog are ME/CFS symptoms, and parvovirus B19 is linked to ME/CFS.

Parvovirus B19 can also cause arthralgias and arthritis, and is the cause of the illness erythema infectiosum.


Parvovirus B19-caused ME/CFS is different to the other forms of ME/CFS (enterovirus and herpesvirus forms) in that there is a clear infection in the blood (whereas you don't find much infection in the blood with enterovirus or herpesvirus ME/CFS).

 

[Wonkmonk]

Which means that if parvovirus was the cause of your ME/CFS, IVIG could completely cure you.

Interesting. Then I got this wrong in my post above that said no treatment is available. Will delete.

 

[Wonkmonk]

This doesn't sound good because it means that I will develop nearly 100% an EBV infection in the future. I think this would completely knock me out.

If you evaded EBV for 30+ years, there is a chance you are going to continue to stay negative in the future. You might not have had any contact with the virus, but you might also be more resiliant against EBV perhaps for genetic reasons, so if there are common types of exposure that would get others infected in everyday life, you might be the one who doesn't get infected.

But it is indeed not unlikely that at some point you are going to get infected, especially if you have a stronger or continuous exposure, e.g. when having a EBV positive partner. In that case, I'd say that over time, it is likely that you will contract the virus.

But even if you contract EBV in the future, it doesn't mean that it causes another round of CFS or worsens your current CFS. It may just establish a latent infection like most people get without any complications. I have seen no evidence that primary infection with EBV on top of existing CFS has a higher probability of complications or of worsening the existing CFS.

 

[Gingergrrl]

Yes Hip, I know, but my insurance would cover IVIG only if Parvo DNA could be shown in blood. I'll let it test, but I have little hope that something will show up.

If you and your doctor(s) thought that Parvo was the cause of your illness, I would fight my insurance to the death to get IVIG covered. IVIG is the #1 treatment for Parvo (which can affect your heart). I am not sure if you are in the US (I apologize, I did not go back and re-read the whole thread) but if I exhausted all appeals with my insurance, I would go to the Dept of Managed Healthcare (DMHC), or whoever is the appropriate entity in your state, or even hire an attorney.

 

[Hip]

my insurance would cover IVIG only if Parvo DNA could be shown in blood. I'll let it test, but I have little hope that something will show up.

This study might be relevant:

Chronic Parvovirus B19 Infection Resulting in Chronic Fatigue Syndrome: Case History and Review

Testing of samples from this patient suggested that in some low viremic states parvovirus B19 DNA is detectable by nested PCR in plasma but not in serum.

 

[Wonkmonk]

I never tested parvovirus B19.

What would I have to tell my doctor to do to get comprehensive test results?

 

[Gingergrrl]

I never tested parvovirus B19. What would I have to tell my doctor to do to get comprehensive test results?

When I first saw my ME/CFS specialist in mid 2014, he included Parvo as part of his standard viral testing. I was positive for IgG (but not a very high positive) and negative for IgM so it was not considered to be a factor in my illness. But if I had been IgM+ (or maybe even a very high IgG, I am not sure?), I am certain my doctor would have pushed hard for IVIG at that time. (I ended up starting IVIG in mid 2016 for autoimmunity but that is a whole other story which you already know ).

 

[Wonkmonk]

Thanks, Ginger, so is the standard IgG and IgM testingp plus PCR enough?

And what does this mean? (from Markus's earlier post)

"Western blot IgG bands found: VP-2p, VP-N, VP-1S, VP-2r, NS1. "

Are they doing that automatically or do I have to tell them specifically?

 

[Markus83]

You should do Western Blot IgM and IgG. I would skip Elisa because it seems useless. You could do the test in MVZ Ettlingen, where I did the test. Depending on the result maybe it make sense to do PCR, too. But it seems that most people will come back negative in PCR (only about 10% of NS1 positive CFS patients had positive PCR).

 

[Hip]

I never tested parvovirus B19.

What would I have to tell my doctor to do to get comprehensive test results?

I am not actually sure which tests are used by the ME/CFS specialist doctors for parvovirus B19. Someone posted the pathogen tests that Prof Montoya gave them in this post, and those tests included parvovirus B19 DNA (ie, a PCR test).

If you look at Table 1 of this study, you'll see that serum PCR detected parvovirus B19 in 3 out of 3 patients, whereas antibody IgG testing only detected it in 2 out of 3 patients. So that suggests PCR may be more sensitive.

 

[Gingergrrl]

Thanks, Ginger, so is the standard IgG and IgM testingp plus PCR enough?

And what does this mean? (from Markus's earlier post) "Western blot IgG bands found: VP-2p, VP-N, VP-1S, VP-2r, NS1." Are they doing that automatically or do I have to tell them specifically?

@Wonkmonk I don't know very much re: Parvo testing (and don't want to steer you wrong!) and hoping you can check with your doctor. Thinking back, I was tested for PCR for Parvo (which was negative) and was tested for IgG (positive) and IgM (negative) so it was not considered a factor in my case. I am not sure if I had a Western Blot vs. another test and it was sent to Quest Lab in the US (through OMI at that time).

 

[Markus83]

If you look at Table 1 of this study, you'll see that serum PCR detected parvovirus B19 in 3 out of 3 patients, whereas antibody IgG testing only detected it in 2 out of 3 patients. So that suggests PCR may be more sensitive.

I think you cannot conclude anything about PCR sensitivity based on this article because the 3 persons were suggested to have Parvo only because the PCR was positive. We don't know how many other patients were tested negative who had actually a chronic parvo infection. But what is interesting to me are two things: You can have chronic parvo viremia even if you have antibodies against it in your blood. The second thing is that even with a chronic infection you can be seronegative. Unfortunately we cannot conclude much on the basis of 3 patients.

Maybe you linked to the study before, but have a look at this one (fulltext is also available).

"In this study, we analysed parvovirus B19 markers in CFS/ME patients (n=200), diagnosed according to Fukuda CDC criteria, and normal blood donors (n=200). Serum from each subject was tested for anti-B19 VP2 IgM and IgG (by Biotrin ELISA), anti-B19 NS1 IgM and IgG (by immunofluorescence), and B19 DNA (by real-time PCR). CFS/ME patients and normal blood donors had a similar B19 seroprevalence (75 % versus 78 %, respectively). Eighty-three CFS patients (41.5 %) as compared with fourteen (7 %) normal blood donors tested positive for anti-B19 NS1 IgG (chi(2)=64.8; P<0.0001; odds ratio=9.42, CI 5.11-17.38). Of these 83 patients, 61 complained of chronic joint pain, while 22 did not. Parvovirus B19 DNA was detected in serum of 11 CFS patients and none of the controls by Taqman real-time PCR (chi(2)=9.35, P<0.002)."

So, CFS patients do have much more often the NS1 band in IgG western blot than healthy controls, but in mere seroprevalance there is no difference. So that's why I would skip Elisa and just do the western blot.

Only about 10 % of those CFS patients with NS1 band were positive in PCR. I think this is not correct, because the high rate of NS1 bands in CFS patients compared to HC (40,5% vs. 7%) indicates (at least for me) that there might be a chronic infection that cannot be diagnosed reliably with blood PCR (maybe the infection is primarily in the tissues).

Btw, is there a quote function?

 

[Wonkmonk]

maybe the infection is primarily in the tissues

Dr Lerner found tissue damage in the hearts of patients who responded to antivirals, but did not find (or did not check) viral presence.

 

[Hip]

Unfortunately we cannot conclude much on the basis of 3 patients.

Agreed. The trouble is, there is very little research on parvovirus B19 ME/CFS, so it is hard to get any info. I don't know much about parvovirus ME/CFS, because it's not a common cause of ME/CFS. So it's good to have this discussion, as it gives the opportunity to look into it more.

If you look at Dr Chia's article: "Diverse Etiologies for Chronic Fatigue Syndrome", in Table 1 you see that he finds only around 1.5% of ME/CFS cases are due to parvovirus B19 (3 out 200 patients had active parvovirus infection). Here Dr Chia uses high IgM or a positive blood PCR as the criteria for active parvovirus infection.

I just now saw in this paper that sometimes there are no IgG antibodies even in chronic viremia:

For most patients the diagnosis of parvovirus B19 infection has been made serologically, by the detection of IgM and/or IgG antibodies to parvovirus B19. Antibody may not be de- tected, however, in patients who are chronically viremic. Such patients continue to have measurable virus, without detectable IgG antibody

So that seems strange.


A lot the parvovirus ME/CFS papers come from Dr Jonathan Kerr's research interest in it. Kerr wanted to study parvovirus ME/CFS because he thought it might throw some light on the other more common forms of ME/CFS, enterovirus and herpesvirus ME/CFS. With parvovirus B19 ME/CFS, you get viremia (viral infection in the blood), so that makes it easier to study the infection and study how the infection might cause ME/CFS.

This viremia is why, I believe, blood PCR can detect the virus in parvovirus ME/CFS. By comparison, blood PCR often comes back negative in enterovirus and herpesvirus ME/CFS. In the case of enterovirus, we know there is a non-cytolytic infection in the tissues; but there is not much virus in the blood.

So, CFS patients do have much more often the NS1 band in IgG western blot than healthy controls, but in mere seroprevalance there is no difference. So that's why I would skip Elisa and just do the western blot.

I think they are using IFA (immunofluorescence assay) to detect antibodies to the parvovirus NS1 protein (rather than Western blot). I am not sure if a commercial test exists for NS1 antibodies.

Only about 10 % of those CFS patients with NS1 band were positive in PCR.

Since parvovirus B19 is common in the general population, perhaps that explains the NS1 antibody?

Btw, is there a quote function?

Yes, you just highlight the text you want to place in an orange quote box, and then select "Quote" by pressing the button at the top of the text edit area that looks like this: