Early ME/CFS Enterovirus Research (Which is Mainly British):
Dating from 1970 to 2003
Encephalomyelitis Resembling Benign Myalgic Encephalomyelitis
S.G.B. Innes.
The Lancet.
1970 May.
▶︎ This study examined 4 cases of ME. In the cerebrospinal fluid they found coxsackievirus B2 in one case and echovirus 3 in another. In the sera of the two other cases they found elevated coxsackievirus B2 and elevated coxsackievirus B5 titers via antibody testing.
Sporadic myalgic encephalomyelitis in a rural practice
B. D. Keighley and E. J. Bell.
J R Coll Gen Pract. 1983 June.
▶︎ This study found elevated coxsackievirus B titers in 16 of of 20 patients in an ME/CFS outbreak in Ayrshire, UK.
Myalgic encephalomyelitis—report of an epidemic
K. G. Fegan, P. O. Behan, and E. J. Bell.
J R Coll Gen Pract. 1983 June.
▶︎ This study found elevated coxsackievirus B titers in 18 out of 20 patients in an ME/CFS outbreak in Ayrshire, UK.
Coxsackie B infection in a Scottish general practice
B. D. Calder and P. J. Warnock.
J R Coll Gen Pract. January 1984.
▶︎ This study found high antibody titers to coxsackievirus B in 38 out of 81 patients who experienced a syndrome with many of the features of myalgic encephalomyelitis.
Some long-term sequelae of Coxsackie B virus infection
J. A. Gray.
J R Coll Gen Pract. 1984 January.
▷ Discussion of coxsackievirus B and echovirus in relation to ME/CFS.
A study of Coxsackie B virus infections, 1972-1983
Bell EJ and McCartney RA.
J Hyg (Lond).
1984 October.
▶︎ Found that in well-documented cases of ME/CFS, 41% of patients had elevated neutralizing antibody titers, compared to 4% of healthy controls.
Coxsackie B viruses and myalgic encephalomyelitis
E J Bell, R A McCartney, and M H Riding.
J R Soc Med. 1988 June.
▶︎ This study on 290 adults and 47 children with ME/CFS found 37% and 38% respectively were IgM positive for coxsackievirus B, compared to 9% in 500 healthy adult controls.
Persistence of enteroviral RNA in chronic fatigue syndrome is associated with the abnormal production of equal amounts of positive and negative strands of enteroviral RNA (full text
here).
Cunningham L, Bowles NE, Lane RJ, Dubowitz V, Archard LC.
J Gen Virol. 1990 June
.
▷ This study found that normally, positive strand enterovirus RNA is 100-fold more common over negative strand enterovirus RNA; but in ME/CFS patients, equal amount of both were found. This study I believe was the first to demonstrate an unusual viral phenomenon in ME/CFS that would later be termed and understood as a
non-cytolytic enterovirus infection (aka:
non-cytopathic, or
defective enterovirus infection).
Myalgic encephalomyelitis--a persistent enteroviral infection?
Dowsett EG, Ramsay AM, McCartney RA, Bell EJ.
Postgrad Med J. 1990 July.
▶︎ This study found that out of 420 cases of ME/CFS, 205 had significant titers to coxsackievirus B.
Enteroviral RNA sequences detected by polymerase chain reaction in muscle of patients with postviral fatigue syndrome
Gow JW, Behan WM, Clements GB, Woodall C, Riding M, Behan PO.
BMJ. 1991 March.
▶︎ This study on 60 ME/CFS patients found 20% had high titers to coxsackievirus B, compared to 14% of healthy controls. Furthermore, 53% of these ME/CFS patients had enteroviral RNA sequences in their muscles, compared to 15% for healthy controls.
Amplification and identification of enteroviral sequences in the postviral fatigue syndrome
Gow JW1, Behan WM.
Br Med Bull. 1991 October.
▶︎ This study of 60 ME/CFS patients found that ME/CFS patients were 6.7 times more likely to have enteroviral RNA in their muscle tissue, compared to healthy controls.
Persistent virus infection of muscle in postviral fatigue syndrome
Cunningham L, Bowles NE, Archard LC.
Br Med Bull. 1991 October.
▶︎ This study of 140 ME/CFS patients found enteroviral RNA in 24% of their muscle biopsy samples, and Epstein-Barr virus DNA in a further 9% of these biopsy samples, whereas enterovirus RNA was not detected in any of 152 control samples of human muscle.
Persistence of enterovirus RNA in muscle biopsy samples suggests that some cases of chronic fatigue syndrome result from a previous, inflammatory viral myopathy
Bowles NE, Bayston TA, Zhang HY, Doyle D, Lane RJ, Cunningham L, Archard LC.
J Med. 1993.
▶︎ This study of 158 ME/CFS patients found enteroviral RNA in 26% of the patients' muscle biopsy samples, compared to only 1% in healthy controls.
Studies on enterovirus in patients with chronic fatigue syndrome
Gow JW, Behan WM, Simpson K, McGarry F, Keir S, Behan PO.
Clin Infect Dis. 1994 January.
▶︎ This study of 121 patients with ME/CFS found enteroviral RNA in 26.4% of the patients' muscle biopsy samples, and found enteroviral RNA in 19.8% the muscle biopsies of patients other neuromuscular disorders. From these results the authors concluded that "
it is unlikely that persistent enterovirus infection plays a pathogenetic role in CFS, although an effect in initiating the disease process cannot be excluded."
However, this conclusion may not be a sound, firstly because persistent enterovirus is associated with a wide range of diseases, including chronic inflammatory myopathy, and thus might be playing a role in these other neuromuscular disorders as well; and secondly because persistent enterovirus infections are also found in other organs in ME/CFS patients, such as the brain and stomach (though this fact was not known at the time of publication), and it is possible ME/CFS might in fact be caused by an enterovirus brain infection, rather than (or in addition to) a muscle infection.
Enterovirus in the chronic fatigue syndrome (full text
here and
here)
McGarry F, Gow J, Behan PO.
Ann Intern Med. 1994 June.
▶︎ This study details an autopsy of a deceased ME/CFS patient. Enteroviral RNA was found in the heart, muscles, hypothalamus and brainstem of this patient, and this RNA showed an 83% similarity to coxsackievirus B3. Control tissue samples taken from four patients who died of cerebrovascular diseases, and another four who had depression and committed suicide, showed no evidence of enteroviral RNA.
Enteroviruses and the chronic fatigue syndrome
Swanink CM, Melchers WJ, van der Meer JW, Vercoulen JH, Bleijenberg G, Fennis JF, Galama JM.
Clin Infect Dis.
1994 November.
▶︎ This study, conducted by some of the psychologists at the Nijmegen Group (who consider ME/CFS to be psychogenic), did not find any difference between the blood and stool samples of 76 ME/CFS patients and 76 healthy controls; but the enterovirus detection methods they used are now known to be quite insensitive in terms of detecting chronic enterovirus infections.
Detection of enterovirus-specific RNA in serum: the relationship to chronic fatigue
Clements GB, McGarry F, Nairn C, Galbraith DN.
J Med Virol. 1995 February.
▶︎ This study of 88 ME/CFS patients found enteroviral RNA in the serum of 41% of patients, compared to 2% of healthy controls.
Phylogenetic analysis of short enteroviral sequences from patients with chronic fatigue syndrome
Galbraith DN, Nairn C, Clements GB.
J Gen Virol. 1995 July.
▷ This study found that ME/CFS patients with persistent enteroviral infections nearly always have viruses with a different genetic makeup compared to enteroviruses found in acute, self-limiting infections in healthy controls.
Investigation by polymerase chain reaction of enteroviral infection in patients with chronic fatigue syndrome
McArdle A, McArdle F, Jackson MJ, Page SF, Fahal I, Edwards RH.
Clin Sci (Lond). 1996 April.
▶︎ This study examined 34 muscle biopsies from ME/CFS patients and 10 muscle biopsies from healthy controls, but did not detect enterovirus RNA in the patient or control muscle tissues. But commenting on the differences between their negative and the positive results found in
Gow 1991, the authors say:
"
The difference in findings between our study and that of Gow et al. [21] may be due to the population of CFS patients studied. Although the diagnostic criteria of both groups was broadly similar, the patients used in the study of Gow et al. [21] all reported that the illness had an acute onset after a feverish illness, whereas only 58% of patients in our study reported a viral infection before the onset of their illness."
No findings of enteroviruses in Swedish patients with chronic fatigue syndrome
Lindh G, Samuelson A, Hedlund KO, Evengård B, Lindquist L, Ehrnst A.
Scand J Infect Dis. 1996.
▶︎ This Swedish study examined 29 muscle biopsies from ME/CFS patients, but could not detect enterovirus RNA in the tissues.
Viral Isolation from Brain in Myalgic Encephalomyelitis (A Case Report)
Richardson, J.
Journal of Chronic Fatigue Syndrome, Vol. 9(3/4) 2001.
▶︎ This study examined the brain of an ME patient who died through suicide, and found enteroviral VP1 protein in the fibroblasts of small blood vessels in the cerebral cortex, plus some patchy distribution of enteroviral VP1 protein in a small fraction of glial cells.
Enterovirus related metabolic myopathy: a postviral fatigue syndrome
Lane RJ, Soteriou BA, Zhang H, Archard LC.
J Neurol Neurosurg Psychiatry. 2003 October.
▶︎ This study of 48 patients with ME/CFS found enteroviral sequences by RT-NPCR in 20.8% of patients' muscle biopsy samples, while all the 29 control samples were negative for such sequences.