Testing for a coxsakie and enterovirus

[hunter1899]

That possibly might turn out to the case, we will have to wait and see.

But to my knowledge, ME/CFS doctors will only treat HHV-6 if there are high antibody levels. So I am just reflecting current clinical practice.

Would high antibody levels mean IGG or only EA and/or IGM? I'm still so confused if ONLY high IGG is cause for alarm and can be treated with antivirals or if you need also a high EA and/or IGM.

 

[Hip]

Would high antibody levels mean IGG or only EA and/or IGM? I'm still so confused if ONLY high IGG is cause for alarm and can be treated with antivirals or if you need also a high EA and/or IGM.

In the case of enterovirus antibody tests performed by the neutralization method (the most sensitive method, and the one recommended by Dr Chia for enterovirus), I believe both IgM and IgG antibodies are combined into one measure.

So with a neutralization test, it's not possible to know whether you have high IgM, high IgG or both. However, in chronic enterovirus (once the acute initial infection is over), IgM is low, so these neutralization test results probably reflect high IgG in ME/CFS patients.


In case you are wondering what IgM and IgM mean:

During onset of acute viral infection, IgM antibody levels are acutely raised. As the infection is brought under control, these levels of IgM go down to zero, and at the same time, IgG antibodies comes into play.

IgG antibodies against that particular virus will remain for the whole life of a person.

Thus finding high levels of IgG and low levels of IgM indicate a past infection. The reverse indicates a new acute current infection. And both high IgG and high IgM indicates a viral reactivation, or a chronic active infection.

Antibody Testing Rules in Summary:

High IgM + Low IgG – New infection.
Low IgM + High IgG – Probable past infection, inactive or cured.
High IgM + High IgG – Reactivated infection.



EA is only found in Epstein-Barr virus testing, it does not relate to other viruses. EBV testing is more complex and involves more antibodies than other viruses.

 

[hunter1899]

In the case of enterovirus antibody tests performed by the neutralization method (the most sensitive method, and the one recommended by Dr Chia for enterovirus), I believe both IgM and IgG antibodies are combined into one measure.

So with a neutralization test, it's not possible to know whether you have high IgM, high IgG or both. However, in chronic enterovirus (once the acute initial infection is over), IgM is low, so these neutralization test results probably reflect high IgG in ME/CFS patients.


In case you are wondering what IgM and IgM mean:

During onset of acute viral infection, IgM antibody levels are acutely raised. As the infection is brought under control, these levels of IgM go down to zero, and at the same time, IgG antibodies comes into play.

IgG antibodies against that particular virus will remain for the whole life of a person.

Thus finding high levels of IgG and low levels of IgM indicate a past infection. The reverse indicates a new acute current infection. And both high IgG and high IgM indicates a viral reactivation, or a chronic active infection.

Antibody Testing Rules in Summary:

High IgM + Low IgG – New infection.
Low IgM + High IgG – Probable past infection, inactive or cured.
High IgM + High IgG – Reactivated infection.



EA is only found in Epstein-Barr virus testing, it does not relate to other viruses. EBV testing is more complex and involves more antibodies than other viruses.

I have positive IGG for CMV, HHV6, and EBV. No positive IGM for anything and no positive EA for EBV. I did test positive for three mold toxins which my doctor thinks is at the root of my symptoms (light fatigue but mainly pressure in my forehead, bridge of my nose, and eyes that makes me feel more tired). On a protocol to get rid of these toxins, but I guess I'm just making sure with you smart folks if mold is truly the cause. I was exposed to it for a few years in my house and other places...

 

[Hip]

I have positive IGG for CMV, HHV6, and EBV.

ME/CFS doctors use different rules for diagnosing different viruses. Those rules are summarized in this mini roadmap. Generally you must not just be positive for these antibodies, but must have high levels for a diagnosis of chronic active infection from an ME/CFS specialist.

I am not familiar with mold testing, but major mold exposure has been linked to ME/CFS. It's also considered the cause of an ME/CFS-like disease called CIRS (chronic inflammatory response syndrome), which has its own treatments. See my roadmap for details about CIRS (search for the word CIRS).

 

[sometexan84]

@Markus83 I can help w/ Echo 11, but not the other two.

There was a study not long ago that looked at the evolution of Echovirus 11 over a long period of time, in multiple populations. They found evidence that EV11's Protease 3C plays an important role, possibly necessary for replication.

Then this yr, there was a study showing a synergistic effect of Quercetin and Vitamin C together working as a strong Protease 3C inhibitor.

My EV 11 levels were same as yours. After putting 2 and 2 together, I went for it and I started Quercetin + Buffered Vit C (Ultra Potent-C 500 by Metagenics) on 7/21/20. Two weeks later my EV 11 titers had dropped to 1:320.

I'll update this when I re-test my titers soon. I did NOT find this to be effective in reducing my Coxsackievirus titers, despite the fact that CVB uses Protease 3C as well.

It's also possible this could have an effect on the other Echoviruses, but I don't know because I was only ever positive for EV11.


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5875893/
https://www.frontiersin.org/articles/10.3389/fimmu.2020.01451/full

 

[Markus83]

I'm not sure if it makes sense to compare test results between different labs, at least if we don't know the cutoff value for positive/negative. For example I had a bartonella IFT also at Frankfurt university lab where the lab says: < 1:80 is negative, 1:160 is borderline and from 1:320 on it's considered positive. So in this case 1:320 or 1:640 seems not so high for bartonella, but if a test would be used where the cutoff lies at (say) 1:20, then 1:320 would be pretty high.

I would just guess that the cutoff of my Coxsackie tests lies at 1:20, so my highest titer of 1:80 seems unsuspicious to me like the lab says. Unfortunately I don't know which titer they use as cutoff for the ECHO virus, but if (say) >= 1:320 would indicate positive, I find 1:640 not that high. It would be interesting to see results from other patients also tested in Frankfurt to compare each other.

 

[Markus83]

In the case of enterovirus antibody tests performed by the
High IgM + High IgG – Reactivated infection.

This is what most doctors tell you but it's not entirely correct. You can have a virus reactivation without positive IgM and just IgG rising. For example this is the case in most Varicella zoster reactivations. So that means that you can well have a chronic active infection with negative IgM.

 

[Markus83]

I looked on the ARUP website and they say both for Coxsackie and ECHO:
- Reference Interval less than 1:10
- Single positive antibody titers of greater than or equal to 1:80 may indicate past or current infection

Dr Chia says 1:160 to 1:320 in ARUP lab test indicates active infection.

 

[sometexan84]

@Markus83 1:640 is probably the cutoff. As in, the max limit for results.

Note: I have no idea how the testing from Frankfurt university lab differs from that of ARUP. So, keep that in mind...

But... like, yours says 1:640... but mine actually says >=1:640, because it doesn't go higher.

Also, ARUP's starts at 1:80 to indicate (potentially) positive, active infection. Regardless of your lab, you'll know more if you take a second test, and see if titers have changed.

I had Coxsackie B2 at 1:40, and I wasn't concerned. And 2 months later it was 1:160. My goal is to have all of these at or below 1:40. And the for my titers that have been the highest, I'd like to see those fall to 1:20 or <1:10.

 

[sometexan84]

Dr Chia says 1:160 to 1:320 in ARUP lab test indicates active infection.

It is a decent initial indicator I suppose. But it doesn't mean you can't have an active infection w/ a titer of 1:40.

 

[Hip]

I'm not sure if it makes sense to compare test results between different labs, at least if we don't know the cutoff value for positive/negative.

That's right. Dr Chia told me that in order to be precise, the neutralization tests at different lab would have to be calibrated against ME/CFS patients and healthy controls.

The way Dr Chia calibrated the ARUP lab test is detailed in the graph in this post. Basically Dr Chia observed that almost all healthy controls have enterovirus titers below 1:160 on the ARUP test, whereas ME/CFS patients typically had titers of 1:160 and higher.

 

[Hip]

I would just guess that the cutoff of my Coxsackie tests lies at 1:20, so my highest titer of 1:80 seems unsuspicious to me like the lab says.

You might be right, but it's hard to know for sure.

Let's assume for the sake of argument that the Frankfurt test is slightly less sensitive than the ARUP test. Then 1:80 at Frankfurt might correspond to 1:160 at ARUP, which would imply a positive diagnosis for chronic active infection.


It's also useful to consider which are the most common enteroviruses found in ME/CFS. According to Dr Chia's testing, the CVB and echovirus serotypes most often found in ME/CFS are:

• CVB3 and CVB4 first and foremost
• Then CVB2, EV6, EV7 and EV9
• And then much less EV11

Ref: here

This is what most doctors tell you but it's not entirely correct. You can have a virus reactivation without positive IgM and just IgG rising. For example this is the case in most Varicella zoster reactivations. So that means that you can well have a chronic active infection with negative IgM.

Interesting. Yes I think you're right: this paper says during VZV reactivation (as evidenced by a herpes zoster shingles rash), IgM was only positive in 37% of cases.

Though VZV is an unusual virus in that even in ME/CFS patients, it is only diagnosed visually by observing a manifestation of a shingles rash. VZV reactivation is not diagnosed by a blood test.

Dr Chia had one severe bedbound ME/CFS patient, and on one occasion, Chia noticed just two tiny blisters of a shingles rash. Just two tiny blisters (usually there are hundreds of blisters in shingles). But that was enough to alert Chia to a ZVZ reactivation. So he gave the patient acyclovir, and within weeks she was back to work (ZVZ ME/CFS responds extremely well and very quickly to antiviral treatment).

But whether other viruses can reactivate without generating an IgM response, I'd like to see a good reference for that.



Perplexingly, it's really hard to find info online about how IgM and IgG behave during infection. What I posted just above about the way IgM and IgM function during acute, past and reactivated infections I only found in one place on the Internet, in this slide presentation (slide 5).

I did ask Prof Edwards if that slide was correct, and he told me that yes, those are the general rules regarding how IgM and IgG behave in infection. But I don't understand why there is so little information about how IgM and IgG generally behave online. If you can find any authoritative sources on the general way IgM and IgM function during acute, past and reactivated infections, I'd really love to see them.

 

[hunter1899]

You might be right, but it's hard to know for sure.

Let's assume for the sake of argument that the Frankfurt test is slightly less sensitive than the ARUP test. Then 1:80 at Frankfurt might correspond to 1:160 at ARUP, which would imply a positive diagnosis for chronic active infection.


It's also useful to consider which are the most common enteroviruses found in ME/CFS. According to Dr Chia's testing, the CVB and echovirus serotypes most often found in ME/CFS are:

• CVB3 and CVB4 first and foremost
• Then CVB2, EV6, EV7 and EV9
• And then much less EV11

Ref: here





Interesting. Yes I think you're right: this paper says during VZV reactivation (as evidenced by a herpes zoster shingles rash), IgM was only positive in 37% of cases.

Though VZV is an unusual virus in that even in ME/CFS patients, it is only diagnosed visually by observing a manifestation of a shingles rash. VZV reactivation is not diagnosed by a blood test.

Dr Chia had one severe bedbound ME/CFS patient, and on one occasion, Chia noticed just two tiny blisters of a shingles rash. Just two tiny blisters (usually there are hundreds of blisters in shingles). But that was enough to alert Chia to a ZVZ reactivation. So he gave the patient acyclovir, and within weeks she was back to work (ZVZ ME/CFS responds extremely well and very quickly to antiviral treatment).

But whether other viruses can reactivate without generating an IgM response, I'd like to see a good reference for that.



Perplexingly, it's really hard to find info online about how IgM and IgG behave during infection. What I posted just above about the way IgM and IgM function during acute, past and reactivated infections I only found in one place on the Internet, in this slide presentation (slide 5).

I did ask Prof Edwards if that slide was correct, and he told me that yes, those are the general rules regarding how IgM and IgG behave in infection. But I don't understand why there is so little information about how IgM and IgG generally behave online. If you can find any authoritative sources on the general way IgM and IgM function during acute, past and reactivated infections, I'd really love to see them.

So would I. Despite all the detailed and helpful info from folks a lot smarter than I am, I am more confused than ever if my symptoms of forehead, eye, and nose pressure is from a virus or just mold alone! Is there no other test that can give a more definitive answer whether a virus is active or not?

 

[Markus83]

You might be right, but it's hard to know for sure.
If you can find any authoritative sources on the general way IgM and IgM function during acute, past and reactivated infections, I'd really love to see them.

I went after this question years ago because I knew it must be false what doctors told me about IgM/IgG. I even consulted a book which is considered "the bible of immunology" (I've forgotten the precise title) but that didn't answer my question, too. So in short: I did not find a reputable source either. The only thing I found that VZV reactivation usually comes along without positive IgM. So at least that was enough for me to falsify the claims of doctors that an active infection always goes with positive IgM. For late lyme disease it is known even in mainstream medicine that there is usually only IgG found. So the question is if these two infections are the rule or just an exception. Until someone proves me the opposite I will consider it a general rule.

My rule is this:
IgM = early infection
IgG = chronic infection (if it is high) or past infection
IgA = indicating active infection, whether early or late

 

[hunter1899]

I went after this question years ago because I knew it must be false what doctors told me about IgM/IgG. I even consulted a book which is considered "the bible of immunology" (I've forgotten the precise title) but that didn't answer my question, too. So in short: I did not find a reputable source either. The only thing I found that VZV reactivation usually comes along without positive IgM. So at least that was enough for me to falsify the claims of doctors that an active infection always goes with positive IgM. For late lyme disease it is known even in mainstream medicine that there is usually only IgG found. So the question is if these two infections are the rule or just an exception. Until someone proves me the opposite I will consider it a general rule.

My rule is this:
IgM = early infection
IgG = chronic infection (if it is high) or past infection
IgA = indicating active infection, whether early or late

Seems like Lerner and Montoya had success with antivirals with patients only with patients with a high IGG and high EA (EBV). I wonder did they or anyone try giving antivirals to folks with ONLY a high EBV IGG and was it successful or not? Or he’ll has anyone here seen noticeable improvements from antivirals despite only having a high IGG?

Actually first I should ask what is considered a high IGG for EBV?

 

[Hip]

I am more confused than ever if my symptoms of forehead, eye, and nose pressure is from a virus or just mold alone!

Have you considered sinus infection of the frontal sinus?

 

[sometexan84]

So would I. Despite all the detailed and helpful info from folks a lot smarter than I am, I am more confused than ever if my symptoms of forehead, eye, and nose pressure is from a virus or just mold alone! Is there no other test that can give a more definitive answer whether a virus is active or not?

Wish I could help, but I'm not familiar w/ the mold toxin aspect at all. Though I would be curious to see if treating the mold heals you. So Pls keep us posted!

How high were your CMV and HHV-6 titers again?

Enterovirus, Adenovirus, Chlamydia Pneumoniae, and Streptococcus pneumonia (and others) can cause some of what you're describing. I think HSV can too.

 

[Cipher]

I would just guess that the cutoff of my Coxsackie tests lies at 1:20, so my highest titer of 1:80 seems unsuspicious to me like the lab says. Unfortunately I don't know which titer they use as cutoff for the ECHO virus, but if (say) >= 1:320 would indicate positive, I find 1:640 not that high. It would be interesting to see results from other patients also tested in Frankfurt to compare each other.

These papers from the University Hospital Frankfurt am Main and its associated university (Goethe University Frankfurt am Main) indicates that some of your titers seem pathological, assuming they use the same neutralization test technique today:

In a paper titled "Diagnostic and Outcome of Neurotropic Enterovirus Infections in Childhood", published in 2002, they considered a titer of 1:640 and higher to be pathological in the context of acute echovirus 30 infection (if the translation from German was correct).

In a paper titled "Evaluation of a New Automated Microneutralization Assay for the Quantitative Detection of Neutralizing Antibodies Against Enteroviruses", published in 1994, the negative cut off titer was <1:10 for both echoviruses & coxsackieviruses, and the titers went on as follows; 1:10, 1:20, 1:40, 1:80, 1:160, 1:320, 1:640, 1:1280.

In a paper titled "Quantitative detection of neutralizing antibodies against polioviruses and non-polio enteroviruses (NPEV) using an automated microneutralization assay: a seroepidemiologic survey", published in 1994, the geometric mean titer for coxsackievirus B1-B6, A9 and echovirus (6, 9, 11, 30) in patients suffering from diseases not attributable to enterovirus infections was between 1:11,3 (CVB6) and 1:55,4 (CVB2).

The full-texts are available on sci-hub.

 

[sometexan84]

Regarding Enterovirus (testing, results, labs), I've created a poll. I'm hoping to get enough responses so we can see how common it is, and maybe learn more about testing accuracy.

If you get a moment, please have a look and respond - https://forums.phoenixrising.me/thr...r-enterovirus-b-which-lab-results-poll.83744/

 

[Guwop2]

I live in the UK and have been looking into getting the Coxackievirus B & Echovirus tests done as per the treatment roadmap and have discovered that IMD Berlin doesnt do the neutralisation tests anymore and the Institute of Medical Virology doesnt offer this service to people not referred to them by a doctor. Is it then the case that the only option, if i'm living in Europe, is to go to the Hellenic Pasteur Inst. in Athens for these tests? - I spoke to them and it seems they offer these tests, but id need to go in person. Seems wierdly casual too - i just turn up after 9am withouth an app., making sure i havent eaten the light before, and can get the test done. It doesnt seem like anyone here has used this place, but maybe this is my only option?

As the first port of call on the roadmap it is a bit of a roadblock, since the options for this test for Europeans are almost non-existent - unless everyone is just using the exorbitantly priced america tests (is that what everyone is doing?)