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Varicella Zoster IGM

dmholmes

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Hello all, quick zoster antibodies question. About a month after my disease onset in 2008 I contracted shingles. I've tested varicella zoster antibodies 3 times this year. 2 times it was in the Equivocal range and 1 time Positive. Is this worth pursuing? What should I be looking for? Antivirals? Thanks!
 

Hip

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Shingles can be caused by the immunosuppression which occurs from enterovirus infection in the first few months of infection. This immunosuppression can allow VZV to reactivate. So if your ME/CFS is due to catching enterovirus (have you been properly tested for coxsackievirus B and echovirus using the right tests, namely the ARUP Lab micro-neutralization tests?), then that might explain the shingles outbreak. That is assuming you already had chicken pox as a kid, which means you will have VZV in your body, which can reactivate at times of immune weakness.

If you have ongoing shingles, even just a few blisters, then you might look at the shingles treatment given by Dr Chia.
 

dmholmes

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I've never been tested for enteroviruses, not sure where to do that.

I haven't had any shingles outbreaks since the one in 2008, I only have the elevated IGG. Might be a false positive?
 

Hip

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I haven't had any shingles outbreaks since the one in 2008, I only have the elevated IGG. Might be a false positive?
My understanding is that doctors detect VZV reactivation by the presence of singles blisters, rather than elevated antibodies. I am not quite sure why that is, but it says here:
Serologic methods have limited use for laboratory confirmation of herpes zoster
Serology = antibody testing.



I've never been tested for enteroviruses, not sure where to do that.
It's not easy to get tested for enterovirus: Dr Chia found the only tests sensitive enough to detect chronic enterovirus in ME/CFS are the neutralization antibody tests, and these are hard to find. By the CVB and echovirus section of this roadmap explain where you can find these neutralization tests.
 

Hip

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So not worth pursuing zoster?
If you want to sure that VZV is not behind your ME/CFS, then you might consider a short course of acyclovir or Valtrex for a few weeks, which is the treatment Dr Chia finds effective for VZV ME/CFS. But I believe Dr Chia only gives this treatment when he observes some shingles blisters on the patient.

As you may recall from the Dr Chia video in the VZV thread, Chia noticed just two tiny little shingles blisters appearing on this patient. Just two! But that was enough to signal VZV reactivation, and treatment with acyclovir. Within a few weeks of treatment, this bedbound ME/CFS patient was cured and back to work.

I also have highish IgG antibody levels to VZV (1395 mIU/ml, where positive is ≥ 160), and so just to be sure, tried Famvir (which also works for VZV, and is often better tolerated than Valtrex), but did not notice any improvements in ME/CFS symptoms. Which shows that highish antibodies do not necessarily indicate VZV ME/CFS.
 

Hip

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Right, well I only tested IGG once and it was not elevated. But my IGM is.
IgM is high during primary infection, or reactivation of the infection. The link I provided says:
Primary infection can be distinguished from reactivation or reinfection with VZV IgG avidity testing. High avidity IgG in the context of VZV IgM is indicative of a remote infection; low avidity IgG indicates a primary infection.
 

Hip

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Yes, so what does that mean having high IGM 11 years later?
The high IgM will likely only be present during the time of your shingles, when the virus was active. If you no longer have shingles, I would think that your IgM will go down to normal.

The general rules for how IgM and IgG behave are found in this article I wrote. However, those are the general rules, but there are also subtleties that apply to specific viruses, and I do not know that much about the subtleties of VZV testing.
 

dmholmes

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The high IgM will likely only be present during the time of your shingles, when the virus was active. If you no longer have shingles, I would think that your IgM will go down to normal.

The general rules for how IgM and IgG behave are found in this article I wrote. However, those are the general rules, but there are also subtleties that apply to specific viruses, and I do not know that much about the subtleties of VZV testing.
That's the issue, my IGM has been equivocal twice this year and elevated on most recent test Wednesday. But no shingles.
 

Hip

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Can you put the dates of all of your tests down, along with the antibody levels, and the lab reference range for positive please. And please put the date you developed ME/CFS down. Also, did you develop ME/CFS after an infectious episode? And was your ME/CFS rapid onset (few days) or gradual onset (over several months)?
 

dmholmes

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Actually looking back I see my IGG was quite high also.

IGM Ranges
0.00-0.90 Negative
0.91-1.09 Equivocal
>=1.10 Positive

IGG Ranges
<135 Negative - Antibody not detected
135.00-164.99 Equivocal
> or = 165.00 Positive - Antibody detected

Results
3/18/2019
IGG 2,255.00
IGM 1.00 (High)

4/24/2019
IGM 0.98 (High)

9/18/2019
IGM 1.21 (High)

Chronic fatigue (rapid onset) started in mid to late May 2008 after upper respiratory infection. Treated with Levaquin. Also on Clonazepam at the time. Shingles started in mid June.
 
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Hip

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So you were hit with ME/CFS in May 2008 after a viral infection. Then a month later you got shingles (that's consistent with your viral infection being an enterovirus, and causing temporary immunosuppression which allowed VZV to reactivate and cause shingles).

Then your first VZV test was around 9 months after the shingles outbreak, in Mar 2019.


I am confused as to why the lab classified you VZV IgM as high. In the first two tests, the IgM was around 1, which is not even in the positive range (positive is ≥ 1.1). And in the third test, IgM is 1.21, which is just about positive, but that would not be classed as high.

These are all low values for IgM. So your low IgM and high IgG would indicate a past infection which is now under control.
 

Hip

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No, the first VZV test was this year, illness started in 2008. So first test was almost 11 years afterwards.
Whoops, sorry, pretty brain fogged today. I mistakenly saw 2019 as 2009.

But still the low IgM and high IgG would I think indicate a past infection.
 

Markus83

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You cannot conclude that this is a past infection just because of low or even negative IgM. As far as I know even in most cases of Zoster reactivation with the typical blisters, the vast majority of patients are IgM negative.

The IgG seems normal for a past infection, mine is also around 2000 (with almost the same reference range). I also thought this is very high and talked with a doctor at the lab. She said that this is just a normal titer for a past infection. So, the only people who can judge whether an antibody titer is high or not are those who can overlook many test results, that means specialized physicians or doctors who work at the lab. I would not rely on feelings here, this can be misguiding.