Who's Had Their Coxsackie B Virus and Echovirus Antibody Titers Tested at ARUP Lab?

[concepcion]

Hi,

I have done coxsackie B antibody testing on my daughter since 2004.

By chance, I did first did them at ARUP in 2005. For ten years the ARUP has come back consistently very high for Cox b3 and b4. Coxsackie B4 is often >1:640. I showed these to Dr. Chia and he said his son's antibodies at ARUP were the same.

I have over the years sent other samples to Quest or Focus labs. These labs come in much lower levels and with no consistency.

Once I sent the same blood draw to Focus and ARUP, and they did not line up at all.


I have spoken to a number of physicians about these tests, urging them to test their patients at ARUP. They showed no interest.

Chris

Thanks for the information Chris. That's very good to know.

 

[halcyon]

I wonder if it comes down to the type of antibody being detected then, binding versus neutralizing and/or IgM versus IgG? @Jonathan Edwards can probably answer this; do neutralizing antibodies fix complement?

I guess he can't answer my question.

I tried to answer it for myself but I'm unable to. There does appear to be such a thing as non-complement-fixing antibodies. This is my only guess for why the CF antibody test doesn't work on chronic infections; the antibodies that we are producing in large quantities, the effects of which show up readily on the microneutralization test, don't fix complement in sufficient quantities to be detected by the CF method.

It looks like the CF method can actually be used to detect virus in the blood too. They simply add in antibodies instead of the virus, but perform the test the same otherwise. I'm guessing this is not what Focus does though as the test is advertised as an antibody detection test.

 

[Hip]

@halcyon
I wonder if the loss of sensitivity of the complement fixation test (CFT) for chronic coxsackievirus B / echovirus infections relates to the fact that you get IgM antibodies produced in the acute infection, and these are then replaced by IgG antibodies once the infection becomes chronic.

I think I read that the CFT is more sensitive during acute enterovirus infections compared to chronic (though I can't find a reference for this now).

The CFT detects both IgM and IgG, so will respond to both types of antibody (in fact it cannot distinguish between them). However, perhaps the CFT responds better to the IgM produced during the acute infection.



The other problem with the CFT is that even when it is able to detect an coxsackievirus B / echovirus infection, it cannot distinguish between serotypes (ie, will not tell you if your coxsackievirus infection is CVB1, CVB2, CVB3, etc).

 

[halcyon]

The CFT detects both IgM and IgG, so will respond to both types of antibody (in fact it cannot distinguish between them). However, perhaps the CFT responds better to the IgM produced during the acute infection.

That could be. The microneutralization test should in theory "detect" IgM and IgG but cannot differentiate either, though I imagine IgG antibodies provide stronger neutralization and would provide protection at a higher dilution.

The other problem with the CFT is that even when it is able to detect an coxsackievirus B / echovirus infection, it cannot distinguish between serotypes (ie, will not tell you if your coxsackievirus infection is CVB1, CVB2, CVB3, etc).

I'm pretty sure this test does detect serotype actually. Take a look at the echovirus panel for example.

 

[Hip]

I'm pretty sure this test does detect serotype actually. Take a look at the echovirus panel for example.

When I had my enterovirus CFT test in the UK around 8 years ago, my results (copied directly from the lab report) were:

Coxsackie / Echo virus antibodies

Coxsackie virus CFT: Negative
[serotypes B1 - B6 & A9]

Echovirus CFT: Negative
[serotypes 4, 6, 9, 14, 24 & 30]

Comment:
Significant antibody levels to the above
were NOT detected. Paired testing of acute
and convalescent specimens is recommended.

You can see that the lab did not provide individual test results for each serotype.

It could be that my memory is faulty, but I think I spoke to the lab and asked them if their CFT detects individual serotypes, and they said it did not. But my memory these days is not to be relied on. Perhaps it depends on the lab; perhaps some labs might provide individual serotype results fro CFT, and other not.

 

[Emootje]

If you look at @Emootje's two enterovirus test results posted earlier in this thread, these were done at European labs: the first test at a Belgium lab, and the second test in a Dutch lab, both tests showing elevated CVB3 antibody titers. The second test looks like it is a neutralization test (not sure about the first — would you know, @Emootje?).

Sorry for the delay Hip, didn't notify your questions.
Meirleir order the first test, it's probably a neutralization test but I'm not sure. He did also a PCR for enteroviruses and coxsackie viruses, both came back negative. The second test is definitely a neutralization test.

Perhaps the Dutch lab, the University Medical Center (UMC) Utrecht, might be one good lab that ME/CFS patients might use. @Emootje, do you remember how much the UMC coxsackievirus B neutralization test cost?

In the Netherlands you can order standard blood/urine test without a referral from a doctor (http://bloedwaardentest.nl/). The coxsackie neutralization test is unfortunately not one of there standaard test. I managed to convince them to do the test, which was not easy. I can't remember the cost of the test but I'm sure it was less than 100 euro's.

 

[Hip]

. I can't remember the cost of the test but I'm sure it was less than 100 euro's.

Less than €100 seems a pretty good price for a neutralization test, in comparison to $500 for the ARUP Lab micro-neutralization test for coxsackievirus B.

It's possible that the ARUP Lab test is a more complex and sensitive test, though, and that's why it costs a lot.

I wrote to UMC Utrecht a few days ago, asking about the cost, and whether they can accept blood samples from abroad, from the UK.


It would be nice if we could somehow check ME/CFS patients tested to coxsackievirus B at ARUP Lab, to see if they get the same results at UMC Utrecht, as this would be a much cheaper option for ME/CFS patients.

 

[Isaiah 58:11]

I initially didn't reply because I wasn't tested by ARUP, but I see that the issue is false negatives so I will go ahead and post.

I was tested by Sonora Quest and was negative for Coxsackie A and B 1 but positive for Coxsackie B 2, 3, 4, 5, and 6. I don't remember the actual numbers, but B2 was the highest of them all and it came with a warning that they could cross react with each other and that the doctor may want to consider the highest as the most likely culprit.

I have not been tested for echoviruses.

 

[Gingergrrl]

@Hip Sorry if I already posted this and have not re-read the entire thread. I was tested at ARUP in Jan and Feb of 2015. I was positive both times for Coxsackie B4 and Echo 11 but with each test the titers flipped and the results were inconsistent.

I just tested again in Dec 2015 and will be seeing Dr. Chia for a consult in about 2-3 weeks. I called his office to confirm that they received my ARUP results and they did but are not allowed to tell me over the phone prior to the consult. I am lucky that these tests are covered by my insurance b/c my insurance rarely covers anything!

So it will be very interesting to see how they compare to the earlier ones.

 

[Hip]

I have been writing to a few UK and European testing labs to get details of their coxsackievirus B / echovirus tests.


I have just discovered that the Armin Lab test for coxsackievirus B (which is not expensive at £52) is an immunofluorescence assay (IFA) test.

I am wondering what kind of sensitivity an IFA enterovirus test has, and how it compares to the sensitivity of a neutralization test.

EDIT: the ArminLab test fro CVB looks very bad: see this thread.

 

[halcyon]

I am wondering what kind of sensitivity an IFA enterovirus test has, and how it compares to the sensitivity of a neutralization test.

This is the method that LabCorp uses to measure coxsackie A IgM or IgG antibodies here in the US. A patient here posted her IgG results from this test and I recall several of them were elevated. The problem is that we don't have a useful clinical correlation for this testing methodology, whereas Dr. Chia and several British investigators used a titer over x amount (e.g. 1:320) to represent an active infection, and they could back this up with presence of VP1 and/or RNA in blood or tissues. We don't know what the equivalent cutoff might be for the IFA test.

LabCorp notes on their coxsackie A IFA assay:

Limitations
A positive test result does not necessarily indicate current or recent infection as antibodies to Coxsackie species can be detected in uninfected individuals due to moderate passive exposure to infected hosts. It is, therefore, crucial that results from all Coxsackie A serologies correlate with the clinical history of the patient and all other data available to the physician. Samples collected at the early stage of infection (primarily in children) may not yield detectable antibodies. If a recent infection is suspected, a second specimen should be collected 10 to 20 days following the initial collection and tested.

Looks like the Armin Lab test is IgA/IgG only for coxsackie A and B.

 

[Hip]

The problem is that we don't have a useful clinical correlation for this testing methodology, whereas Dr. Chia and several British investigators used a titer over x amount (e.g. 1:320) to represent an active infection, and they could back this up with presence of VP1 and/or RNA in blood or tissues. We don't know what the equivalent cutoff might be for the IFA test.

Yes, that would seem to be the problem, we don't have any reference points for the IFA test.

I am tempted to send blood samples to both the UMC Utrecht CVB neutralization test that @Emootje had done, and also on the same day send a blood sample to Armin Labs for their coxsackievirus IFA test, since the Armin test is inexpensive, and then compare results.

UMC Utrecht told me that they can accept blood samples from the UK.

Looks like the Armin Lab test is IgA/IgG only for coxsackie A and B.

Yes, and unfortunately the UMC Utrecht neutralization test also only covers CVB, but not echovirus.

 

[frederic83]

Hello Hip,

So finally, did you sent a sample to the UMC Utrecht Lab? I'm interested to do this.

 

[Hip]

So finally, did you sent a sample to the UMC Utrecht Lab? I'm interested to do this.

Funny that you should ask, because I finally sent my blood serum sample to UMC Utrecht just last week, and I am expecting the results back in two weeks.

However, I learnt that UMC Utrecht are unfortunately going to close down their coxsackievirus B neutralization test in the next month or so, due to lack of demand, making it uneconomic to run. UMC Utrecht told me that unless I get my serum sample to them within the next few weeks, they would not be able to process it.

This is sad because I am not aware of any other commercial coxsackievirus B neutralization test in Europe, and the neutralization test is the only one that is sensitive enough to reliably detect chronic coxsackievirus B infections in the blood of ME/CFS patients.

What's more, the UMC Utrecht neutralization test, which costs around $120, seems very good value in comparison to the ARUP Lab micro-neutralization test, which costs around $500 (though I am not sure if they are equally as sensitive).

I did in fact suggest to UMC Utrecht that they could try to see if ME/CFS doctors like Dr Chia would be interested in using their test, in order to increase demand.

 

[Hip]

I recently came across this blog article in which Dr Chia says the coxsackievirus B (CVB) and echovirus (EV) serotypes that he thinks most commonly cause ME/CFS are:

• CVB3 and CVB4 first and foremost

• Then CVB2, EV6, EV7 and EV9

• And then much less EV11.


Though Dr Chia also points out that "there's a whole bunch of these guys we can't identify" (ie, other enterovirus subtypes that are not detected in current lab tests).

 

[frederic83]

Then, @halcyon 's EV30 infection is quite rare, according to Dr Chia's declaration. Halcyon, did he say something when he saw your echovirus serotype?

 

[halcyon]

Then, @halcyon 's EV30 infection is quite rare, according to Dr Chia's declaration. Halcyon, did he say something when he saw your echovirus serotype?

If I recall correctly he did say that he doesn't see this one as often. I have met two or three other patients on here with that serotype though.

 

[Hip]

Just got by coxsackievirus B antibody neutralization test results back from UMC Utrecht today:

CVB1 < 1:4 Negative
CVB2 1:128 Positive
CVB3 < 1:4 Negative
CVB4 1:1024 Positive
CVB5 1:8 Positive
CVB6 < 1:4 Negative

These results show that my antibody titers to CVB4 are high, whereas CVB2 and CVB5 are not high and the lab report says CVB2 and CVB5 results are evidence of past infections.

Unfortunately this coxsackievirus B neutralization test from UMC Utrecht is being discontinued at the end of this month (April 2016).



A recent study showed that dihydroquercetin (a flavonoid supplement) has antiviral effects against CVB4 comparable in potency to the antiviral drug ribavirin. I am going to be trying this supplement soon.

I compiled a list of antiviral drugs and supplements for the various different CVB and echovirus serotypes here.



During the period 2005 to 2008 I also had several other pathogen tests; I was test for:

EBV, HHV-6, cytomegalovirus, varicella zoster, herpes simplex 1, herpes simplex 2, coxsackievirus and echovirus (using the insensitive complement fixation test), parvovirus B19, Toxoplasma gondii, HTLV I & II, HIV, hepatitis B.

I was positive only to the pathogens in bold text. All these positive results were latent infections, except my cytomegalovirus and HSV-1, which were reactivated.

The virus that originally triggered my ME/CFS I caught in 2003. This virus had a very fast incubation period (observed on multiple occasions) of just 12 hours. In fact that is faster that coxsackievirus B can normally achieve (CVB incubation period is 3 to 5 days; echovirus incubation period is 2 to 7 days).

 

[Kryssieness]

Sorry to necro this thread, but I may actually (finally!) be closer to an actual diagnosis. I was referred to Dr. Chia just this week. Was thinking of just skipping it because new doctors tend to look at me and tell me everything's in my head/I'm a hypochondriac/etc.

I did have a Coxsackie virus & echovirus serum run last year, via LabCorp. I came back negative in the echovirus serum panel (<1:10); but in the Coxsackie Virus Group B, I came back "High" in all but B-4. My numbers were as follows:

B-1: 1:8 High
B-2: 1:16 High
B-3: 1:8 High
B-4: Negative
B-5: 1:32 High
B-6: 1:16 High

I also had an EBV panel run, just recently, and it came back with positive results indicating a past infection. I've never actually been sick with anything resembling mono and I don't have ANA indicators for an autoimmune disorder. By all accounts, my immune system is really strong.

I did, however, have chicken pox twice; once when I was 5, then again when I was 21. I get cold sores 3-4 times a year, I believe, and I'm very sensitive to sunlight and loud noises. I used to be a powerlifter and a runner; but in October of 2014, I got sidelined by debilitating fatigue from out of nowhere, followed two days later by such intense pain, I couldn't walk or stand. Now, I can't walk around for too long because my feet and legs will feel like I have knitting needles being shoved upwards into them, erupt into flames, or just go numb from the knee down. An old surgery point (left knee) is starting to give me trouble, again, by going out without warning; my right ankle (which had surgery in Jan 2014) is also starting to randomly give out. Despite the Ortho saying he did not touch the nerves in my ankle, another doctor insists the ortho did damage the nerves in my ankle because there's latency in the transmission of electrical impulses.

After a car accident in 2013, I remember mentioning that my left leg (which was uninjured) felt abnormally weak and inquired if MS could be triggered by a car accident. The person I asked jabbed electrodes into my leg, ran a conductivity test, and told me I was fine. That was the only problem I was having at that time...abnormal weakness/sensations in my left leg. It wasn't until October of 2014 (which is a year and a half after the car accident and 10 months after the surgery) when everything went sideways.

 

[knackers323]

@Hip Sorry if I already posted this and have not re-read the entire thread. I was tested at ARUP in Jan and Feb of 2015. I was positive both times for Coxsackie B4 and Echo 11 but with each test the titers flipped and the results were inconsistent.

I just tested again in Dec 2015 and will be seeing Dr. Chia for a consult in about 2-3 weeks. I called his office to confirm that they received my ARUP results and they did but are not allowed to tell me over the phone prior to the consult. I am lucky that these tests are covered by my insurance b/c my insurance rarely covers anything!

So it will be very interesting to see how they compare to the earlier ones.

@Gingergrrl hello. How did the last test compare with the two previous ones?