Stomach Enteroviral infection in Chronic Fatigue?

In January, published report found evidence of persistent enteroviral infection in the stomach of people with chronic fatigue.
Similarly, duodenal ulcers were found to be due, in part, to a stomach germ, helicobacter pylori. Many carry this germ harmlessly but others can’t heal the irritation created by the germ presence so well. One factor is stress which can slow down healing because it can cut blood flow to stomach and the stress induced cortisone excess impairs wound healing. Now one wonders if chronic fatigue is a persistent stomach infection.

Enterovirus infection of the stomach in chronic fatigue syndrome/myalgic encephalomyelitis
Author(s): Kerr JR (Kerr, Jonathan R.)
Source: JOURNAL OF CLINICAL PATHOLOGY Volume: 61 Issue: 1 Pages: 1-2 Published: JAN 2008

Biopsies for viral capsid protein I in parietal stomach cells – 82% CF; 20% controls p<0.001
Enterovirus RNA 9/24 (37%) versus only 1 in control P<0.01

6 people initially positive were tested later and found to still have evidence of persistent virus.

Hence they felt:

“A significant subset of CFS patients may have a chronic, disseminated, non-cytolytic form of enteroviral infection, which could be diagnosed by stomach biopsy”

Comment – interestingly, polio is an enterovirus and I feel post polio is a persistent infection.

Possible treatments of enterovirus?

• Interferon alpha has been tried in coxsackie myocarditis abstract earlier abstract
  this can be a difficult drug to tolerate and can cause serious depression but is available.

• Vitamin D – Recent evidence demonstrated TB infection does not clear well in patients with low vitamin D. abstract
  Low Vit D levels are very common and implicated in MS.Additional Vit. D helps TB immunity and increases antibody reaction to polio vaccination. polio abstract
  I use Osto D2 – 50,000 IU once weekly in chronic pain subjects and found it helpful. I also had a Hepatitis C patient undergoing treatment that responded once started on Vit D high dose.Suggestions in:
  http://www.emedicine.com/PED/topic688.htm
• Immune globulin, intravenous (Carimune NF, Gammagard, Polygam S/D) g/kg IV as a single infusion over 12 h; alternatively, 2 g/kg IV as a single dose infused over 4 d (ie, over 96 h); must gradually increase rate of infusion to avoid infusion-related toxicityused in severe infections abstract
• Pleconaril (Picovir) 200 mg PO bid for 5-7 d; administer with a fatty meal – experimental
  link

This adds to the list of potentially treatable defects in chronic fatigue:

1) ?Persistent chlamydia pneumonia responsive to azythromycin full article
“Of the 99 patients investigated, 58 reported a decrease in the symptoms by the use of azithromycin.”

One of may patients went to a chronic fatigue clinic in Las Vegas where persistently high Chlamydia Pneumonia IgG titers were found. Azithromycin seemed to help. Our lab will often NOT do the IgG – just the IgM unfortunately.

2) chronic herpesvirus type 6 or chronic epstein barr virus responding to valganciclovir

abstract

Nine out of 12 (75%) patients experienced near resolution of their symptoms, allowing them all to return to the workforce or full time activites
3) There are a variety of non-specific treatments found helpful in chronic fatigue.J Clin Psychiatry. 2005 May;66(5):625-32.
Prospective observational study of treatments for unexplained chronic fatigue.
Bentler SE, Hartz AJ, Kuhn EM. abstract

• Yoga appeared to be most effective treatment
• coenzyme Q10 (69% of 13 subjects),
• dehydroepiandrosterone (DHEA) (65% of 17 subjects),
• ginseng (56% of 18 subjects).

Treatments at 6 months that predicted subsequent fatigue improvement were:

• yoga (p = .002).
• Magnesium (p = .002). (I have used magnesium citrate, the most soluble form, in patients with chronic headaches link – they used 913 mg BID.
  There is a liquid Citromag 5 gm/100ml = 50 mg/ml used as a bowel prep laxative.
  913 mg BID = 18 ml BID – I used one tablespoon twice daily and watch for any diarrhea!)

• support groups (p = .06)
• vitamins (p = .08),
• vigorous exercise (p = .09)

One chronic fatigue expert I talked to felt SAD (seasonal Affective Disorder) was common and a sun light helpful (there is a depression support group in Regina that builds flourescent light units for $85). BTY a PhD research project found for depression the best results were with twice daily use 1/2-1 hour.
This expert also felt that pacing was important otherwise they have too much down time (similar with overdoing it in chronic pain and spending days in bed with pain after).

Obviously, it would be nice not to miss celiac disease or sleep apnea. This is a huge topic and so I hope people will add input.