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The Enterovirus Theory of Disease Etiology in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Critical Review, Hanson et al (2021)

Discussion in 'BioMedical ME/CFS Research' started by strategist, Jun 2, 2021.

  1. strategist

    strategist Senior Member (Voting Rights)

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    Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex, multi-system disease whose etiological basis has not been established. Enteroviruses (EVs) as a cause of ME/CFS have sometimes been proposed, as they are known agents of acute respiratory and gastrointestinal infections that may persist in secondary infection sites, including the central nervous system, muscle and heart. To date, the body of research that has investigated enterovirus infections in relation to ME/CFS supports an increased prevalence of chronic or persistent enteroviral infections in ME/CFS patient cohorts than in healthy individuals. Nevertheless, inconsistent results have fueled a decline in related studies over the past two decades.

    This review covers the aspects of ME/CFS pathophysiology that are consistent with a chronic enterovirus infection and critically reviews methodologies and approaches used in past EV-related ME/CFS studies. We describe the prior sample types that were interrogated, the methods used and the limitations to the approaches that were chosen.

    We conclude that there is considerable evidence that prior outbreaks of ME/CFS were caused by one or more enterovirus groups. Furthermore, we find that the methods used in prior studies were inadequate to rule out the presence of chronic enteroviral infections in individuals with ME/CFS. Given the possibility that such infections could be contributing to morbidity and preventing recovery, further studies of appropriate biological samples with the latest molecular methods are urgently needed.
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    Last edited by a moderator: Jun 2, 2021
    brf, Mithriel, sebaaa and 14 others like this.
  2. Creekside

    Creekside Senior Member (Voting Rights)

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    To me, the lack of a definite 'all PWME have this virus' finding means that ME is not a viral disease. Viral infections might trigger ME in people susceptible to developing ME, and might increase the severity in PWME who are susceptible to that, but that there are also other PWME who triggered from other factors and who don't have a chronic viral infection or hidden viral fragments or other excuses for why a guilty virus can't be found.

    If I was allocating ME research funding, viral hypotheses wouldn't be at the top of my list.
    Andy, Mij, cfsandmore and 9 others like this.
  3. duncan

    duncan Senior Member (Voting Rights)

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    Pathogens of all sorts would be considered for my list of ME/CFS causes, just as they would be for MS. I fully would expect multiple infectous agents to be behind discreet ME/CFS cases, i.e, enteroviruses cause ME for some, other viruses for some, bacteria for some, parasites for some, etc.

    Moreover, I'd be looking in tissue whenever possible.
    cfsandmore, sebaaa, Kitty and 9 others like this.
  4. rvallee

    rvallee Senior Member (Voting Rights)

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    I'm skeptical of enteroviruses as a category of pathogens, rather than pathogens with the ability to infect the GI tract. My understanding of enteroviruses is that it's a class of viruses known to do that, but viruses not in that category can still infect the gut, like Covid-19 does. And GI symptoms have been one of the strongest predictors of LC so far, although that's limited because of how little the right questions are asked.

    So is that really about the family of viruses known to do that? Or any pathogen that can take hold in there, which is an overlap but not the same thing. Because that would not explain LC, or mono, for that matter. Unless it's just a chance interaction that allows an enterovirus to go into rage mode.
    cfsandmore, sebaaa, Kitty and 6 others like this.
  5. James Morris-Lent

    James Morris-Lent Senior Member (Voting Rights)

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    United States
    Seems promising other than the part where we can't find any evidence of viruses in anybody and the drugs used to treat them are useless.
  6. Mithriel

    Mithriel Senior Member (Voting Rights)

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    Enteroviruses are known to cause diseases of the brain and heart as well as hand foot and mouth disease and summer flu. They also have mechanisms for evading the immune system. They are a seriously neglected class with the CDC taking far too long to be forced to admit that acute flaccid paralysis is enteroviral because of a conforting feeling they are not a cause of serious disease any more. Remember coronaviruses were just the common cold 2 years ago.

    Viruses are way more complicated organisms to detect and study than bacteria. Fifty years ago we were taught about a type of plant virus that was just a naked piece of RNA and the lecturer said it gave him nightmares if something like that was infecting humans.

    A virus that is very good at evading the immune system is a very successful virus. Causing a subclinical infection then finding a niche and causing barely noticeable ill health until it can get a better foothold if there is disruption to the body is a very good strategy.

    I don't think that research funds for viruses are the way to go - actually looking at how the disease is experienced so we are all talking about the same thing is the most important thing - but there is a good chance many things that go wrong in the body are triggered by viruses.
    Yessica, Peter Trewhitt and Perrier like this.
  7. Mij

    Mij Senior Member (Voting Rights)

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    I had a sudden viral onset, and whatever was occurring in my immune system during that time period seems to have activated h pylori infection. I might have been asymptomatic w h pylori for years, but the viral onset altered my immune system and brought it to surface.

    Just a theory of mine of course, but a big coincidence if it didn't. My gut was increasingly becoming worse 5 years after onset until I was treated.

    I don't think that it's an ongoing viral infection in my case, but an altered immune system that occurred after the initial infection.
    Mithriel, Michelle and Peter Trewhitt like this.

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