ORIGINAL ARTICLES

Chronic fatigue syndrome is associated with chronic enterovirus infection of the stomach

J K S Chia and A Y Chia

EV Med Research, Lomita, California, USA

Correspondence to:
Dr John K S Chia, EV Med Research, LLC, 25332 Narbonne Ave # 170, Lomita, CA 90717, USA; evmed{at}sbcglobal.net

Background and Aims: The aetiology for chronic fatigue syndrome (CFS) remains elusive although enteroviruses have been implicated as one of the causes by a number of studies. Since most CFS patients have persistent or intermittent gastrointestinal (GI) symptoms, the presence of viral capsid protein 1 (VP1), enterovirus (EV) RNA and culturable virus in the stomach biopsy specimens of patients with CFS was evaluated.

Methods: 165 consecutive patients with CFS underwent upper GI endoscopies and antrum biopsies. Immunoperoxidase staining was performed using EV-specific monoclonal antibody (mAb) or a control mAb specific for cytomegalovirus (CMV). RT-PCR ELISA was performed on RNA extracted from paraffin sections or samples preserved in RNA later. Biopsies from normal stomach and other gastric diseases served as controls. 75 samples were cultured for EV.

Results: 135/165 (82%) biopsies stained positive for VP1 within parietal cells, whereas 7/34 (20%) of the controls stained positive (p0.001). CMV mAb failed to stain any of the biopsy specimens. Biopsies taken from six patients at the onset of the CFS/abdominal symptoms, and 2–8 years later showed positive staining in the paired specimens. EV RNA was detected in 9/24 (37%) paraffin-embedded biopsy samples; 1/21 controls had detectable EV RNA (p<0.01); 1/3 patients had detectable EV RNA from two samples taken 4 years apart; 5 patient samples showed transient growth of non-cytopathic enteroviruses.

Conclusion: Enterovirus VP1, RNA and non-cytopathic viruses were detected in the stomach biopsy specimens of CFS patients with chronic abdominal complaints. A significant subset of CFS patients may have a chronic, disseminated, non-cytolytic form of enteroviral infection, which could be diagnosed by stomach biopsy.

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This article has been cited by other articles:

• Chia, J. K, Chia, A. A (2009). Varicella-zoster virus reactivation during acute enterovirus infection is associated with CD8 lymphocytopenia. BMJ Case Reports 2009: bcr0820080803-bcr0820080803 [Abstract] [Full Text]  
• FREMONT, M., METZGER, K., RADY, H., HULSTAERT, J., DE MEIRLEIR, K. (2009). Detection of Herpesviruses and Parvovirus B19 in Gastric and Intestinal Mucosa of Chronic Fatigue Syndrome Patients. In Vivo 23: 209-213 [Abstract] [Full Text]  
• Kerr, J R, Burke, B, Petty, R, Gough, J, Fear, D, Mattey, D L, Axford, J S, Dalgleish, A G, Nutt, D J (2008). Seven genomic subtypes of chronic fatigue syndrome/myalgic encephalomyelitis: a detailed analysis of gene networks and clinical phenotypes. J. Clin. Pathol. 61: 730-739 [Abstract] [Full Text]  
• Kerr, J. R (2008). Enterovirus infection of the stomach in chronic fatigue syndrome/myalgic encephalomyelitis. J. Clin. Pathol. 61: 1-2 [Full Text]  

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