Page 1, 2
Viral infections add a whole other bag of complications to our patients. More often than not, a Lyme patient will be treated, and their symptoms get 50% better; but they wax and wane. Many practitioners will say "biofilm" or "cysts" and augment the treatment protocol. Sometimes it works but often it doesn't. I have found that in many of my chronic patients, their latent viruses come back to life—Epstein-Barr virus (EBV), Herpes 1-8, Coxsackie, Cytomegalovirus (CMV) amongst others. Never mind other infections such as Powassan virus that very few labs test for.
EBV is a tricky beast. Acutely known as "mono," few doctors realize that it can become chronic. How many doctors have had patients that we treat that have said that they have never been well since having mono as a teenager? Or how many patients have all the pain symptoms resolve after treatment for Lyme but have persistent fatigue issues now being called "post Lyme syndrome"? My clinical experience has shown that if a person still feels sick for a long period of time, they are still fighting something. It is normal to have a medication hangover from long-term antibiotics and inflammation, but anything past a couple months should raise alarm bells. EBV has also been associated with non-Hodgkin's lymphoma.16
Herpesvirus 6, 7, and 8 are usually acquired during childhood and can re-emerge later. The symptoms for herpes-virus 6 mimic MS, Hashimoto's, and fibromyalgia. Bone marrow suppression seems the main characteristic, so abnormal white blood cell counts should get you thinking. Herpesvirus 7 (roseola) is acute but also chronic. The key mechanism to think about is myelin degradation. Signs include memory issues, twitches, headaches, unusual sensations, and muscle spasms or knots that don't relate to tension or overuse. Herpesvirus 8 is usually associated with the immune compromised (such as HIV/AIDS). Patients will often present with fatigue, arthralgia, and fevers. In HIV/AIDS patients, this virus is associated with the onset of Karposi's sarcoma.
Cytomegalovirus does not stand out in terms of unusual symptoms. They are typically fatigue, fever, and swollen lymph glands. However, there are some papers to show that there is an association between this virus and coli-tis, atherosclerosis, esophagitis, hepa-titis, pneumonitis, and non-Hodgkin's lymphoma.17,18
Parvovirus (slapped cheek disease) can reinvigorate during adulthood and clinically present as polyarthritis and chronic fatigue. The arthritis would typically be symmetric and chronic, showing a similar pattern to rheumatoid arthritis.
Coxsackie (hand, foot & mouth disease) in children presents with the classic sore throat, cough, fatigue, headache, night sweats, and conjunctivitis. Complications that can arise include diabetes, aseptic meningitis, and central nervous system paralysis. However, I have noticed that many of my chronic fatigue syndrome patients have tested positive for active Coxsackie and responded quite well to anti-viral therapies. Coxsackie has been associated with chronic fatigue syndrome many times in the literature.19
This is the developing part of the story. Many labs still rely on the standard IgG and IgM antibody testing. While this may be useful in the acute onset of the disease, these tests can be useless in the second coming of a latent virus. Some labs have started to develop new tests such as the Elispot test that looks at the activity of the immune cells over the last 72 hours. There are a few labs in the world using this test now but call it by different names. This has been extremely useful as antibody testing can be flawed. Western and Southern blot and DNA PCR testing can be helpful but are often plagued with false positives from cross reactivity or false negatives from lack of genetic strain diversity. Cystic forms of the disease such as in Lyme disease can now be tested for using antibody testing. While no test exhibits 100% accuracy, my experience has taught me that we are better to check off more boxes on the test requisition form than less. Many infections present as chronic fatigue, so how do you pick which one? Some useful tips for using lab tests include the following:
- Test for more than less. It is easier to convince a patient to spend a bit more than to see a negative test come back and convince them to send another kit back in.
- Call the lab and talk to the physician or lab director in charge of testing to interpret results that are not clear. I have learned a ton doing this.
- Most labs use great technique and science. If one lab says they are the best and tells you not to use another lab, be wary. Profit should not trump care.
- Don't test too often or too early. You will drive yourself crazy as these diseases wax and wane. A good pattern is 12-week protocol with retesting.If we test the CD57+/CD 56, do antibody testing, DNA PCR, and Elispot testing, we can get pretty darn close to 99% specificity and 99% sensitivity. This usually will come to $2000 - $3000 to put together a full panel. I currently use three different labs – two situated in the United States and one in Germany (see the Resources section). As a clinician, there is nothing worse than sending away for testing after convincing the patient to drop a fair chunk of money and have it come back negative for everything.
Some naysayers will preach that if you check off enough boxes, you will eventually find something. This could be true, but that is the meaning of the word medical "practice." Experience will show you trends that lead you to the diagnosis. There are always going to be false positives; but if you combine that with knowledge and clinical experience, the true diagnosis will reveal itself. At the end of the day, we need to park the ego and realize that we have to continue to learn and grow as a clinician. So, the next time a patient does not respond to treatment, perhaps you will start to think about the possibility of a hidden infection.
Now the fun part begins as you will notice that there are very few proven medical treatments for these chronic infections, but there are many natural interventions with historical use and success. But that is another article.
Page 1, 2
1. Rashid T, Ebringer A. (2011, September 2). Autoimmunity in Rheumatic Diseases Is Induced by Microbial Infections via Crossreactivity or Molecular Mimicry. Autoimmune Dis. September 2, 2011; or Hsieh Y-F, et al. Serum Reactivity against Borrelia burgdorferi OspA in Patients with Rheumatoid Arthritis. Am Soc Microbiol. September 19, 2007.
2. Saberi A, Akhondzadeh S, Kazemi S. Infectious agents and different course of multiple sclerosis: a systematic review. Acta Neurologica Belgica. July 13, 2018.
3. Sertour N, et al. Infection Kinetics and Tropism of Borrelia burgdorferi sensu lato in Mouse After Natural (via Ticks) or Artificial (Needle) Infection Depends on the Bacterial Strain. Front. Microbiol. 2018;9:1722.
4. How to Handle a Tick Bite. https//iladef.org
5. Janegova A, et al. The role of Epstein-Barr virus infection in the development of autoimmune thyroid diseases. Endokrynologia Polska. May 1, 2015.
6. Dittfeld A, et al. A possible link between the Epstein-Barr virus infection and autoimmune thyroid disorders. Cent J Eur Immunol. October 25, 2016.
7. Cassell GH. Infectious Causes of Chronic Inflammatory Diseases and Cancer. Emerging Infectious Diseases. July-September 1998.
8. Manitoba Annual Tick-Borne Disease Report – 2017. https://www.gov.mb.ca/health/publichealth/cdc/tickborne/docs/tbd_report2017.pdf
9. Messinger CJ, et al. (2017 March 22). Seroprevalence of Bartonella species, Coxiella burnetii and Toxoplasma gondii among patients with hematological malignancies: A pilot study in Romania. Zoonoses Public Health. September 2017.
10. Mazur-Melewska, K, et al. The significance of Bartonella henselae bacterias for oncological diagnosis in children. Inf Agent Cancer. 2015.
11. Marrodan M, et al. The role of infections in multiple sclerosis. Mult Scler. 2019 Jan 14 : 1352458518823940.
12. Saberi A, Akhondzadeh S. Kazemi S. Infectious agents and different course of multiple sclerosis: a systematic review. Acta Neurol Belg. September 2018.
13. Contini C, et al. Chlamydophila pneumoniae Infection and Its Role in Neurological Disorders. Interdiscip Perspect Infect Dis. 2010:273573.
14. Huang S, et al. (2001, April 15). Mycoplasma infections and different human carcinomas. World J Gastroenterol. April 15, 2001.
15. Saebø A, Lassen J. Acute and chronic gastrointestinal manifestations associated with Yersinia enterocolitica infection. A Norwegian 10-year follow-up study on 458 hospitalized patients. Ann Surg. 1992 Mar;215(3):250-5.
16. Jha HC, Banerjee S, Robertson ES. The Role of Gammaherpesviruses in Cancer Pathogenesis. Pathogens. 2016;5(1):18.
17. Mehravaran H, et al. Association of Human Cytomegalovirus with Hodgkin's Disease and Non-Hodgkin's lymphomas. Asian Pac J Cancer Prev. 2017;18(3):593–597.
18. Weng MT, et al. Cytomegalovirus colitis in hospitalized inflammatory bowel disease patients in Taiwan: a referral center study. BMC Gastroenterol. 2017;17(1):28.
19. Rasa S, et al. Chronic viral infections in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). J Transl Med. 2018;16(1):268.
Arminlabs (Germany): www.arminlabs.com
- Can test for bacteria, viruses, parasites, and mold as well as many others.
- Turn-around time is usually 1-2 weeks sometimes even less.
- Do not need a centrifuge; simply draw and ship Monday or Tuesdays.
- Price is relatively lower than other labs for complete viral and bacterial panel, about $1000 - $1500 US
- Gives you the option of testing for cyst or round body form of Lyme disease, which is pretty unique.
- Elispot testing shows recent cellular activity so it is a way of tracking.
- Have to draw and send by UPS early in the week to ensure it gets there quick enough, which can be hard for some people's schedules.
IgeneX (US): www.Igenx.com
- Similar testing options to Arminlabs now; their version is called the Immunoblot (vs. Elispot).
- May be easier shipping option for doctors in the US.
- Need to centrifuge the samples prior to shipping.
- Similiar comprehensive panel could cost about $1500 -$3000 US.
- Less viral options for testing.
DNA Connexions (US): www.dnaconnexions.com
- Easy urine sample – great for pediatric, young kids, or people with terrible veins.
- Cheap: about $500 US
- Tests Lyme and co-infections but no viruses.
- DNA PCR testing; it is possible that the absence of DNA in the urine does not mean you are free and clear of infection.
Jason Bachewich, ND, is a naturopathic doctor practicing in Winnipeg, Manitoba, Canada. He is the owner and clinical director of Nature Doctors and has a keen interest in infectious disease and cancer. He graduated from the Canadian College of Naturopathic Medicine and has consulted for many of the large professional nutraceutical manufacturers. He has lectured internationally on a number of topics and has been a presenter on many local television stations. For more information, please see www.lymedoc.net or www.thenaturedoctors.ca.