The Virus Detailed on This Website is Very Likely an Enterovirus
In this section, by examining the symptoms manifested by my virus, we confirm that this virus is most likely an enterovirus, such as a coxsackievirus B or echovirus. Coxsackievirus B and echovirus are two species of enterovirus known to cause chronic infections. Coxsackievirus B can cause most, if not all, of the symptoms I experienced.
However, be aware that other infectious microbes can cause approximately similar symptoms. So if you have slightly different symptoms to me, have a look at the other microbes detailed on the ME/CFS Info page, as one of those may be the culprit in your case.
We now examine each of the major symptoms produced by my virus, and we find that all these major symptoms strongly match the symptoms known to be produced by enteroviruses.
Herpangina symptom: strong match. An initial characteristic symptom of my virus is a sore throat looking like herpangina (an inflamed red throat at the back of the soft palete). In my case, the herpangina was without any pain, and without blisters or ulcers, but with a cluster of small papules (raised pimples not producing pus) in the pharynx, these papules being a slightly whiter shade of the red/pink color of the throat itself. The name lymphonodular pharyngitis is given to a herpangina-type sore throat where there are only papules, but no blisters or ulcers; so lymphonodular pharyngitis may be a better description of my sore throat.
Herpangina sore throats are usually only caused by certain viruses of the Enterovirus genus, namely enterovirus 71, coxsackievirus A16, and coxsackievirus B species. Lymphonodular pharyngitis is normally caused by coxsackievirus A10 only (but this virus does not produce chronic infections, so we can rule this out). So regarding the herpangina (or lymphonodular pharyngitis) sore throat symptoms, we have strong match between the symptoms produced by my virus, and the symptoms that enteroviruses precipitate. Note that more rarely, herpangina can be caused by echovirus (also from the Enterovirus genus), parechovirus 1, adenovirus, and herpes simplex virus. 1
Incubation period: possible match. I happen to know exact time I was exposed to this virus; so the fact that its first symptoms appeared 12 hours after this exposure shows that this virus has a very fast incubation period. This rapid 12 hour incubation period was also noted in several other people who were infected by this virus, and an incubation period of 8 hours was actually observed in one individual. This is an extremely fast incubation period, and should be of scientific note just in itself. Using this very valuable incubation period information, we can rule out a whole range of infectious microbial pathogens that have much longer incubation periods. Thus for example, the virus I caught could not possibly be Epstein-Barr virus (EBV), as EBV has an incubation period of 4 to 6 weeks, which considerably longer that the roughly 12 hour incubation period of my virus. Similarly, we can rule out nearly all other viruses and other microbes, as the incubations for most microbes tend to be much longer than 12 hours.
Figures quoted for coxsackievirus B incubation periods are 3 to 5 days, 1 and echovirus incubation periods are 2 to 14 days. 1 By contrast, the virus that I caught has a more rapid incubation period of around 12 hours (and I have noted my virus incubate in precisely 8 hours in one individual who caught it). So on first analysis, it might seem that the incubation period of my virus is too fast to make it a coxsackievirus B or echovirus. However, there are some enteroviruses which can incubate in 24 hours, such as enterovirus 70. 1 Might the virus described on this website be a newly-emerging recombinant enterovirus, combining the genes of say coxsackievirus B with a more rapidly incubating enterovirus? Research indicates that recombination events are common in the coxsackievirus B group. 1 Such a recombination could help explain why the incubation period of the virus described on this website is so remarkably fast.
Contagiousness: possible match. My virus is mildly contagious, and is transmitted from person-to-person via normal household or social contact, taking many months to a year before it transmits to everyone in the household. It will generally transmit when there is close contact such as kissing (especially French kissing), or when eating or drinking together (where spittle ejected from an infected person’s mouth may fall on another person’s food). The enteroviruses are generally easily passed from person-to-person via normal household contact, as they are spread by saliva and nasal secretions.
Organs and areas affected: strong match. Out of the various enteroviruses, a virus in the Coxsackie B group fits my symptoms particularly well, as coxsackievirus B often causes upper respiratory tract infection, gastrointestinal symptoms, significant neurological disease, persistent long-term infection, heart conditions, and systemic spread throughout the body — all of which have be precipitated by my virus. So regarding the organs and areas affected, we have strong match between the my virus, and enteroviruses. There are six serotypes within this coxsackievirus B group; these are coxsackievirus B1, B2, B3, B4, B5 and B6.
Muscle weakness in pelvic girdle: strong match. The virus described on this website can cause muscle weakness in the pelvic girdle and thighs (the lower proximal muscles). Proximal muscle weakness is the characteristic of the diseases of dermatomyositis and polymyositis, and these two chronic inflammatory myopathy diseases have been linked to group B coxsackieviruses (as well as parvovirus B19 infections, HIV and HTLV-I). Polymyositis and dermatomyositis generally affect the thighs and hips to begin with, but then progress to all the proximal muscles. So these pelvic and thigh muscle weakness symptoms may strongly match the symptoms known to be caused by enteroviruses such as coxsackievirus B.
Dermatomyositis is characterized by a heliotrope rash, a symptom myself and several other people with this virus display on the upper chest; thus along with my pelvic muscle weakness, my heliotrope rash tends to support the idea that the virus described on this website is causing something akin to a mild, benign version dermatomyositis.
Hearing loss and increased tinnitus: strong match. Quite a few elderly people (aged 70+) that caught my virus soon (within year or so) experienced sensorineural hearing loss, increased tinnitus, and sometimes even a mild loss of balance or dizzy spells. This little cluster of symptoms is actually a well-known syndrome called Meniere’s disease. Studies have found that coxsackievirus B5, influenza B virus, varicella zoster virus and herpes simplex virus are associated with these type of ear symptoms. 1 2 I myself noticed a loss in hearing acuity, after catching this virus. Greater age seems to predispose an individual to greater aural damage from this virus. So regarding the hearing loss and increased tinnitus symptoms, we have match between the symptoms produced by my virus and those produced by enteroviruses.
Chronic fatigue syndrome: strong match. What about the fact I developed chronic fatigue syndrome (ME/CFS) from my virus? The enteroviruses coxsackievirus B and echovirus have been strongly linked to chronic fatigue syndrome, 1 2 3 so the ME/CFS precipitated by my virus is a typical characteristic of enteroviruses.
Myocarditis, pericarditis and sudden heart attacks: strong match. In terms of the people who manifested myocarditis, pericarditis and sudden heart attacks after catching my virus, it is known that coxsackievirus B is a very common cause of all these conditions. So regarding these cardiological events precipitated by my virus, these strongly match the characteristic diseases caused by enteroviruses such as coxsackievirus B.
Immunosuppression: strong match. For the first two years after catching the virus described on this website, people tend to get more infections, such as fungal skin infections, urinary tract infections, ear infections, tooth infections, all generally requiring antibiotics or antimicrobials to clear. Now enteroviruses are known to cause immune suppression in the first two months after catching them: in the first two months CD8 cell counts can drop well below the normal range (down to around 100 per mm3, when the normal range is 150 to around 800), and there can sometimes also be significant decreases in CD3 and CD4 cell counts during these first two months. 1
So transient immunosuppression is normal for enteroviruses. In the case of the virus described on this website, judging by the increased number of mild opportunistic infections it gives rise to during the first two years of infection in many people, this immunosuppression may last longer than two months before it eases off; but nevertheless, this is more or less in keeping with the effects of enteroviruses.
In conclusion: nearly all clinical signs and symptoms of my virus closely match those produced by enteroviruses, strongly suggesting that my virus is an enterovirus of some type. Dr John Chia (a highly regarded infectious disease specialist and expert in enterovirus and chronic fatigue syndrome) has very generously taken the time to read my symptoms listed on this web site, and said my symptoms are consistent with a chronic enterovirus infection.
There are a number of difficulties in testing for the presence of enteroviruses in the body in the case of chronic infections. This is because in chronic enterovirus infections, very few viral particles are present in the blood or tissues, and so only very sensitive laboratory tests are able to detect these infections.
ARUP Lab micro-neutralization tests are the only blood tests that are sensitive enough to be able to detect the very low levels of enterovirus antibodies typically found in chronic, long-term infections. If you suspect you may have the virus described on this website, these ARUP Lab micro-neutralization tests are probably the best ones to take.
Dr John Chia found that this ARUP Lab micro-neutralization antibody test is highly sensitive and specific: the test is able to detect the very small quantities of enterovirus antibodies that are present in the blood in chronic enterovirus infections, and furthermore, this test will determine which specific coxsackievirus B serotypes you have (it tests for all 6 Coxsackie B viruses), and which specific echovirus serotypes you have (out of the 5 echoviruses tested). These tests can be ordered directly from ARUP or ordered through Labcorp (if ordered through Labcorp, write on the form to specifically send this test to ARUP). The ARUP Lab coxsackievirus B1 to B6 antibody test is here, and the ARUP Lab echovirus antibody test is here. These tests are expensive though, around $500 each.
The immunohistochemistry enterovirus test is a more sensitive (but unfortunately less specific) way of detecting chronic enterovirus infections. The immunohistochemistry test is more complicated, as it requires you to visit a gastroenterologist, who will place an endoscope down your throat to obtain a tissue sample from your stomach. The tissue sample is then tested for the presence of enterovirus VP1 protein. Dr John Chia has pioneered this approach for detecting chronic enterovirus infections in ME/CFS patients, and with this technique he has demonstrated the presence enteroviruses in the stomach tissues of 82% of ME/CFS patients (versus 20% of healthy subjects). This immunohistochemistry test can detect most types of enterovirus, and it is the most sensitive test of all, but it unfortunately does not determine the specific types of enteroviruses you have (whereas the ARUP micro-neutralization test does determine the specific types of enterovirus). The stomach biopsy immunohistochemistry enterovirus test provided by Dr Chia’s lab costs $250 (this excludes the fees of the gastroenterologist).
Polymerase Chain Reaction (PCR) is NOT sensitive enough to detect chronic enteroviral infections. Echoviruses are cleared quickly from the blood stream, so after the acute infection, there is not much chance of finding enteroviral RNA in the blood.
Taking an enterovirus CFT test (Complement Fixation Test) for chronic enterovirus infection is NOT appropriate. The enterovirus CFT test is fine for testing acute enterovirus infections (in the first 10 days of infections), but it is of no use whatsoever for chronic enterovirus infections, which are low level, hard-to-detect infections.
More details on the ARUP micro-neutralization test and the immunohistochemistry test can be found on the Enterovirus Foundation web site.
Details of possible antiviral treatments for enterovirus infections are given on the Treatments page. Unfortunately, though, enterovirus infections are very hard to treat, as there is a lack of good antiviral drugs for enteroviruses.