title: Chronic fatigue syndrome is associated with chronic enterovirus infection of the stomach.
abstract: OBJECTIVE
  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 (p< or =0.001). 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: EV Med Research, Lomita, California 90717, USA. evmed@sbcglobal.net
authors.forename: J K S
authors.initials: JK
authors.lastname: Chia
authors.forename: A Y
authors.initials: AY
authors.lastname: Chia
mesh_terms: D036022:Capsid Proteins / Q000032:analysis; D002908:Chronic Disease; D004770:Enterovirus / Q000235:genetics / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000150:complications*; D015673:Fatigue Syndrome, Chronic / Q000821:virology*; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D012367:RNA, Viral / Q000032:analysis; D013272:Stomach Diseases / Q000150:complications* / Q000821:virology; D046509:Tissue Culture Techniques
chemical_list: D036022:Capsid Proteins; D012367:RNA, Viral