title: Acute enterovirus infection followed by myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and viral persistence.
abstract: OBJECTIVE
  Enteroviruses are well-known causes of acute respiratory and/or gastrointestinal infections and non-specific flu-like illness. Although enterovirus protein, RNA and non-cytopathic viruses have been demonstrated in the stomach biopsies of patients with myalgia encephalomyelitis/chronic fatigue syndrome (ME/CFS), causality for chronic diseases is difficult to establish without having well-documented cases of acute enterovirus infections. The aim of this study was to link acute enteroviral infection to viral persistence in patients with ME/CFS.
  
  
  METHODS
  Patients admitted to the hospital with acute febrile illnesses were screened for enteroviral infections. Acutely infected patients were followed longitudinally, and those who developed symptoms of ME/CFS underwent oesophagogastroduodenoscopy and biopsies of the antrum to document viral persistence by immunoperoxidase staining for viral protein and viral RNA assay.
  
  
  RESULTS
  Three representative patients with different manifestations of acute enterovirus infections progressed to have chronic symptoms of ME/CFS. Persistent viral infection was demonstrated in the antrum years later.
  
  
  CONCLUSIONS
  After acute infections, enteroviruses can persist in patients resulting in manifestation of ME/CFS. Chronic enterovirus infection in an immunocompetent host may be an example of a stalemate between attenuated, intracellular viruses and an ineffective immune response.
authors.affiliation: EV Med Research, Torrance, California, USA. evmed@sbcglobal.net
authors.forename: J
authors.initials: J
authors.lastname: Chia
authors.forename: A
authors.initials: A
authors.lastname: Chia
authors.forename: M
authors.initials: M
authors.lastname: Voeller
authors.forename: T
authors.initials: T
authors.lastname: Lee
authors.forename: R
authors.initials: R
authors.lastname: Chang
mesh_terms: D000208:Acute Disease; D000328:Adult; D004770:Enterovirus / Q000302:isolation & purification; D004769:Enterovirus Infections / Q000150:complications* / Q000473:pathology / Q000821:virology; D015673:Fatigue Syndrome, Chronic / Q000473:pathology / Q000821:virology*; D005260:Female; D006801:Humans; D008297:Male; D012367:RNA, Viral / Q000032:analysis; D013270:Stomach / Q000821:virology; D055815:Young Adult
chemical_list: D012367:RNA, Viral