 |
 |
 |
 |
|
 |
 |
7
Most of the biopsy specimens from patients with gut problems showed evidence of mild long
term inflammation, although few were infected with Helicobacter pylori, a common bacterial
infection associated with inflammation.
But more than 80% of the specimens from the ME patients tested positive for enteroviral
particles compared with only seven of the 34 specimens from healthy people.
In a significant proportion of patients, the initial infection had occurred many years earlier.
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 ex-
tracted 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(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.
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.
*
See article by Craig Woods on page 9
 |