Stomach Virus a Culprit in Chronic Fatigue Syndrome
THURSDAY, Sept. 13 -- A father's concern for his son led to research that now sheds new light on a disease that has long been shrouded in mystery.
Andrew Chia, now 24, was diagnosed with debilitating chronic fatigue syndrome in 1997.
This week he is co-author with his father, Dr. John Chia, of a study which links chronic fatigue syndrome (CFS) with enteroviruses, which cause acute respiratory and gastrointestinal infections.
"This is sort of a new beginning. Now we can have development of antiviral drugs," said the elder Chia, an infectious disease specialist in private practice in Torrance, Calif. "We don't have anything for these poor people, although we've tried a number of things. Now we can study how these viruses behave and how we can kill them."
"Dr. Chia's data was on a substantial number of patients," said Dr. Nancy Klimas, a professor of medicine at the University of Miami Miller School of Medicine and director of the Gulf War Illness Center at the VA Medical Center. "This could send the field in a new direction."
The findings are published in the Sept. 13 online issue of the Journal of Clinical Pathology.
More than 1 million people in the United States are estimated to suffer from CFS, costing the nation some $9 billion annually. The condition is more common in women aged 40 to 60 and is marked by a cluster of debilitating symptoms, including unexplained fatigue, problems sleeping, problems with memory and concentration, and pain. CFS can be as disabling as multiple sclerosis.
The illness was first recognized in the late 1980s and, initially dubbed the "yuppie flu," has suffered from a credibility crisis. The causes of chronic fatigue syndrome (CFS) remain unclear.
Several different viruses, including Epstein-Barr virus, cytomegalovirus and parvovirus have been implicated, along with enteroviruses. There are more than 70 different types of enteroviruses that can affect the central nervous system, heart and muscles, all of which is consistent with the symptoms of CFS.
It was, however, difficult to find definitive proof of the viruses' presence. "That's how we judge a disease, if it causes organ damage or death, then it's a real disease," Chia said. "But if it doesn't show up, it doesn't mean it's not there."
Chia started on a Herculean task of drawing some 3,000 blood samples from patients, looking for viral genes. Over a period of five to six years, he found evidence of enteroviruses in 35 percent of patients, but this was after multiple samples from each patient. "If we were to take one sample from each patient, it would be less than 5 percent," Chia said. "We realized this wasn't the way to look at it. The assumption we made about CFS that we have to find the virus in their blood is totally wrong, so we started looking for the viruses in tissue, meat."
A team of European investigators had found enteroviruses in the brain, muscle and heart of a CFS patient who had committed suicide. But brain and heart biopsies are virtually impossible to perform in living people.
Chia started looking in the viruses' "area of replication," meaning the stomach. The viruses are resistant to stomach acids.
They eventually took stomach biopsies and performed endoscopies on 165 CFS patients, all of whom had had longstanding gastrointestinal complaints (these are common in CFS patients).
Eighty-two percent of the specimens from CFS patients tested positive for enteroviral particles, compared with just 20 percent of the samples from healthy people. In many patients, the initial infection had taken place years earlier (up to 20 years).
Partly, Chia's work was possible because of technological breakthroughs, Klimas pointed out. He also looked in the right "compartment."
"People were busy looking in the bloodstream, but he looked in the gut. He looked in the right compartment and, lo and behold, he found the viruses," she said. "It depends where you look, what you see."
Chia believes that enteroviruses may cause half of cases of CFS. The disease can also be triggered by other infections.
"It makes sense to me as an infectious disease. This makes all the sense in the world," he said. "If this is a virus, it doesn't destroy the cells, it hides inside the cells. It's one smart little virus."
Chia's son has recovered from the disease although, the elder Chia reported, "he spent a lot of time in the laboratory. Without him, I would not have done this."
For more on chronic fatigue syndrome, visit the CFIDS Association of America.
Posted: September 2007
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