Chronic Viral Infections

Viral infections are widespread. Our immune system is capable of fighting these viruses so resulting infections are often short term. However, there are a number of viruses which once into the body, the immune system is not capable of getting rid of them. Therefore, these viruses may flare up now and then causing recurrent symptoms. Most of these viruses belong to the Herpes group and include Herpes I, Herpes II, Epstein Barr Virus (EBV), and Cytomegalic Virus (CMV). There are other viruses that do not belong to this group but behave the same way. Toxoplasma Gondii is a protozoan (single cell parasite) which can also cause chronic recurrent symptoms.

1. We check four antibodies against EB Virus. Normally, all these antibodies should be less than 1:20. Depending on the pattern of these antibodies, a diagnosis of inactive infections (past infection) or recent or reactivation (chronic infection) is made. We will further elaborate on this point a little bit later.
2. CMV Titers are:
   * Normal = < .91 * Equivocal = .91 – 1.09 * Positive = > 1.09
   * High Positive = > 3.49
3. Rubella titers are: (normal less than 1).
4. Toxoplasma Gondii titers are:
   * Normal = < .91 * Equivocal = .91 – 1.09 * Positive = > 1.09
   * High Positive = > 3.49
5. Herpes Simplex: Herpes Simplex is of two types:
   1. Herpes Simplex Type I: This is involved in causing canker sores. Almost everyone is infected by it.
   2. Herpes Simplex Type II: This is involved in genital herpes.

Both these viruses closely resemble each other and can cross-react. Therefore, precaution is needed in interpreting the lab results. Here are the titers:

Herpes Simplex I & II titers:

* Normal = < .91 * Equivocal = .91 – 1.09 * Positive = > 1.09
* High Positive = > 3.49

Please note: If Herpes Simplex Type II titers are positive and if you did not have genital herpes, then this most probably represents cross reactivity.

Infections caused by these agents are worldwide and most of us had some or all of these infections sometime in the past. For a variety of reasons, the immune system is incapable of getting rid of these viruses. However, the most simple and straightforward reason is that after entering the body, these viruses immediately invade various cells and hide themselves inside the cell so they do not present themselves to the immune system. They sit there and do not reproduce, so nothing happens. They may stay there for a long period of time without any ill effects. However, if for any reason the cell is stimulated which forces the cell to divide, it causes the virus also to divide and reproduce. In such a situation, the virus multiplies at a rate much faster than the cell itself, so the virus is released from the cell into the bloodstream causing an episode of infection which results in flare-up of symptoms. As the virus enters the bloodstream, it causes the immune system to produce antibodies against the virus. Before the immune system has a chance to kill all the viruses, these go and invade more cells and hide themselves once again from the immune system. This process is infinite and goes on and on, continuously infecting more and more cells. As the virus goes into hiding again, the antibody response diminishes over a period of time leading to a pattern of inactivity (past infection).

In summary, during reactivation there is an evidence of active infection and during the inactive period there is evidence of past infection. This is what we had initially referred to as two different antibody patterns in relation to EB Virus. EB Virus is one of the most well-studied viruses. Therefore, if your EB Virus titers show past infection, all it means is that you did get the infection. In order to make a diagnosis of reactivation, one may need to do several blood tests during flare-ups to see if those symptoms are being caused by reactivation. Similarly, in other viruses during the inactive state, these antibody titers go down and increase during flare-ups.

EB Virus titers:
ANTIBODY NORMAL

1. IgG Anti-VCA LESS THAN 1:20
2. IgM Anti-VCA LESS THAN 1:20
3. Anti-EA LESS THAN 1:20
4. Anti-EBNA LESS THAN 1:20

EB Virus has a special preference for the lymph glands which play a very important role in our overall immunity. As more and more cells get infected, this can lead to weakening of the immune system. As a result of the weakened immune system, allergies to inhalants, foods, chemicals, Candida, etc. may get exacerbated. Some researchers feel that this provides a link between chronic viral infections and allergies.

Herpes virus has a special preference for the nerve cells. So flare-ups occur along the route of the nerve fibers. This is evidenced by recurrent canker sores in the mouth. As Herpes virus resides in the nerve cells, it has been implicated as a possible cause for headaches, including migraine headaches.

Here are some of the most common symptoms that are associated with chronic viral infections:

1. Chronic fatigue for which no other cause is found.
2. Recurrent sore throats with recurrent swollen glands in the neck.
3. Repeated flu-like symptoms–at times low grade temperature.
4. Liver and spleen disorders including enlargement of liver and spleen.
5. Blurred vision, inflammation of the iris and sensitivity to bright light.
6. Meniere’s Disease, dizziness, vertigo, balance problems, headaches.
7. Abnormal liver function tests without any obvious cause.
8. As some of these viruses invade the immune system, these should be suspected in any patient with severe allergy problems.
9. Arthralgia – non-specific joint aches and pains and muscle aches and pains.
10. Memory loss and inability to concentrate.
11. Various neurological disorders including temporary paralysis, numbness, sensitivity to heat and cold.
12. Various psychological complaints, especially anxiety, depression, sleep disorders, phobias, and mood changes.
13. History of infectious mononucleosis in earlier life. EB Virus causes infectious mononucleosis as a primary infection.
14. Recurrent canker sores (Herpes Virus I).
15. Recurrent genital sores (Herpes Virus II).
16. Polysymptomatic Multisystemic Disease–a wide variety of non-specific symptoms referred to many organs in the body for which no physical cause is found. Most common symptoms include nausea, diarrhea, chest pain, shortness of breath, irregular heartbeat, weight loss, swelling of eyelids and extremities, rashes, bladder problems, and intolerance to alcohol.

DIAGNOSIS

Blood tests give us a tentative diagnosis only (and at times we may have to repeat the tests several times to make such a diagnosis). However, the final diagnosis is made if you respond to the treatment.

CHRONIC VIRAL INFECTION

The role of these viruses in chronic illness has been brought to the attention of the medical community only in the past few years. We do not have all the answers. However, the following things have been found helpful in various combinations. The usual length of treatment is six months.

1. Antiviral Medicines:
   A. Symmetrel 100 mg per capsule
   B. Tagamet 800 mg per tablet – Tagamet is an anti-ulcer medicine which has been found to have antiviral properties.
   C. Flagyl 250 mg per tablet – Flagyl is used for Trichomonas infection but also has been found to have antiviral properties.
   D. Zovirax 200 mg per capsule
   A combination of two drugs is used — usually Symmetrel and Tagamet.
2. Build up the Immunity: For most of these viruses, no specific vaccine is available. However, two vaccines have been found to boost up the immunity.
   A. Flu Vaccine: Influenza virus resembles Herpes group of viruses. Therefore, flu vaccine can be given to build up the immunity and neutralize the symptoms. You need to be tested to find the neutralization dose. Flu vaccine can be taken either by subcutaneous (under the skin) injection once in four days or as sublingual (under the tongue) drops up to four times per day. Subcutaneous injections are preferred.

    

   These viruses have many different ways to escape the assault from the immune system. One of the ways is by the process of mutation. During flare-ups, they may change their structure a little bit and thus present themselves to the immune system as a new species for which there are no antibodies. By the time the immune system manufactures antibodies, these “newly mutated viruses” go and hide inside the cells. This may necessitate repeated testing to find new neutralization doses.

   B. Staph Lysate Vaccine: This vaccine is made from staphylococci and provides specific immunity against recurrent staphylococcal infections. However, this vaccine plays a very important role in boosting the immunity as a whole. Therefore, this may play a very important role in controlling chronic viral infections. Testing is done to determine the dose. The dose is taken once a week.

   C. MRV (Mixed respiratory vaccine): This consists of bacteria that commonly cause respiratory infections. This vaccine builds up the immunity against such bacteria, and, in addition, it is also a general immunity booster. Testing is done to determine the dose and the allergy technician will explain to you the dosage.

   PLEASE NOTE: For treatment purposes, we usually use a combination of all three vaccines, called Triple Vaccine. Sometimes we may use these vaccines individually.

   D. Rubella Vaccine: If your Rubella titers are elevated, you will be tested for Rubella vaccine. This is done by the neutralization method.

   E. Vitamin C: Vitamin C has strong antiviral properties. Vitamin C is available in the following forms:

3. Sodium Ascorbate . It is derived from corn. If you are allergic to corn, use Vitamin C derived from sago palm.
4. Buffered Vitamin C. This is derived from sago palm. This contains calcium, magnesium, and potassium.
5. Ascorbic Acid. This is also derived from sago palm. This is sour in taste.

During acute flare-up, the need for Vitamin C is increased. In this situation, you may need Vitamin C. The only side effect of large doses of Vitamin C is diarrhea.

F. Multivitamin and mineral preparation (without copper and iron).