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woensdag 28 december 2011

How to monitor chronic Epstein Barr infection?

Voor een wetenschappelijk betrouwbare diagnose en monitoring van de therapie van chronische virale infectie, zoals het Epstein-Barr virus, beveel ik de directe detectie (= antigeen-detectie in het bloed serum) aan.

Antibodies to several antigen complexes may be measured. These antigens are
- the viral capsid antigen,
- the early antigen,
- and the EBV nuclear antigen (EBNA).
- In addition, differentiation of immunoglobulin G and M subclasses to the viral capsid antigen can often be helpful for confirmation.

When the "mono spot" test is negative, the optimal combination of EBV serologic testing consists of the antibody titration of four markers: IgM and IgG to the viral capsid antigen, IgM to the early antigen, and antibody to EBNA.


vrijdag 23 december 2011

Glutathione levels in health and sickness

Indian J Med Sci. 2000 Feb;54(2):52-4.

Glutathione levels in health and sickness.


Departments of Biochemistry and Medicine, Pandit BD, Sharma PGIMS, Rohtak.


We speculate that the glutathione (GSH) status of human subjects could be an indicator of health and functional age. In this regard, in a study in which, 80 young and 40 elderly healthy individuals were selected as control. We also studied 145 patients with chronic illnesses namely, ischaemic heart disease, diabetes, preeclampsia, cataract, chronic renal failure and leukaemia (age 52 +/- 8.6 years). We observed that all the subjects had high malonadildehyde and low glutathione levels as compared to control. These early observations support the hypothesis that oxidative stress may have an important aetiological rule and antioxidants a potential therapeutic role.

It is very difficult to absorb glutathion via supplements (except IV) but you can raise its level with 8% just by consuming 2 brazil nuts a day. They are very high in natural selenium and this is necessary for the production of glutathion.

"As the integrity of the cellular and subcellular membranes depends heavily on glutathione peroxidase, the antioxidative protective system of glutathione peroxidase itself depends heavily on the presence of selenium."

Brazil nuts look like this:

donderdag 22 december 2011

Unexpected cardiac symptoms with cytomegalovirus CMV infection

Rowe and colleagues [11] described seven nonsyncopal adolescents presenting with fatigue an lightheadedness and demonstrated abnormal responses to upright tilt. They followed this work with a prospective, nonselected, nonblinded study confirming a strong association between neurally mediated hypotention and CFS [12]. An abnormal response to upright tilt was observed in 22 of 23 patients with CFS vs. four of 14 controls (P<.001). Open, nonblinded therapy directed at this abnormal reflex with fludrocortisone, B-adreniergic blocking agents and disopyramide appeared beneficial in this nonblinded trial. The authors concluded that neurally mediated hypotension is a cause of the symptoms of CFS or that it is strongly associated with another important etiologic factor.

We reported in 1993 that repetitively oscillating abnormal T-waves inversions and/or T-wave flats during 24-hour electrocardiogram (ECG) monitoring are present in patients with CFS, ECG abnormalities that are nonspecific but seen less frequently in non-CFs patients (P-<.01) [13]. Abnormal left ventricular myocardial dynamics are present in a cohort of patients with CFS. Decreased and /or flat ejection fractions with stress, , abnormal wall motion at rest and stress, dilatation of the left ventricle, and segmental wall motion abnormalities in CFS patients[14].

We now report a subset of CFS patients with (1) high human cytomegalovirus (HCMV) IgG enzyme-linked immunoassay antibody titers (ELISA), (2) minimal or no serologic evidence of concurrent EBV multiplication, and (3) oscillating ECG abnormalities at Holter monitoring. We performed a pilot study to assess the possible efficacy of ganciclovir, an antiviral nucleoside useful in the treatment of several HCMV infections in immunosuppressed patients.

... Mitral valve prolapse without significant mitral valve insufficiency does not cause abnormal T-wave oscillations at Holter monitoring [19]. As previously, 24-hour continuous ECGs were obtained using a mdified standard lead I and precordial lead V [13]. A patient's 24-h Holter monitor was considered flat, i.e., the T-waves were below the horizontal described by inceptions of p and Q waves in on the the two monitored lead with two or more episodes for at least 25.0 normally conducted QRS complexes. A uniformly flat T-wave were evaluated independent of possible ST segment changes. Biphasic T -wave were considered normal. U waves ( a small, shollow, positive, rounded delflection inscribed immediately after the T-wave) did not interfere with this analysis, Labile T- wave abnormalities at Holter monitoring were present in each CFS patient.

Validation of EI for the severity of the CFS:

Grade 0: Patients are confined to bed by number and severity of symptoms listed below.

Grades 1-2: Any activity leads to overwhelming, incapacitating fatigue. Patients are lightheaded, unable to think clearly, concentrate, or read for any extended period (over 60 minutes). Left-sided chest aches, palpitations, sore throats, and feverishness are frequent. Patients can be out of bed only for intermittent, brief parts of each day.

Grades 3-5: With great effort, patients can be out of bed and perform nonphysical activities for several hours each day. Any exertion markedly worsens fatigue. Patients variably express lightheadedness and inability to think clearly or read normally. Left-sided chest aches, palpitations, sore throats, and feverishness are frequent. Patients cannot perform a 40-hour a week sedentary job or maintain the duties of homemaker (e.g., cooking, cleaning, doing laundry, shopping, driving).

Grades 6-9: Patients can assume normal activities, maintain a 40-hour work week, and with pacing, maintain a household. Overwhelming fatigue is lessened. Rare-to-no lightheadedness, foggy thinking, chest aches, palpitations, feverishness, and sore throats are present. Patients can perform light physical work (or exercise) in moderation without fatigue.

Grade 10: Patients are well, with normal energy level, stamina, and sense of well-being. Exercise in moderation leads to an increased sense of well-being. Lightheadedness, difficulties in concentrating and reading ability, chest aches, palpitations, sore throats, and feverishness are absent.

After placement of a peripherally inserted central or Groshong catheter, ganciclovir (5 mg/kg q 12 h) was given intravenously for 30 days. ... After completion of ganciclovir, patients were encouraged to renew normal activities in gradual increments as tolerated. They were asked to not exercise until six months after completion of ganciclovir.

At the start of ganciclovir, the severity of fatigue (E1) in all patients was similar (e.g., 3, mean grade, group A vs. 2, mean grade, group B). Six months later, the energy indices diverged. Mean EIs were grade 7 and grade 4 for groups A and B, respectively (table 4). Before therapy with ganciclovir, n patient (group A or group B) could work or function normally (e.g., homemaker).
After treatment with ganciclovir, the 13 patients from group A, but no patient from group B, returned to his or her premorbid activity. A repeat measures analysis of the EI values between cohorts indicated that patients in group A had greater improvement than those in group B (P <.05).

Read the full report at:

How high are your Epstein Barr titers?

Uittreksel: Hoge titers van anti-VCA IgG en anti-EA IgG, kunnen indiatief zijn voor verhoogde EBV replicatie of reactivatie.

Extract: High titers of anti-VCA IgG and anti-EA IgG, can be indicative of increased EBV reactivation and replication.

Infectious causes for chronic fatigue

Do you have Epstein Barr (EBV), cytomagalovirus (CMV), HHV-6, mycoplasma, chlamydia pneumonia and/or borrelia burgdorferi (Lyme disease)?

Does your doctor say your blood doesn't show you have an active infection?

Maybe he is wrong! Recurrent infections don't trigger IgM antibodies because the infection is intracellular. A few weeks after the reactivation of the virus, the IgM antibodies will stop and be replaced by IgG. Most people have high IgG levels. Some people although have low IgG levels because of their dysfunctional immune system. The body is unable to protect itself.
PCR testing therefore is more appropriate in a research setting.

How does dr Lerner treat these patients? With antivirals mostly.

Let's say you have elevated IgG CMV titers :
a combination of oral Valtrex + intravenous ganciclovir = dramatic improvement

The document has more treatment protocols as well as references to studies.
Have a look at it and hand it over to your doctor. It may be the start of a new beginning!