Human enteroviral infection in fibromyalgia: a case-control blinded study, 2022, Armin Schwarzbach et al

https://www.scielo.br/j/ramb/a/XWwZ6scXv4C6VW6GTMgTzFN/?lang=en

Human enteroviral infection in fibromyalgia: a case-control blinded study

Basant K. Puri
Gary S. Lee
Armin Schwarzbach

SUMMARY
OBJECTIVE:
This study aimed to test the hypothesis that fibromyalgia is associated with a human enteroviral infection.

METHODS:
Venous peripheral blood samples from 27 patients fulfilling the American College of Rheumatology revised diagnostic criteria for fibromyalgia and from 26 age- and sex-matched controls, who underwent immunofluorescence assays for coxsackievirus A7 IgG, coxsackievirus B1 IgG, coxsackievirus A7 IgA, coxsackievirus B1 IgA, echovirus IgG, and echovirus IgA. These immunological tests were performed blind to group status.

RESULTS:
There were no significant differences between the patient and control groups in respect of positive results for coxsackievirus A7 IgG (p=0.467), coxsackievirus B1 IgG (p=0.491), coxsackievirus A7 IgA (p=0.586), coxsackievirus B1 IgA (p=0.467), echovirus IgG (p=0.236), and echovirus IgA (p=1).

CONCLUSIONS:
The results of this systematic study do not support the hypothesis that fibromyalgia is associated with infection by a human enterovirus.

KEYWORDS:
Coxsackievirus; Echovirus; Fibromyalgia; Human enterovirus; Immunofluorescence

 

Armin Schwarzbach runs Armin labs, an alternative/private laboratory which seems associated with people with ME/CFS getting re-diagnosed with Lyme Borrelia or other tickborne or other infections.

I am suspicious about the specificity of the tests for infections there. It would be interesting to see similar testing of controls for other infections there.


Sample: Venous peripheral blood samples from 27 patients fulfilling the American College of Rheumatology revised diagnostic criteria for fibromyalgia and from 26 age- and sex-matched controls

 

The authors note in the discussion:

"As seen in Table 1, relatively high levels of positive results were found in the control group, as follows: coxsackievirus A7 IgG in 88%, coxsackievirus B1 IgG in 100%, coxsackievirus A7 IgA in 58%, coxsackievirus B1 IgA in 88%, echovirus IgG in 100%, and echovirus IgA in 73%. It is noteworthy that coxsackievirus B1 infection has been found to be associated with a wide range of diseases14–16. Coxsackievirus A7 is associated with neurological diseases and can cause paralytic poliomyelitis17. In a recently published analysis of 153 worldwide epidemiological studies, the weighted median prevalence in Europe of all enteroviruses examined, which included, but was not limited to, coxsackievirus A7, coxsackievirus B1, and echovirus, was well under 10%, as was the median prevalence of enteroviruses in those at least 18 years of age18. The much higher prevalence figures in our cohort of healthy adult volunteers are difficult to explain."

So it seems they need to figure out why their results are so high for both patients and controls before they can reliably reach any kind of conclusion about FM. That they evidently chose to just publish this instead of figuring out what was going on might explain why it's published in a journal that does not look very selective.

 

It sounds like they are not sure whether enterovirus is the cause of anything, since it is very prevalent in healthy controls as well. The conclusion should be: "don't buy our tests, we have no clue what we're doing"

 

I should probably have included that I think this lab in Germany is the primary lab people in Ireland use when unhappy with conventional testing for Lyme disease and/or other tickborne infections; it could be the same for people in the UK and some other European countries too.

He gets invited to give talks here by the main tickborne illness patient group.
An example of one is "Lyme Disease and Multiple Chronic Infections: Triggering ME, CFS, MS, RA, Fibromyalgia, Alzheimer, Parkinsonism, Autism, Cancer etc?" - see: https://www.ticktalkireland.org/tick-talk-ireland-past-events/

 

how can this be?

 

The problem with this sort of study is apparent with only a few minutes thought. No one is saying that all enteroviral infections lead to fibromyalgia so counting infections is useless and concluding that they are not involved is even worse.

Measles can cause measles encephalitis. Concluding that it doesn't because a group of healthy controls had measles as well highlights the problem.

There is a case for looking to see if a disease is caused by a unique virus, like HIV and AIDS but many diseases are caused by abnormal consequences of common infections so the approach used by this study is the wrong one.