Many thanks for posting this case history within our forum and for providing the relevant details of this boy’s health history. There are certainly a number of key events and things that may be relevant to his current state of less than ideal health and I hope that I can add to your own considerations for what may help him resolve his symptoms.
That this 12 yo boy tested positive to EBV in September is a strong indicator that this pervasive virus may be involved in his subsequent fatigue, aching joints and occasional headaches. EBV has been implicated as a cause or contributor to multiple symptoms but particularly fatigue.
Firstly, I will provide evidence of the connection with bacterial & viral infections and ITP. Then I will provide evidence of the connection between EBV & fatigue. Then I will make suggestions as to what to consider recommending in terms of therapeutic nutritional intervention, taking into account his C-section birth, the antibiotic courses he has had and the evident need for immune support.
Whilst this boy does not necessarily have H. pylori, and this may be something to rule out, it serves as part of a point of principle that ITP and H. pylori have long been associated. ITP has long been (since the late 1980s) associated with infectious agents. In fact, in Japan since 2010, the treatment of H. pylori has been an approved treatment for the management of ITP.
Tomiyama Y. Management of adult primary immune thrombocytopenia based on Japanese clinical guides. [Article in Japanese] Rinsho Ketsueki. 2017;58(7):843-848. doi: 10.11406/rinketsu.58.843. View abstract
Much work in Japan and Korea, for example, has been done on investigating the cause or contribution that H. pylori has with ITP, and many different groups have studied this.
K Fujimura et al. Is eradication therapy useful as the first line of treatment in Helicobacter pylori-positive idiopathic thrombocytopenic purpura? Analysis of 207 eradicated chronic ITP cases in Japan. Int J Hematol, Feb 2005; 81(2): 162-8. View abstract
K Kaptan and C Beyan. Is induction of platelet recovery related to correction of cobalamin deficiency due to Helicobacter pylori eradication in ITP? Am J Hematol, Oct 2005; 80(2): 168. Letter – View Letter
Zhaoyue Wang, Yanyan Bai, Xia Bai, Wei Zhang, and Changgeng Ruan. Cross Reaction of Antibody Against Helicobacter Pylori Urease B with Platelet Glycoprotein IIIa and Its Significance in the Pathogenesis of ITP. Blood (ASH Annual Meeting Abstracts), Nov 2006; 108: 1084. View abstract
Jang JH et al. Correlation between Helicobacter Pylori Eradication and Platelet Count in Immune Thrombocytopenic Purpura (ITP). Blood (ASH Annual Meeting Abstracts), Nov 2005; 106: 4003.
It is not just H. pylori that is connected with ITP, but also viruses, including the chicken pox virus, varicella zoster).
Takeoka Y et al. Virus-associated hemophagocytic syndrome due to rubella virus and varicella-zoster virus dual infection in patient with adult idiopathic thrombocytopenic purpura. Ann Hematol. 2001 Jun;80(6):361-4. View abstract
“These data provide evidence that virus-specific antibodies occurring in children with varicella-associated acute ITP cross-react with normal platelet antigens, and may contribute to platelet clearance.”
Wright JF et al. Characterization of platelet-reactive antibodies in children with varicella-associated acute immune thrombocytopenic purpura (ITP). Br J Haematol. 1996 Oct;95(1):145-52. View abstract
Herpes group viruses connection with ITP
EBV, a member of the herpes group of viruses, is also implicated in the development of Idiopathic Thrombocytopaenic Purpura (ITP) which then may become Immune Thrombocytopaenic Purpura. It is noted that the chicken pox virus, varicella zoster:
“Seventy-four sera from patients with serological diagnosis of herpes group viral infections comprising 10 cases of cytomegalovirus, nine cases of varicella or zoster, six cases of herpes simplex and four cases of Epstein-Barr virus were examined for the presence of anti-platelet antibodies. Except for two patients with varicella and zoster and one patient with rubella infection, all cases examined showed positive titres of anti-platelet antibodies.”
Kahane S et al. Detection of anti-platelet antibodies in patients with idiopathic thrombocytopenic purpura (ITP) and in patients with rubella and herpes group viral infections. Clin Exp Immunol. 1981 Apr;44(1):49-56. View Full Paper
“Sudden and severe onset of thrombocytopenia has been observed in children after vaccination for measles, mumps, and rubella or natural viral infections, including Epstein-Barr virus, cytomegalovirus, and varicella zoster virus.”
Cines DB, Liebman H, Stasi R. Pathobiology of secondary immune thrombocytopenia. Semin Hematol. 2009 Jan;46(1 Suppl 2):S2-14. doi: 10.1053/j.seminhematol.2008.12.005. View Full Paper
EBV & Fatigue
It is well documented that EBV can lead to mononucleosis, also known as glandular fever, from which chronic fatigue (CFS) can then develop, and aching joints & headaches are part of the symptom profile of CFS.
Dunmire SK, Hogquist KA, Balfour HH. Infectious Mononucleosis. Curr Top Microbiol Immunol. 2015;390(Pt 1):211-40. doi: 10.1007/978-3-319-22822-8_9. View Full Paper
This study below, although assessing the connection of BMI with the duration of the condition of CFS, confirmed that 66% of those tested were positive to EBV.
Petrov D, Marchalik D, Sosin M, Bal A. Factors affecting duration of chronic fatigue syndrome in pediatric patients. Indian J Pediatr. 2012 Jan;79(1):52-5. doi: 10.1007/s12098-011-0463-4. Epub 2011 May 27. View abstract
This research shows how a long term viral infection of EBV can upset immune reactivity, promoting inflammation and leading to the chronic condition of CFS. This suggests a need to support innate immunity & reduce immunity is going to be an integral part of a healing programme.
Agliari E, Barra A, Vidal KG, Guerra F. Can persistent Epstein-Barr virus infection induce chronic fatigue syndrome as a Pavlov reflex of the immune response? J Biol Dyn. 2012;6:740-62. doi: 10.1080/17513758.2012.704083. View abstract
For a balanced perspective, it is also true that multiple previous studies have sought evidence for ongoing, active infection with, or reactivation of, Herpesviruses in patients with chronic fatigue syndrome (CFS), with conflicting results.
Cameron B et al. Serological and virological investigation of the role of the herpesviruses EBV, CMV and HHV-6 in post-infective fatigue syndrome. J Med Virol. 2010 Oct;82(10):1684-8. doi: 10.1002/jmv.21873. View abstract
However, in my own clinical experience with patients, numbering in the hundreds, who have had CFS, I have found that as part of an overall immune supportive nutritional intervention programme, that an anti-viral component has been a key. In this case with this young lad, there is also recent evidence of a positive EBV finding, therefore strengthening the case to engage in an anti-viral programme.
With a history of his C-section, then the ITP being triggered (if not mediated or caused) by the chicken pox virus, and then the antibiotics likely upsetting his gut microbiotia and with the low vitamin D (like so much of the UK population), and then the EBV positive test in September, it is clear that immune support is also warranted, along with appropriate gut bacteria, as well as ensuring that inflammation is being kept in check.
Mitochondria are affected in almost all human health conditions, but they are certainly worthy of attention in terms of energy production in fatigue conditions. However, given this scenario you describe, I wonder if this is not premature to focus on the mitochondria compared to supporting immunity, inhibiting viral expression and reducing inflammation. For me, this sequence appears appropriate. This is not to say that mitochondrial support is not going to be warranted, and there may be other benefits to those nutrients not just on or within the mitochondria.
In the past 7 years in particular, I have focused on addressing viral burdens within patients who have a variety of conditions but in particular CFS and auto-immune conditions. I have not used high dose vitamin C in any of these folk, so I cannot say that it would or would not be of benefit in these patients. However, in the many years of practice before that, commencing in 1992, I found that the frequently recommended high dose vitamin C was not effective for what I was hoping for; namely, a stronger immune response against infections. I found that other remedies achieved improved outcomes compared to those taking oral vitamin C.
However, intravenous vitamin C (IVC) has been shown to be beneficial for those with EBV, as this 2014 paper shows.
“The clinical study of ascorbic acid and EBV infection showed the reduction in EBV EA IgG and EBV VCA IgM antibody levels over time during IVC therapy that is consistent with observations from the literature that millimolar levels of ascorbate hinder viral infection and replication in vitro”.
Mikirova N, Hunninghake R. Effect of high dose vitamin C on Epstein-Barr viral infection. Med Sci Monit. 2014 May 3;20:725-32. doi: 10.12659/MSM.890423. View Full Paper
Given that the boy is not likely to be able to access IVC, then there may be benefits to a newly available form of vitamin C which is in liposomal delivery form. However, even in the liposomal delivery form, it is still not going to achieve what the IVC did in terms of blood levels of vitamin C, as is shown by this study.
Davis JL et al. Liposomal-encapsulated Ascorbic Acid: Influence on Vitamin C Bioavailability and Capacity to Protect Against Ischemia-Reperfusion Injury. Nutr Metab Insights. 2016 Jun 20;9:25-30. doi: 10.4137/NMI.S39764. eCollection 2016. View Full Paper
Nonetheless, this liposomal form of vitamin C may be worth including in an overall programme, and is included in the suggestions below.
I have included below an anti-viral supplement, an anti-inflammatory supplement, something for his gut bacteria and gut lining and mucosal immunity.
Lastly, do consider ruling out an H. pylori infection, albeit that his ITP appears to be stable.
The following supplements are suggested for you to consider in light of your relevant expertise and intimate understanding of the needs of your client or patient. It is not intended for them all to be taken, but rather just those that you select. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.
Humic Acid (ARG) – 1 with breakfast & dinner – http://tinyurl.com/lmj7lu7
CurcumRx® (BRC) – 1 with breakfast & dinner – http://tinyurl.com/yc3yqfwu
Probiotics, mucosal immune support, gut lining support and inflammation controlling
Lactobacillus Plantarum, Rhamnosus, Salivarius (ARG) – 2 with breakfast & 2 with dinner – http://tinyurl.com/z9g65f2
S. Boulardii (ARG) – 1 with breakfast & 1 with dinner – http://tinyurl.com/z27sdwn
Well absorbed Vit C
Micro-Liposomal C (ARG) – 5 ml 20 mins before two meals – http://tinyurl.com/yap4p76z
If on re-testing the level of vitamin D is not optimal, then consider this emulsified, well absorbed vit D
Bio-D-Mulsion Forte (BRC) – 2-3 drops a day with dinner – http://tinyurl.com/hbdjlfn
If vitamin D is optimal, then this mix of fat-soluble vitamins is recommended:
Vitamin D3 Complete (ARG) – 1 with dinner – http://tinyurl.com/jqx3ttt
Please consider these suggestions in light of the other clinical information pertaining to this individual. If you have any more information about the specific problems this individual is experiencing, further refinement of these suggestions may be considered. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.
I do hope that this information helps you to support this boy, and that he recovers from his fatigue, aches and headaches as soon as is possible (which may take a short while). Do let us know how he gets on, with thanks
Registered Nutritional Therapist Helen Perks is collaborating with Clinical Education to bring you the first-ever Functional Medicine book club for Practitioners.
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