Dr. Lerner's Testing Protocol

Dr. Lerner's Testing Protocol

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Martin Lerner
From the Website:

[/fright]After nearly 20 years in academia, Dr. Lerner began an Internal Medicine and Infectious diseases practice in 1982. His background was Infectious Diseases, particularly viral diseases, and he was aware of virus induced heart disease, having studied this in his university research.

Soon after beginning his practice, Dr. Lerner noticed that the symptoms of CFS resembled a prolonged infectious mononucleosis. Infectious mononucleosis may be caused by one of two herpesviruses: the Epstein-Barr virus (EBV) or the Human Cytomegalovirus (HCMV). These two mononucleosis syndromes are self-limited; that is, patients recover.

Dr. Lerner began to question… Could the Chronic Fatigue Syndrome be a prolonged mononucleosis syndrome? There isn’t anyone who has any kind of a heart condition who isn’t fatigued. Could the Chronic Fatigue Syndrome also involve the heart?
Initial patient overview:

Complete history, physical examination, chest X-ray, electrocardiogram, complete blood count, urinalysis, serum aspartate and aminotransferases (AST, ALT), glucose, thyroid stimulating hormone, sodium, potassium, uric acid, alkaline phosphatase and creatinine measurements were performed.

CFS analysis:
  • Energy Index Point Score® assessing physical functional capacity in activities of daily life documenting limitations
Cardiac testing:
  • 24-hour Holter monitor - symptoms recorded (syncope, chest pain, palpitations, muscle aches)
  • Standard 12-lead resting electrocardiogram
  • Rest/stress myocardial perfusion study
  • Multigated (radionuclide) MUGA rest/stress ventriculographic examination
Viral testing for EBV, HCMV, HHV6:
  • EBV serum IgM viral capsid antibodies (VCA) - Diasorin, Inc., Stillwater, MN
  • EBV early antigen diffuse (EA) - Diasorin, Inc., Stillwater, MN
  • ELISA HCMV(V) IgG and IgM serum antibodies to viral capsid, strain 169 HCMV - Diasorin, Inc., Stillwater, MN
  • HHV6 IgM and IgG serum - Lab Corp, Dublin, OH
Co-infection testing:
  • ELISA and Western blot to Borrelia burgdorferi (IgM and IgG) - Lab Corp, Dublin, OH
  • IgM and IgG of Babesia microti - Lab Corp, Dublin, OH
  • IgM and IgG of Anaplasma phagocytophila - Lab Corp, Dublin, OH
  • IgM and IgG of Mycoplasma pneumoniae - Lab Corp, Dublin, OH
  • Anti-streptolysin O (ASO) titer <400 units - Lab Corp, Dublin, OH
  • Every 4-6 weeks - Complete blood counts, sodium, potassium, AST, ALT, alkaline phosphatase, creatinine and urinalysis.
  • Every 3 months – Serum assays for EBV VCA IgM, EBV EA, HCMV(V) IgM and IgG, HHV6 IgM and IgG

Source: Lerner AM, Beqaj SH, Deeter RG, Fitzgerald JT. Valacyclovir treatment in Epstein-Barr virus subset chronic fatigue syndrome: thirty-six months follow-up. In Vivo. 2007 Sep-Oct;21(5):707-13.
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