It was, however, difficult to find definitive proof of the viruses' presence. "That's how we judge a disease, if it causes organ damage or death, then it's a real disease," Chia said. "But if it doesn't show up, it doesn't mean it's not there."
Chia started on a Herculean task of drawing some 3,000 blood samples from patients, looking for viral genes. Over a period of five to six years, he found evidence of enteroviruses in 35 percent of patients, but this was after multiple samples from each patient. "If we were to take one sample from each patient, it would be less than 5 percent," Chia said. "We realized this wasn't the way to look at it. The assumption we made about CFS that we have to find the virus in their blood is totally wrong, so we started looking for the viruses in tissue, meat."
A team of European investigators had found enteroviruses in the brain, muscle and heart of a CFS patient who had committed suicide. But brain and heart biopsies are virtually impossible to perform in living people.
Chia started looking in the viruses' "area of replication," meaning the stomach. The viruses are resistant to stomach acids.
They eventually took stomach biopsies and performed endoscopies on 165 CFS patients, all of whom had had longstanding gastrointestinal complaints (these are common in CFS patients).
Eighty-two percent of the specimens from CFS patients tested positive for enteroviral particles, compared with just 20 percent of the samples from healthy people. In many patients, the initial infection had taken place years earlier (up to 20 years).
Partly, Chia's work was possible because of technological breakthroughs, Klimas pointed out. He also looked in the right "compartment."
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