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Objective: To detect and characterise enterovirus RNA in skeletal muscle from patients with chronic fatigue syndrome (CFS) and to compare efficiency of muscle energy metabolism in enterovirus positive and negative CFS patients. Methods: Quadriceps muscle biopsy samples from 48 patients with CFS were processed to detect enterovirus RNA by two stage, reverse transcription, nested polymerase chain reaction (RT-NPCR), using enterovirus group specific primer sets. Direct nucleotide sequencing of PCR products was used to characterise the enterovirus. Controls were 29 subjects with normal muscles. On the day of biopsy, each CFS patient undertook a subanaerobic threshold exercise test (SATET). Venous plasma lactate was measured immediately before and after exercise, and 30 minutes after testing. An abnormal lactate response to exercise (SATET+) was defined as an exercise test in which plasma lactate exceeded the upper 99% confidence limits for normal sedentary controls at two or more time points. Results: Muscle biopsy samples from 20.8% of the CFS patients were positive for enterovirus sequences by RT-NPCR, while all the 29 control samples were negative; 58.3% of the CFS patients had a SATET+ response. Nine of the 10 enterovirus positive cases were among the 28 SATET+ patients (32.1%), compared with only one (5%) of the 20 SATET- patients. PCR products were most closely related to coxsackie B virus. Conclusions: There is an association between abnormal lactate response to exercise, reflecting impaired muscle energy metabolism, and the presence of enterovirus sequences in muscle in a proportion of CFS patients.

The possible risks of infection associated with the practice of licking envelopes, stamps and labels were investigated. Although pathogenic bacteria and viruses were not isolated from sample envelopes obtained from various sources, the gums used in manufacture were found to exert a protective effect against death from desiccation on the bacteria and viruses which had been introduced into them.Staph. aureus and Salm. paratyphi Bremained viable for several months in dried films of two out of four gums tested. An echovirus could be recovered from similar films for up to 30 days, and an adenovirus for up to 10 days.Bacterial multiplication occurred in the gum used for the manufacture of postage stamps. The comparison is drawn between the possible consequences of minimal contamination of this gum and of cans of corned beef in the light of recent studies.