Dr. Amy Nett: Most often, I run a panel through Immunosciences. They have a viral panel. They have, like, Viral Panel Premier and Viral Panel Comprehensive. I normally run the Immunosciences panel. It includes EBV, HHV-6, HSV, and CMV. When I’m doing a more comprehensive chronic infection workup, I will expand that a little bit, and I also run mycoplasma, and I will sometimes include things like Q fever. I do sometimes do tick-borne illness. Again, that really depends on the clinical picture, and it’s not the first place I go.
If this is just kind of run-of-the-mill fatigue and I’m not wanting to bring tick-borne illness into the picture, I would probably include Epstein-Barr virus, cytomegalovirus, and HHV-6. There’s been some research at Stanford linking HHV-6 with chronic fatigue syndrome. Sometimes I do HSV-1 and HSV-2. That’s on the Immunosciences viral panel, and again, I might put mycoplasma in there. Even though it’s not on the Immunosciences panel, I’ll sometimes add it through LabCorp or Quest and get mycoplasma levels as well.
When I test depends a little bit on what the picture is. If a patient comes with a very strong predominant complaint of fatigue, I will sometimes run a viral panel with the initial stool test, SIBO breath test, and hormone profile. It’s very dependent on the clinical context. Most often, yes, it’s not in the first round of testing just because, for most people, I suspect we are going to find something to deal with on the stool test and the SIBO breath test, and you can generally only layer in so much treatment. So most often, yes, it could be after the initial stool test, but again, if the patient is just having fatigue, sleeping 10 to 12 hours a day, still not having their normal energy, then I’ll just run a viral panel. You can run the antibody titers through Quest or LabCorp, so that’s another consider. Depending on the patient’s insurance, it might be pretty well covered, in which case you almost might as well just run it. We get a basic blood panel—well, basic, but comprehensive blood panel—on all of our new patients, and so sometimes I’ll just add on the antibody titers, as well, to that initial panel since they’re already going to get blood drawn. Whether or not their insurance covers it is something else that might come into play.