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Coxsackie B virus
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== Chronic infection == {{Main article| page_name=Non-cytolytic enterovirus}}Coxsackievirus B is able to establish a chronic intracellular [[Non-cytolytic enterovirus|non-cytolytic infection]] which can persist for years. Non-cytolytic enterovirus infection does not involve the destruction of infected cells. Non-cytolytic infection is difficult to measure in the serum as viral particles remain in the cell membranes of tissues. The molecular mechanisms of non-cytolytic infection were examined in a small study comparing [[#Coxsackie B2|Coxsackie B2]] virus cultured ''in vitro'' to RNA extracted via [[muscle biopsy]] from eight patients with a [[chronic fatigue syndrome]] diagnosis. All patients had symptoms of [[muscle fatiguability]]. Four of these samples tested positive for enteroviral RNA. In all four patients with enteroviral-specific RNA, the enteroviral RNA had equal amounts of [[positive sense]] and [[negative sense]] RNA. By contrast, CVB2 virus in culture produced positive sense RNA at a ratio of 100:1. An equal ratio of positive to negative sense RNA would inhibit the translation of virus-specific gene products, explaining the failure to attract a response from the host [[immune system]], and might account for how CVB2 could establish a persistent infection in these four patients.<ref>{{Cite journal | last = Cunningham|first = Louise | date = 1990 | title = Persistence of enteroviral RNA in chronic fatigue syndrome is associated with the abnormal production of equal amounts of positive and negative strands of enteroviral RNA | url = http://jgv.microbiologyresearch.org/content/journal/jgv/10.1099/0022-1317-71-6-1399|journal=Journal of General Virology|volume=71 | pages = 1399-1402|via=}}</ref> Models of persistent infection of the heart<ref>Chapman N.M., Kim K.S. (2008) Persistent Coxsackievirus Infection: Enterovirus Persistence in Chronic Myocarditis and Dilated Cardiomyopathy. In: Tracy S., Oberste M.S., Drescher K.M. (eds) Group B Coxsackieviruses. Current Topics in Microbiology and Immunology, vol 323. Springer, Berlin, Heidelberg</ref> and brain<ref>{{Cite journal | last = Feuer | first = Ralph | date = September 2009 | title = Viral Persistence and Chronic Immunopathology in the Adult Central Nervous System following Coxsackievirus Infection during the Neonatal Period | url =http://jvi.asm.org/content/83/18/9356.short|journal=Journal of Virology|volume=83 | pages = 9356-9369|via=}}</ref> have also been studied in mice and in [[thyroid carcinoma]].
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