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Test ID: SEBV    
Epstein-Barr Virus (EBV) Antibody Profile, Serum

Useful For Suggests clinical disorders or settings where the test may be helpful

Diagnosing infectious mononucleosis when a mononucleosis screening procedure is negative and infectious mononucleosis or a complication of Epstein-Barr virus infection is suspected

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Epstein-Barr virus (EBV), a member of the herpesvirus group, is the etiologic agent of infectious mononucleosis. EBV infections are difficult to diagnose in the laboratory since the virus does not grow in standard cell cultures. The majority of infections can be recognized, however, by testing the patient's serum for heterophile antibodies (rapid latex slide agglutination test; eg, MONOS / Infectious Mononucleosis, Rapid Test, Serum), which usually appear within the first 3 weeks of illness, but then decline rapidly within a few weeks. The heterophile antibody, however, fails to develop in about 10% of adults, more frequently in children, and almost uniformly in infants with primary EBV infections. Most of these heterophile antibody-negative cases of infectious mononucleosis-like infections are due to cytomegalovirus, but in a series of 43 cases, EBV was the cause in 7. In cases where EBV is suspected but the heterophile antibody is not detected, an evaluation of the EBV-specific antibody profile (eg, EBV viral capsid antigen [VCA] IgM, EBV VCA IgG, and EBV nuclear antigen [EBNA]) may be useful.

 

Infection with EBV usually occurs early in life. For several weeks to months after acute onset of the infection, it is spread by upper respiratory secretions that contain the virus. Among the clinical disorders due to EBV infection, infectious mononucleosis is the most common. Other disorders due to EBV infection have been recognized for several years, including African-type Burkitt lymphoma and nasopharyngeal carcinoma. EBV infection may also cause lymphoproliferative syndromes, especially in patients who have undergone renal or bone marrow transplantation and in those who have AIDS.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

Epstein-Barr Virus (EBV) VIRAL CAPSID ANTIGEN (VCA) IgM ANTIBODY

Negative

 

Epstein-Barr Virus (EBV) VIRAL CAPSID ANTIGEN (VCA) IgG ANTIBODY

Negative

 

EPSTEIN-BARR NUCLEAR ANTIGEN (EBNA) ANTIBODIES

Negative

Interpretation Provides information to assist in interpretation of the test results

The test has 3 components: viral capsid antigen (VCA) IgG, VCA IgM, and Epstein-Barr nuclear antigen (EBNA). Presence of VCA IgM antibodies indicates recent primary infection with Epstein-Barr virus (EBV). The presence of VCA IgG antibodies indicates infection sometime in the past. Antibodies to EBNA develop 6 to 8 weeks after primary infection and are detectable for life. Over 90% of the normal adult population has IgG class antibodies to VCA and EBNA. Few patients who have been infected with EBV will fail to develop antibodies to the EBNA (approximately 5%-10%).

 

Possible Results

VCA IgG

VCA IgM

EBNA IgG

Interpretation

-

-

-

No previous exposure

+

+

-

Recent infection

+

-

+

Past infection

+

-

-

See note*

+

+

+

Past infection

 

*Results indicate infection with EBV at some time (VCA IgG positive). However, the time of the infection cannot be predicted, (ie, recent or past) since antibodies to EBNA usually develop after primary infection (recent) or, alternatively, approximately 5% to 10% of patients with EBV never develop antibodies to EBNA (past).

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Specimens drawn too early during the course of the disease may not contain detectable antibody to Epstein-Barr virus (EBV). Another specimen drawn 1 to 2 weeks later may be required.

 

Test results should be evaluated in relation to patient symptoms, clinical history, and other laboratory findings.

 

The timing of the appearance of IgG antibodies to viral capsid antigen (VCA) or Epstein-Barr nuclear antigen (EBNA) or IgM antibodies to VCA is subject to variations among individuals and serological assays.

 

This assay's performance characteristics with immunosuppressed individuals, newborns, cord blood, or matrices other than human serum have not been established.

 

Assay performance characteristics have not been established for the diagnosis of nasopharyngeal carcinoma, Burkitt lymphoma, and other EBV-associated lymphomas.

 

This assay is not intended for viral isolation or identification.

 

Anti-VCA-specific IgG may compete with IgM for binding sites, leading to false-negative results. Rheumatoid factor (RF), in the presence of specific IgG, may contribute to false-positive results. The absorbent in the VCA IgM diluent is intended to neutralize the effects of RF and specific IgG. Studies have shown that the absorbent was able to neutralize up to 98% of the activity in a specimen known to contain 3,328 IU/mL of RF activity.

 

Testing for VCA IgM should not be performed as a screening procedure on the general population. The predictive value of positive or negative results depends on the pretest likelihood of Epstein-Barr-associated disease being present. Testing should only be performed when clinical evidence suggests the diagnosis of this syndrome.

Clinical Reference Provides recommendations for further in-depth reading of a clinical nature

1. Fields' Virology. Fifth edition. Edited by DM Knipe, PM Howley, DE Griffin, et al. Philadelphia, Lippincott Williams and Wilkins, 2007

2. Linde A, Falk KI: Epstein-Barr virus. In Manual of Clinical Microbiology. Ninth edition. Edited by EJ Barron, JH Jorgensen, ML Landry, et al. ASM Press, 2007, pp 1564-1573