Epstein-Barr Virus Antibodies

Very commonly the laboratory will need to run more than one test for EBV on your blood sample to make the diagnosis. Which tests are run and in what combination will depend on the clinical situation, and may vary between laboratories.

Some laboratories will first do a Monospot test (which tests for a heterophile antibody) if glandular fever is suspected. If the Monospot test is positive this will usually mean that you have EBV infection. Sometimes the Monospot test can be negative even if you have EBV (this is called a ‘false negative’ result). This is especially common in younger children and in the first few weeks of the infection. Sometimes ‘false positive’ results are also seen. This is when the Monospot test is positive because of a different infection, not EBV.

EBV antibody tests are more accurate than the Monospot test at diagnosing glandular fever due to EBV infection. Usually a combination of different EBV antibody tests is needed to tell when your EBV infection has occurred. The most commonly used EBV antibody tests are called VCA-IgM, VCA-IgG and EBNA-IgG.

EBV antibodies may be requested when you have symptoms suggesting glandular fever. Signs and symptoms may include:

• Tiredness
• Fever
• Sore throat
• Swollen lymph glands
• Sometimes enlarged spleen and/or liver
• Sometimes rash.

Sometimes a doctor will also test for EBV antibodies to find out whether you have ever had EBV infection in the past or whether you are susceptible to it. This can be important if you are going to start taking immunosuppressive medication or you are going to have a transplant.

Here are the commonest patterns of results and what they mean:

1) Results: VCA-IgM and VCA-IgG and EBNA-IgG all NEGATIVE.

    Means: You have never had EBV infection.

2) Results: VCA-IgM and VCA-IgG POSITIVE, EBNA-IgG NEGATIVE.

    Means: You have recent EBV infection (in the last 4-6 weeks).

3) Results: VCA-IgM NEGATIVE, VCA-IgG and EBNA-IgG POSITIVE.

    Means: You have had EBV infection in the past, but it was more than 6-8 weeks ago. (This would mean that EBV is not likely to be the cause of your current illness.)

Occasionally the results on your first blood sample may not be clear-cut. In this case you may be asked to have a follow-up blood sample taken in a few weeks’ time.

The most common complication of glandular fever is a ruptured spleen. Other complications of EBV infection that can occur include trouble breathing due to a swollen throat, streptococcal sore throat at the same time, and, rarely, jaundice, skin rashes, pancreatitis, seizures, and/or encephalitis. EBV is also associated with, and may play a role in, several rare forms of cancer, including Burkitt’s lymphoma and nasopharyngeal carcinoma.

Although EBV stays in your body for the rest of your life, it is rarely a health concern unless you become significantly and persistently immune compromised. This can occur in people who have HIV/AIDS or in those who have received an organ transplant. Primary infections in these patients can be more severe. Previous EBV infection in immune compromised people can reactivate and lead to chronic EBV-related symptoms, such as post-transplant lymphoproliferative disease (PTLD).

They do, but it is rare because most have already been infected at an earlier age. When they do, they tend to have less lymph node swelling and sore throat and more liver enlargement and jaundice. As glandular fever / EBV is less common in this age group, is it particularly important to look for other infections that might cause the person’s symptoms (such as CMV, toxoplasmosis, HIV).