|Downtime form:||A-1a Doctor/Provider Orders - Pathology Core and Specialty Care Nursery|
|Plasma Separator Tube 4.5 mL|
Reference ranges changed effective 12/11/2012. Reference range for all analytes (Heterophile IgM, VCA IgG, VCA IgM, EBNA): 0.8 AI or less: Negative 0.9-1.0 AI: Indeterminate 1.1 AI or greater: Positive
Epstein-Barr virus (EBV) is the etiologic agent of infectious mononucleosis. EBV infection can be difficult to diagnose by laboratory testing; however, the majority of acute infections can be recognized by testing the patient's serum for heterophile antibodies (e.g., by the "Monospot" latex agglutination assay), which usually appear within the first 3 weeks of illness, but then decline rapidly within a few weeks. Heterophile antibodies are found in a very high percentage of infants and older children with acute mononucleosis. However, heterophile antibodies do not develop in approximately 10% of adults. In cases where EBV is suspected but the heterophile antibody is not detected, evaluation of a panel of 4 EBV antibodies can be useful: Heterophile IgM Viral capsid antigen (VCA) IgG VCA IgM EBV nuclear antibody (EBNA) Infection with EBV usually occurs early in life, typically as infectious mononucleosis. Other disorders due to EBV infection have been recognized, including Burkitt's 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. Presence of VCA IgM antibodies indicates recent primary infection with 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 usually detectable for life. Over 90% of the normal adult population have 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%). EBV serology pattern interpretation is adapted from the findings in J. Clin. Microbiol. 47(10): 3204-3210, 2009. The table below has the likely interpretations of the 16 patterns possible from the four assays in the EBV panel. For purposes of classification, indeterminate/equivocal results are considered negative in the table below. Results should always be interpreted in conjunction with patient history and physical examination. Heterophile VCA VCA EBNA IgM IgM IgG IgG Interpretation Neg Neg Neg Neg EBV naïve Neg Pos Neg Neg Primary acute EBV infection Pos Neg Neg Neg Primary acute EBV infection Pos Pos Neg Neg Primary acute EBV infection Neg Pos Pos Neg Primary acute EBV infection Pos Neg Pos Neg Primary acute EBV infection Pos Pos Pos Neg Primary acute EBV infection Neg Pos Neg Pos Recovery from/reactivation of EBV infection Neg Pos Pos Pos Recovery from/reactivation of EBV infection Pos Neg Pos Pos Recovery from/reactivation of EBV infection Pos Pos Neg Pos Recovery from/reactivation of EBV infection Pos Pos Pos Pos Recovery from/reactivation of EBV infection Neg Neg Pos Neg Past EBV infection Neg Neg Pos Pos Past EBV infection Pos Neg Neg Pos Unknown* Neg Neg Neg Pos Unknown* * These two patterns are uncommon and have unknown significance.
Klutts JS et al. Evidence-based approach for interpretation of Epstein-Barr virus serological patterns. J. Clin. Microbiol. 47(10): 3204-3210.