At a Glance
Why Get Tested?
To help diagnose infectious mononucleosis (mono); to distinguish between an Epstein-Barr virus (EBV) infection and another illness with similar symptoms; to help evaluate susceptibility to EBV
When to Get Tested?
A blood sample drawn from a vein in your arm
Test Preparation Needed?
The Test Sample
What is being tested?
Epstein-Barr virus causes an infection that is very common. According to the Centers for Disease Control and Prevention (CDC), as many as 95% of people in the United States will have been infected by EBV by the time they are 40 years old. The virus is easily passed from person to person. It is present in the saliva of infected individuals and can be spread through close contact such as kissing and through sharing utensils or cups.
After initial exposure to EBV, there is a period of several weeks before associated symptoms may appear called the incubation period. During the acute primary infection, the virus multiplies in number. This is followed by a decrease in viral numbers and resolution of symptoms, but the virus never completely goes away. Latent EBV remains in the person's body for the rest of his life and may reactivate but usually causes few problems unless the person's immune system is significantly weakened.
Most people are infected by EBV in childhood and experience few or no symptoms. However, when the initial infection occurs in adolescence, it can cause infectious mononucleosis, commonly called mono, a condition associated with fatigue, fever, sore throat, swollen lymph nodes, an enlarged spleen, and sometimes an enlarged liver. These symptoms occur in about 35% to 50% of infected teens and young adults and usually resolve within a month or two.
People with mono are typically diagnosed by their symptoms and the findings from a complete blood count (CBC) and a mono test (which tests for a heterophile antibody). About 10% to 20% of those with mono will not produce heterophile antibodies and will have a negative mono test; this is especially true with children. Tests for EBV antibodies can be used to determine whether or not the symptoms these people are experiencing are due to a current infection with the EBV virus.
Sometimes, it can be important to distinguish EBV from other illnesses. For instance, it may be important to diagnose the cause of symptoms of a viral illness in a pregnant woman. Testing can help to distinguish a primary EBV infection, which has not been shown to affect a developing baby, from a cytomegalovirus (CMV), herpes simplex virus, or toxoplasmosis infection, as these illnesses can cause complications during the pregnancy and may harm the fetus. It can also be important to rule out EBV infection and to look for other causes of the symptoms. Those with strep throat, an infection causes by Group A streptococcus, for instance, need to be identified and treated with antibiotics. A person may have strep throat instead of mono or they may have both conditions at the same time.
Several tests for different types and classes of EBV antibodies are available. The antibodies are proteins produced by the body in an immune response to several different Epstein-Barr virus antigens. During a primary EBV infection, the level of each of these EBV antibodies rises and falls at various times as the infection progresses. Measurement of these antibodies in the blood can aid in diagnosis and typically provides the doctor with information about the stage of infection and whether it is a current, recent, or past infection.
|Antibody||Timing of when the antibody is typically detected in the blood|
|Viral Capsid Antigen (VCA)-IgM antibody||Appears first after exposure to the virus and then tends to disappear after about 4 to 6 weeks|
|VCA-IgG antibody||Emerges during acute infection with the highest level at 2 to 4 weeks, then drops slightly, stabilizes, and is present for life|
|Early Antigen (EA-D) antibody||Appears during the acute infection phase and then tends to disappear; about 20% of those infected will continue to have detectable quantities for several years after the EBV infection has resolved.|
|Epstein-Barr Nuclear Antigen (EBNA) antibody||Does not usually appear until the acute infection has resolved; it develops about 2 to 4 months after the initial infection and is then is present for life.|
How is the sample collected for testing?
A blood sample is obtained by inserting a needle into a vein in the arm.
NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.
Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.
Is any test preparation needed to ensure the quality of the sample?
No test preparation is needed.
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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.
Sources Used in Current Review
Bennett, N. and Domachowske, J. (Updated 2012 May 30). Pediatric Mononucleosis and Epstein-Barr Virus Infection. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/963894-overview through http://emedicine.medscape.com. Accessed November 2012.
Vorvick, L. (Updated 2011 August 24). Epstein-Barr virus test. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003513.htm. Accessed November 2012.
Delgado, J. et. al. (Updated 2012 August). Epstein-Barr Virus – EBV. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/EBV.html?client_ID=LTD through http://www.arupconsult.com. Accessed November 2012.
(© 1995-2012). Epstein-Barr Virus (EBV) Antibody Profile, Serum. Mayo Clinic Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/84421 through http://www.mayomedicallaboratories.com. Accessed November 2012.
Cunha, B. and Levy, C. (Updated 2011 September 21). Infectious Mononucleosis. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/222040-overview through http://emedicine.medscape.com. Accessed November 2012.
Mayo Clinic Staff (2010 June 26). Mononucleosis. Mayo Clinic [On-line information]. Available online at http://www.mayoclinic.com/print/mononucleosis/DS00352/DSECTION=all&METHOD=print through http://www.mayoclinic.com. Accessed November 2012.
Pagana, K. D. & Pagana, T. J. (© 2011). Mosby's Diagnostic and Laboratory Test Reference 10th Edition: Mosby, Inc., Saint Louis, MO. Pp 407-409.
Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL eds, (2005) Harrison's Principles of Internal Medicine, 16th Edition, McGraw Hill, pp1046-1048.
Henry's Clinical Diagnosis and Management by Laboratory Methods. 21st ed. McPherson R, Pincus M, eds. Philadelphia, PA: Saunders Elsevier: 2007, pp 555-556.
Hess R. Mini Review: Routine Epstein-Barr Virus Diagnostics from the Laboratory, Perspective: Still Challenging after 35 Years. Journal of Clinical Microbiology, Aug. 2004, Vol. 42, No. 8., Pg. 3381–3387.
Sources Used in Previous Reviews
Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].
Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby's Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO. Pp 373-375.
Ebell, M. (2004 October 1). Epstein-Barr Virus Infectious Mononucleosis. American Family Physician [On-line journal]. Available online at http://www.aafp.org/afp/20041001/1279.html through http://www.aafp.org.
Levy, D. (2004 January 19, Updated). Epstein-Barr virus test. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003513.htm.
(© 1995-2005). Epstein-Barr Virus Infection. The Merck Manual- Second Home Edition [On-line information]. Available online at http://www.merck.com/mmhe/sec17/ch198/ch198f.html through http://www.merck.com.
(© 2005). Epstein-Barr Virus. ARUP's Guide to Clinical Laboratory Testing [On-line information]. Available online at http://www.aruplab.com/guides/clt/tests/clt_a238.jsp#1147825 through http://www.aruplab.com.
Schmid, S., Leader Herpesvirus Group (2005 September 13, Updated). Epstein-Barr Virus and Infectious Mononucleosis. CDC, National Center for Infectious Diseases [On-line information]. Available online at http://www.cdc.gov/ncidod/diseases/ebv.htm through http://www.cdc.gov.
Pagana, Kathleen D. & Pagana, Timothy J. (© 2007). Mosby's Diagnostic and Laboratory Test Reference 8th Edition: Mosby, Inc., Saint Louis, MO. Pp 401-403.
Wu, A. (2006). Tietz Clinical Guide to Laboratory Tests, Fourth Edition. Saunders Elsevier, St. Louis, Missouri. Pp 1556-1557.
Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition]. Pp 663.
Smith, D. S. (2007 August 6). Epstein-Barr virus test. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003513.htm. Accessed on 11/23/08.
Bennett, N. J. and Domachowske, J (2008 August 12). Mononucleosis and Epstein-Barr Virus Infection. EMedicine [On-line information]. Available online at http://www.emedicine.com/ped/TOPIC705.HTM through http://www.emedicine.com. Accessed on 11/23/08.
(© 2006-2008). Epstein-Barr Virus – EBV. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/InfectiousDz/Viruses/EBV.html through http://www.arupconsult.com. Accessed on 11/23/08.
Mayo Clinic Staff (2008 June 28). Mononucleosis. MayoClinic [On-line information]. Available online at http://www.mayoclinic.com/health/mononucleosis/DS00352 through http://www.mayoclinic.com. Accessed on 11/23/08.
(2005 November). Infectious Mononucleosis. The Merck Manual for Healthcare Professionals [On-line information]. Available online at http://www.merck.com/mmpe/sec14/ch189/ch189f.html?qt=EBV&alt=sh through http://www.merck.com. Accessed on 11/23/08.
Peridin F, et. al (Published online 2007 March 28). Comparison of commercial and in-house Real-time PCR assays for quantification of Epstein-Barr virus (EBV) DNA in plasma. BMC Microbiol. 2007; 7: 22. Available online at http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=pmc1852802 through http://www.pubmedcentral.nih.gov. Accessed January 2009.
(Updated Feb 2, 2009) Centers for Disease Control and Prevention. Epstein-Barr Virus and Infectious Mononucleosis. Available online at http://www.cdc.gov/ncidod/diseases/ebv.htm through http://www.cdc.gov. Accessed February 2009.