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
Epstein-Barr Virus (EBV) Antibody Tests
When you have symptoms of mono but a negative mono test; when a pregnant woman has flu-like symptoms; occasionally when an asymptomatic person has been exposed to someone with mono; or possibly as a means to check immune system function
A blood sample drawn from a vein in your arm
None
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How is it used?
Blood tests for Epstein-Barr virus (EBV) antibodies are used to help diagnose EBV infection, the most common cause of infectious mononucleosis (mono), if a person is symptomatic but has a negative mono test.
In pregnant women with symptoms of a viral illness, one or more EBV antibody tests may be ordered along with tests for cytomegalovirus (CMV), toxoplasmosis, and other infections (sometimes as part of a TORCH screen) to help distinguish between EBV and conditions that may cause similar symptoms.
These tests may be ordered for an asymptomatic person to see if that person has been previously exposed to EBV or is susceptible to a primary EBV infection. This is not routinely done, but it may be ordered when someone, such as an adolescent or an immunocompromised person, has been in close contact with a person who has mono.
The Centers for Disease Control and Prevention (CDC) recommend ordering several tests to help determine whether a person is susceptible to EBV or to detect a recent infection or a prior infection, or a reactivated EBV infection. These tests include:
- Viral capsid antigen (VCA)-IgM
- VCA-IgG
- D early antigen (EA-D)
- Epstein Barr nuclear antigen (EBNA)
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When is it ordered?
EBV antibody tests may be ordered when someone has symptoms suggesting mono but a negative mono test and when a pregnant woman has flu-like symptoms and her healthcare provider wants to determine whether the symptoms are due to EBV or another microbe. Some signs and symptoms associated with mono include:
- Extreme weakness or fatigue
- Fever
- Headache
- Sore throat
- Swollen lymph glands in the neck and/or armpits
- Enlarged spleen and/or liver (sometimes)
Testing may be ordered when a healthcare practitioner wants to establish previous exposure to EBV. Testing may occasionally be repeated when the healthcare provider wants to track antibody concentrations (titers) and/or when the first test was negative but the healthcare practitioner still suspects that the person's symptoms are due to EBV.
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What does the test result mean?
Care must be taken when interpreting results of EBV antibody testing. The signs and symptoms as well as the medical history of the person tested must be taken into account. A healthcare practitioner may consult a specialist in infectious diseases, specifically one who is experienced with EBV testing.
If someone is positive for VCA-IgM antibodies, then it is likely that the person has an EBV infection and it may be early in the course of the illness. If the individual also has symptoms associated with mono, then it is most likely that the person will be diagnosed with mono, even if the mono test was negative.
If someone has positive VCA-IgG and EA-D IgG tests, then it is highly likely that the person has a current or recent EBV infection.
If the VCA-IgM is negative but VCA-IgG and an EBNA antibody are positive, then it is likely that the person tested had a previous EBV infection.
If an individual is asymptomatic and negative for VCA-IgG, then that person has likely not been previously exposed to EBV and is vulnerable to infection.
In general, rising VCA-IgG levels tend to indicate an active EBV infection, while falling concentrations tend to indicate a recent EBV infection that is resolving. However, care must be taken with interpreting EBV antibody concentrations because the amount of antibody present does not correlate with the severity of the infection or with the length of time it will last. High levels of VCA-IgG may be present and may persist at that concentration for the rest of a person's life.
Below, examples of some results are provided in table form.
Test results most likely indicate the following: VCA-IgM VCA-IgG EA-D, IgG EBNA, IgG Possible Interpretation Negative Negative Negative Negative No infection, symptoms due to another cause, susceptible to EBV infection Positive Positive Negative Negative Early, primary infection Negative or positive Positive Positive Negative Active infection, though EA-D IgG may persist for life in about 20% of people Negative Positive Negative Positive Past infection Negative Positive Positive Positive May indicate reactivation of virus -
Is there anything else I should know?
The most common complication of mono is a ruptured spleen. Other complications of EBV infection that can occur include trouble breathing due to a swollen throat 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, Hodgkin lymphoma, and nasopharyngeal carcinoma, as well as multiple sclerosis and fibromyalgia.
Reactivation of the virus is rarely a health concern unless the person is significantly and persistently immunocompromised, as may happen in those who have HIV/AIDS or organ transplant recipients. Primary infections in these people can be more severe, and some may experience chronic EBV-related symptoms.
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How is Epstein-Barr virus (EBV) infection or infectious mononucleosis (mono) treated?
Care is largely supportive and typically includes plenty of rest and fluids as well as treatment of the symptoms. Avoiding any contact sports or heavy lifting for several weeks to months may be recommended to avoid spleen rupture. There are no anti-viral medications available to speed healing; however, anti-virals and steroids can be used to treat symptoms in severe cases. At present, there is no vaccine for EBV, but clinical trials are underway.
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Do adults get mono?
They do, but it is rare because most have already been infected with EBV at an earlier age. When they do, they tend to have less lymph node swelling and sore throat and more liver enlargement and jaundice.
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Do EBV infection and mono occur throughout the world?
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If I have had EBV infection, can I still get mono?
No. Once you have had an EBV infection, you will not get mono. You could, however, experience similar symptoms from another viral illness. In individuals with weakened immune systems, the virus can reactivate and cause illness.
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Why is mono sometimes called "the kissing disease"?
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Are there other types of tests available for EBV?
Yes. There are molecular tests that can detect and measure EBV DNA.