The usual reason to test for EBV is to help diagnose glandular fever (also known as Infectious Mononucleosis). Some people may also be tested for EBV if they are having treatment that weakens the immune system, such as immunosuppressive medication or a transplant.
Epstein-Barr Virus Antibodies
If you have symptoms of glandular fever (fevers, tiredness, swollen lymph nodes, sore throat)
A blood sample taken from a vein in your arm
No test preparation is needed
Epstein-Barr virus (EBV) antibodies are a group of tests that are requested to help diagnose a current, recent, or past EBV infection.
EBV is a member of the herpes virus family. Passed through the saliva, the virus causes an infection that is very common. As many as 95% of people in the United Kingdom will have been infected by EBV by the time they are 40 years old. After exposure to the virus, there is an incubation period of several weeks. After recovery from this initial infection the virus remains dormant (‘sleeping’) in the body for the rest of a person’s life. EBV can reactivate from time-to-time during a person’s life, but causes few problems unless the person’s immune system is significantly weakened.
Most people catch EBV infection in childhood and experience few or no symptoms, even during the infection. However, when the initial infection happens during adolescence, EBV can cause a glandular fever illness. This happens in about 35 – 50% of those infected at this age. Glandular fever commonly causes: tiredness, fever, sore throat, swollen lymph nodes, an enlarged spleen. Less commonly it can also cause: an enlarged liver or hepatitis, rash. Those who have glandular fever usually have symptoms for a month or two before the infection gets better. A few people can have symptoms that last many months, but this is uncommon.
A doctor will suspect glandular fever based on a person’s symptoms. A full blood count (FBC) test will be done and usually shows clues that suggest EBV. For example the lymphocyte count is usually high and the lymphocytes may have an unusual appearance when the blood is looked at down a microscope. These findings on FBC are called ‘atypical lymphocytosis’. Although healthy people will recover from glandular fever due to EBV infection it is important to make the right diagnosis. For instance, the enlarged spleen of those with an EBV infection is vulnerable to rupture (bursting). Patients who have glandular fever should not be involved in contact sports for several weeks to months after infection, as a ruptured spleen can be a medical emergency.
It is also important to distinguish EBV from other illnesses that have similar symptoms. For example, cytomegalovirus (CMV), toxoplasmosis, and HIV can also cause a glandular fever-like illness. Because these infections can be very hard to tell apart, many laboratories will check for all these infections at the same time as testing for EBV. It is especially important to look for these other infections in pregnant women. This is because EBV infection has not been shown to affect the baby, but cytomegalovirus (CMV), or toxoplasmosis infection can cause complications during the pregnancy and may damage the growing baby.
How is it used?
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.
When is it requested?
- 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.
What does the test result mean?
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.
Is there anything else I should know?
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).
Do adults get glandular fever?
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).
Do EBV infection and glandular fever occur throughout the world?
Can EBV be prevented?
If I have had EBV infection, can I still get glandular fever?
Why is glandular fever sometimes called “the kissing disease”?
Are there other types of tests available for EBV?
Yes. There are molecular tests, called EBV PCR, that can detect and measure EBV DNA. They can be helpful in diagnosing and monitoring EBV-related diseases in immune suppressed people, such as post-transplant lymphoproliferative disease (PTLD). They are also occasionally used to help clarify EBV antibody results which are not clear-cut.
How is EBV infection treated?
For glandular fever, care is largely supportive: rest, treating the symptoms, and avoiding any contact sports or heavy lifting for several weeks to months to avoid spleen rupture. There are no anti-viral medications or vaccines available to speed healing or prevent infection. EBV related conditions in immune suppressed people (such as PTLD) require specialist treatment.
How is EBV infection/Mono treated?
Care is largely supportive, rest, treating the symptoms, and avoiding any contact sports or heavy lifting for several weeks to months to avoid spleen rupture. There are no anti-viral medications or vaccines available to speed healing or prevent infection.