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| {{CMG}}; {{AOEIC}} {{LG}} | | {{CMG}}; {{AOEIC}} {{LG}} |
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| ==Overview==
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| If [[antibody|antibodies]] to the viral capsid antigen are not detected, the patient is susceptible to [[EBV|EBV infection]].
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| ==Diagnosis Summary: Based on the Stage of Infection==
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| ===Primary Infection===
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| *Primary [[EBV]] infection is indicated if [[IgM|IgM antibody]] to the viral capsid antigen is present and [[antibody]] to EBV nuclear antigen (EBNA), is absent.
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| *A rising or high [[IgG|IgG antibody]] to the viral capsid antigen and negative antibody to EBV nuclear antigen after at least 4 weeks of illness is also strongly suggestive of primary infection.
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| *In addition, 80% of patients with active EBV infection produce antibody to early antigen.
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| ===Past Infection===
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| *If [[antibody|antibodies]] to both the viral capsid antigen and EBV nuclear antigen are present, then past infection (from 4 to 6 months to years earlier) is indicated.
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| *Since 95% of adults have been infected with [[EBV]], most adults will show [[antibody|antibodies]] to [[EBV]] from infection years earlier.
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| *High or elevated [[antibody]] levels may be present for years and are not diagnostic of recent infection.
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| ===Reactivation===
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| *In the presence of [[antibody|antibodies]] to EBV nuclear antigen, an elevation of antibodies to early antigen suggests reactivation.
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| *However, when [[antibody|EBV antibody]] to the early antigen test is present, this result does not automatically indicate that a patient's current medical condition is caused by [[EBV]].
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| *A number of healthy people with no symptoms have antibodies to the EBV early antigen for years after their initial [[EBV]] infection. Many times reactivation occurs subclinically.
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| ===Chronic EBV Infection===
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| *Reliable laboratory evidence for continued active [[EBV]] infection is very seldom found in patients who have been ill for more than 4 months.
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| *When the illness lasts more than 6 months, it should be investigated to see if other causes of chronic illness or [[chronic fatigue syndrome|chronic fatigue syndrome (CFS)]] are present.
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| {| border="1" align="center" style="background:lightskyblue"
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| |-
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| | bgcolor="CornFlowerBlue" |'''Antibody (AB)'''
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| | bgcolor="CornFlowerBlue" |'''Time of appearance'''
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| | bgcolor="CornFlowerBlue" |'''Persistence'''
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| | bgcolor="CornFlowerBlue" |'''% Patients present'''
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| |-
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| | Viral capsid antigen-IgM '''''(VCA-IgM)'''''
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| | At clinical presentation
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| | 1-3 months
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| | 100%
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| |-
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| | Viral capsid antigen-IgG '''''(VCA-IgG)'''''
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| | At clinical presentation
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| | Lifelong
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| | 100%
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| |-
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| | Early antigen-IgG '''''(EA IgG)'''''
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| | Peak 3-4 weeks after onset
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| | 3-6 months
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| | 70%
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| |-
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| | EBV nuclear antigen-IgG '''''(EBNA IgG)'''''
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| | 6-12 weeks after onset
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| | Lifelong
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| | 100%
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| |}
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| ==Resources==
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| *[http://www.cdc.gov/ncidod/diseases/ebv.htm CDC Mononucleosis]
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| ==References== | | ==References== |