Mononucleosis diagnosis summary

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

Overview

• If antibodies to the viral capsid antigen are not detected, the patient is susceptible to EBV infection.

Diagnosis Summary: Based on the Stage of Infection

Primary Infection

• Primary EBV infection is indicated if IgM antibody to the viral capsid antigen is present and antibody to EBV nuclear antigen (EBNA), is absent.

• A rising or high 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.

• In addition, 80% of patients with active EBV infection produce antibody to early antigen.

Past Infection

• If 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.

• Since 95% of adults have been infected with EBV, most adults will show antibodies to EBV from infection years earlier.

• High or elevated antibody levels may be present for years and are not diagnostic of recent infection.

Reactivation

• In the presence of antibodies to EBV nuclear antigen, an elevation of antibodies to early antigen suggests reactivation.

• However, when 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.

• 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.

Chronic EBV Infection

• Reliable laboratory evidence for continued active EBV infection is very seldom found in patients who have been ill for more than 4 months.

• When the illness lasts more than 6 months, it should be investigated to see if other causes of chronic illness or chronic fatigue syndrome (CFS) are present.

Antibody (AB)	Time of appearance	Persistence	% Patients present
Viral capsid antigen-IgM (VCA-IgM)	At clinical presentation	1-3 months	100%
Viral capsid antigen-IgG (VCA-IgG)	At clinical presentation	Lifelong	100%
Early antigen-IgG (EA IgG)	Peak 3-4 weeks after onset	3-6 months	70%
EBV nuclear antigen-IgG (EBNA IgG)	6-12 weeks after onset	Lifelong	100%

Resources

• CDC Mononucleosis

References

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