{"id":4400,"date":"2021-09-15T14:18:41","date_gmt":"2021-09-15T02:18:41","guid":{"rendered":"https:\/\/www.awanuilabs.co.nz\/central\/wellington\/?page_id=4400"},"modified":"2025-05-05T14:04:54","modified_gmt":"2025-05-05T02:04:54","slug":"epstein-barr-virus-ebv","status":"publish","type":"page","link":"https:\/\/www.awanuilabs.co.nz\/central\/wellington\/for-referrers\/microbiology\/how-do-i-diagnose\/epstein-barr-virus-ebv\/","title":{"rendered":"Epstein Barr virus (EBV)"},"content":{"rendered":"\n<p><strong>Infection:<\/strong> Epstein Barr Virus (EBV) infection; Infectious mononucleosis (IM); Glandular fever<\/p>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\">Brief description:<\/summary><div class=\"ab-accordion-text\">\n<p>The commonest symptoms are feeling generally unwell, fever, sore throat (often with exudate\/tonsillitis) and cervical lymph node enlargement. Rash can occur but is uncommon unless beta-lactam antibiotics have been given.<\/p>\n\n\n\n<ul>\n<li>Many primary (acute) infections are minimally symptomatic and go undiagnosed.<\/li>\n\n\n\n<li>Most patients get mild liver test derangement, and about half get splenic enlargement.<\/li>\n<\/ul>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\">Did you know?<\/summary><div class=\"ab-accordion-text\">\n<p>Fatigue can persist in some patients for months after initial infection. This is sometimes incorrectly labelled as \u2018chronic EBV infection\u2019, whereas it should be considered a \u2018post-viral\u2019 effect. True chronic EBV infection is very rare, and is characterised by ongoing IM-type symptoms e.g. fever, lymphadenopathy, deranged liver tests, low white blood cell count.<\/p>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\">Who should I test?<\/summary><div class=\"ab-accordion-text\">\n<p>Laboratory confirmation of EBV infection is <strong>not usually required<\/strong> in young people with typical symptoms that self-resolve.<\/p>\n\n\n\n<ul>\n<li><strong>Mimics to consider<\/strong>: HIV, syphilis. Toxoplasmosis and CMV infection if pregnant. Other causes of lymphadenopathy if persistent e.g. malignancy, TB.<\/li>\n\n\n\n<li><strong>Lymphocytosis<\/strong> with <strong>atypical lymphocytes<\/strong> are consistent with, but not specific for, EBV.<\/li>\n<\/ul>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\">Test of choice:<\/summary><div class=\"ab-accordion-text\">\n<p>Request<strong> <a href=\"https:\/\/scg.labapps.nz\/#\/WEL\/details\/27008\" target=\"_blank\" rel=\"noreferrer noopener\">EBV serology<\/a><\/strong><\/p>\n\n\n\n<p><strong>EBNA IgG <\/strong>develops slowly (6-12 weeks) after primary infection, so is a marker of <strong>past<\/strong> <strong>infection<\/strong>. Its presence early in the course of an illness means acute EBV is not the cause.<\/p>\n\n\n\n<ul>\n<li>Reasonable <strong>sensitivity<\/strong> &#8211; negative result makes past infection <strong>unlikely<\/strong>, however 5-10% of people may never develop EBNA IgG<\/li>\n\n\n\n<li>Excellent<strong> specificity<\/strong> &#8211; positive result<strong> confirms <\/strong>past infection<\/li>\n<\/ul>\n\n\n\n<p><strong>VCA IgG<\/strong> indicates infection <strong>at some point in time <\/strong>(can be acute <strong>or<\/strong> past infection).<\/p>\n\n\n\n<ul>\n<li>Excellent <strong>sensitivity<\/strong> &#8211; negative result <strong>excludes<\/strong> infection, unless very early in illness<\/li>\n\n\n\n<li>Excellent<strong> specificity &#8211; <\/strong>positive result<strong> confirms <\/strong>infection at some stage<\/li>\n<\/ul>\n\n\n\n<p><strong>VCA IgM <\/strong>is used to indicate <strong>primary (acute) infection<\/strong><\/p>\n\n\n\n<ul>\n<li>Good <strong>sensitivity<\/strong> &#8211; negative result makes <strong>primary infection unlikely<\/strong><\/li>\n\n\n\n<li>Poor<strong> specificity &#8211; positive <\/strong>result<strong> doesn\u2019t necessarily indicate acute infection<\/strong><\/li>\n<\/ul>\n\n\n\n<p>IgM can remain positive from old infection or occur with unrelated illnesses. The combination of <strong>positive VCA IgG<\/strong> and <strong>IgM<\/strong> with a <strong>negative EBNA IgG<\/strong> in a person with <strong>compatible symptoms <\/strong>makes primary EBV <strong>likely<\/strong>.<\/p>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\">Tests to avoid\/specialist tests:<\/summary><div class=\"ab-accordion-text\">\n<p><strong><a href=\"https:\/\/scg.labapps.nz\/#\/WEL\/details\/27008\" target=\"_blank\" rel=\"noreferrer noopener\">Heterophile antibody<\/a> (Monospot, Paul Bunnell)<\/strong><\/p>\n\n\n\n<ul>\n<li>Still used in some labs, however we no longer offer, as <strong>false positives<\/strong> can occur in other illnesses, as can <strong>false negatives<\/strong> particularly in early infection and children.<\/li>\n<\/ul>\n\n\n\n<p><strong><a href=\"https:\/\/scg.labapps.nz\/#\/WEL\/details\/1892\">EBV DNA<\/a> (EBV viral load, EBV PCR)<\/strong><\/p>\n\n\n\n<ul>\n<li>Cannot differentiate between primary and past infection and is reserved for specialist use, usually in severely immunocompromised patients.<\/li>\n<\/ul>\n<\/div><\/details><\/div>\n","protected":false},"excerpt":{"rendered":"Infection: Epstein Barr Virus (EBV) infection; Infectious mononucleosis (IM); Glandular fever","protected":false},"author":18,"featured_media":0,"parent":4222,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-left-sidebar.php","meta":{"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.2 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Epstein Barr virus (EBV) &#8211; Awanui Labs - Wellington<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.awanuilabs.co.nz\/central\/wellington\/for-referrers\/microbiology\/how-do-i-diagnose\/epstein-barr-virus-ebv\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Epstein Barr virus (EBV) &#8211; Awanui Labs - Wellington\" \/>\n<meta property=\"og:description\" content=\"Infection: Epstein Barr Virus (EBV) infection; 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