At a glance

Also known as

EBV Antibodies; EBV VCA-IgM Ab; EBV VCA-IgG Ab; EBNA-IgG Ab; EA-D IgG Ab

Why get tested?

To help diagnose glandular fever (infectious mononucleosis or Mono); to help evaluate susceptibility to EBV infection; to distinguish between an EBV infection and another illness with similar symptoms

When to get tested?

When you have symptoms of glandular fever but a negative IM screening test (monospot); when a pregnant woman has flu-like symptoms; sometimes when an asymptomatic person has been exposed to glandular fever

Sample required?

A blood sample drawn from a vein in your arm

Test preparation needed?

None

What is being tested?

Epstein-Barr virus (EBV) antibodies are a group of tests that are ordered 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. According to World Health Organisation (WHO), as many as 95% of people in the world adult population has been infected by EBV. After exposure to the virus, there is an incubation period of several weeks. EBV then causes an acute primary infection, followed by resolution and dormancy. Latent EBV remains in the person’s body for the rest of their life, reactivating intermittently, but causing few problems unless the person’s immune system is significantly compromised.

Most people are infected by EBV in childhood and experience few or no symptoms, even in the acute phase of the infection. However, when the initial infection is delayed until adolescence, EBV causes glandular fever in up to 50% of those infected. Glandular fever is a condition that is associated with fatigue, fever, sore throat, swollen lymph nodes, an enlarged spleen, and, sometimes, an enlarged liver. Those who have it are often symptomatic for a month or two before the initial infection resolves.

Patients with glandular fever are diagnosed by their symptoms and the findings of a full blood count (FBC) and a monospot test (which tests for a heterophile antibody). A certain percentage of those who have glandular fever will have a negative mono test; this is especially true with children. EBV antibodies can be used to determine whether or not the symptoms these patients are experiencing are due to a current infection with the EBV virus.

It can be important to distinguish EBV from other illnesses. For instance, the enlarged spleen of those with a glandular fever infection is vulnerable to rupture. Patients who have glandular fever should not be involved in contact sports for several weeks to months after infection, as a ruptured spleen can cause a medical emergency. Also, pregnant women with symptoms of a viral illness need to be able to distinguish a primary EBV infection, which has not been shown to affect the baby, from a cytomegalovirus (CMV), toxoplasmosis, or herpes simplex virus infection, as these illnesses can cause complications during the pregnancy and may damage the fetus. It can also be important to rule out EBV and to look for other causes for the symptoms. Patients with strep throat, for instance, need to be identified and treated with antibiotics. A patient may have strep throat instead of glandular fever, or they may have both conditions at the same time.

There are several EBV antibodies. They are proteins produced by the body in an immune response to several different Epstein-Barr virus antigens. They include IgM and IgG antibodies to the viral capsid antigen (VCA), and antibodies to the nuclear antigen (EBNA). During a primary EBV infection, each of these EBV antibodies appears independently on its own time schedule. The VCA-IgM antibody is usually detectable at the time of the first blood test, and then tends to disappear after about 4 to 6 weeks. The VCA-IgG antibody develops soon after VCA-IgM, and persists for life. The EBNA antibody usually develops 2-4 months after the initial infection, so does not usually appear until the acute infection has resolved. It persists for life. Using a combination of these EBV antibody tests, a doctor is able to detect an EBV infection and to determine whether it is a current, recent, or past infection.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

The Test

How is it used?

Epstein-Barr Virus (EBV) antibodies are used to help diagnose glandular fever if you are symptomatic but have a negative monospot test. Requesting serology testing for EBV antibodies will include:

  • Viral capsid antigen (VCA)-IgM, and VCA-IgG — to detect a current or recent infection
  • If VCA-IgG is detected then Epstein Barr nuclear antigen (EBNA) may be added — to detect a previous infection

In pregnant women with symptoms of a viral illness, one or more of these EBV antibodies may be ordered along with tests for CMV, toxoplasmosis, and other infections (sometimes as part of a TORCH screen) to help distinguish between EBV and conditions that may cause similar symptoms. Occasionally, a VCA-IgG or other EBV antibody may be repeated 2-4 weeks after the first test, either to see if a test changes from negative to positive or to measure changes in antibody concentrations to see if they rise or fall.

A VCA-IgG test, and sometimes an EBNA test, may be ordered on an asymptomatic patient 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 a patient, such as an adolescent or an immune compromised patient, has been in close contact with a person who has glandular fever.

When is it requested?

EBV antibodies may be ordered when you have symptoms suggesting glandular fever, but a negative monospot test and when a pregnant woman has flu-like symptoms and the doctor wants to determine whether the symptoms are due to EBV or another microorganism. Signs and symptoms may include:

  • Fatigue
  • Fever
  • Sore throat
  • Swollen lymph glands
  • Sometimes enlarged spleen and/or liver

VCA-IgG and EBNA may be ordered whenever your doctor wants to establish previous exposure. Testing may occasionally be repeated when the first test was negative, but your doctor still suspects that your symptoms are due to EBV.

What does the test result mean?

If you have positive VCA-IgM antibodies, then it is likely that you have a current, or had a very recent, EBV infection. If you also have symptoms associated with glandular fever, then it is most likely that you will be diagnosed with it, even if your monospot test was negative. If you also have a reactive VCA-IgG test result, then it is highly likely that you have, or recently had, an EBV infection.

If the VCA-IgM is negative but the others and an EBNA antibody are positive, then it is likely that you had a previous EBV infection. If you are asymptomatic and are negative for VCA-IgG, then you have not been previously exposed to EBV and are vulnerable to infection.

Below, results are provided in table form.

Test results most likely indicate the following:

EBV ANTIBODY TEST

SUSCEPTIBLE TO EBV

CURRENT EBV INFECTION

PAST EBV INFECTION

COMMENTS

VCA-IgM

 

+

+

Appears first, disappears in 4-6 weeks
Can be falsely positive with some other infections

VCA-IgG

+

+

If not present, then you are susceptible
It appears within a week of infection, then persists for life

EBNA-IgG

 

 

+

Becomes reactive in 2 – 4 months, then persists for life

Heterophile IgM (Mono test)

 

+

 

Associated with glandular fever
False positives with other conditions
False negatives common in children

Is there anything else I should know?

There are other antibodies that arise during an EBV infection including an IgG antibody to EBV D early antigen (EA-D IgG), an IgA antibody to the EBV viral capsid antigen (EBV VCA-IgA) and an IgG antibody to the EBV early antigen restricted (EA-R IgG). While it is possible to test for these antibodies as part of the EBV diagnostic workup, it is rarely necessary to do so.

Complications of EBV infection that can occur include trouble breathing due to a swollen throat with or without a bacterial infection, less commonly a ruptured spleen 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.

Reactivation of the virus is rarely a health concern unless the patient is significantly and persistently immune compromised, as may happen in those who have HIV/AIDS or in those who have received an organ transplant. Primary infections in these patients can be more severe, and some may experience chronic EBV-related symptoms.

Common Questions

How is EBV infection treated?

Care is largely supportive - rest, treating the symptoms such as sore throat, 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.

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.

Do EBV infection and glandular fever occur throughout the world?

Yes. However, in less developed nations, it is not as common because most of the population is infected with EBV earlier in life when symptoms are minimal.

Can EBV be prevented?

Not at this time. It is very common in the population, with almost everyone being infected and therefore being infectious at one time or another. The virus may also reactivate intermittently in a previously infected person, usually without causing any symptoms.

If I have had EBV infection, can I still get glandular fever?

No. Once you have recovered from an EBV infection, you will not get glandular fever (again). However you could experience similar symptoms from another viral illness.

Why is glandular fever sometimes called "the kissing disease"?

This is because EBV does not pass through the air; it is present in saliva and is passed through mouth-to-mouth contact and, in the case of children, through saliva transfer to hands and/or toys, etc.

Are there other types of tests available for EBV?

Yes. There are molecular tests that can detect and measure EBV DNA. They can be helpful in diagnosing and monitoring EBV-related diseases such as Burkitt’s lymphoma, Hodgkin’s lymphoma and post-transplant lymphoproliferative disease (PTLD).


Last Review Date: December 12, 2016