To help diagnose infectious mononucleosis (mono); to distinguish between an Epstein-Barr virus (EBV) infection and another illness with similar symptoms; to help evaluate susceptibility to EBV
To help diagnose infectious mononucleosis (mono); to distinguish between an Epstein-Barr virus (EBV) infection and another illness with similar symptoms; to help evaluate susceptibility to EBV
When you have symptoms of mono but a negative mono test; when a pregnant woman has flu-like symptoms; occasionally when an asymptomatic person has been exposed to someone with mono; or possibly as a means to check immune system function
A blood sample drawn from a vein in your arm
None
Epstein-Barr virus (EBV) is a virus that typically causes a mild to moderate illness. Blood tests for Epstein-Barr virus detect antibodies to EBV in the blood and help establish a diagnosis of EBV infection.
Epstein-Barr virus causes an infection that is very common. According to the Centers for Disease Control and Prevention (CDC), most people in the United States are infected by EBV at some point in their lives. The virus is very contagious and easily passed from person to person. It is present in the saliva of infected individuals and can be spread through close contact such as kissing and through sharing utensils or cups.
After initial exposure to EBV, there is a period of several weeks before associated symptoms may appear, called the incubation period. During the acute primary infection, the virus multiplies in number. This is followed by a decrease in viral numbers and resolution of symptoms, but the virus never completely goes away. Latent EBV remains in the person’s body for the rest of that person’s life and may reactivate but usually causes few problems unless the person’s immune system is significantly weakened.
Most people are infected by EBV in childhood and experience few or no symptoms. However, when the initial infection occurs in adolescence, it can cause infectious mononucleosis, commonly called mono, a condition associated with fatigue, fever, sore throat, swollen lymph nodes, an enlarged spleen, and sometimes an enlarged liver. These symptoms occur in about 25% of infected teens and young adults and usually resolve within a month or two.
People with mono are typically diagnosed by their symptoms and the findings from a complete blood count (CBC) and a mono test (which tests for a heterophile antibody). About 25% of those with mono do not produce heterophile antibodies and will have a negative mono test; this is especially true with children. Tests for EBV antibodies can be used to determine whether or not the symptoms these people are experiencing are due to a current infection with the EBV virus.
EBV is the most common cause of mono. According to the CDC, examples of other causes of mono include cytomegalovirus (CMV), hepatitis A, hepatitis B or hepatitis C, rubella, and toxoplasmosis. Sometimes, it can be important to distinguish EBV from these other illnesses. For instance, it may be important to diagnose the cause of symptoms of a viral illness in a pregnant woman. Testing can help to distinguish a primary EBV infection, which has not been shown to affect a developing baby, from a CMV, herpes simplex virus, or toxoplasmosis infection, as these illnesses can cause complications during the pregnancy and may harm the fetus.
It can also be important to rule out EBV infection and to look for other causes of the symptoms. Those with strep throat, an infection caused by group A streptococcus, for instance, need to be identified and treated with antibiotics. A person may have strep throat instead of mono or may have both conditions at the same time.
Several tests for different types and classes of EBV antibodies are available. The antibodies are proteins produced by the body in an immune response to several different Epstein-Barr virus antigens. During a primary EBV infection, the level of each of these EBV antibodies rises and falls at various times as the infection progresses. Measurement of these antibodies in the blood can aid in diagnosis and typically provides the healthcare practitioner with information about the stage of infection and whether it is a current, recent, or past infection.
| Antibody | Timing of when the antibody is typically detected in the blood |
| Viral Capsid Antigen (VCA)-IgM antibody | Appears first after exposure to the virus and then tends to disappear after about 4 to 6 weeks |
| VCA-IgG antibody | Emerges during acute infection with the highest level at 2 to 4 weeks, then drops slightly, stabilizes, and is present for life |
| Early Antigen (EA-D) antibody | Appears during the acute infection phase and then tends to disappear; about 20% of those infected will continue to have detectable quantities for several years after the EBV infection has resolved. |
| Epstein-Barr Nuclear Antigen (EBNA) antibody | Does not usually appear until the acute infection has resolved; it develops about 2 to 4 months after the initial infection and is then is present for life. |
LOINC Observation Identifiers Names and Codes (LOINC®) is the international standard for identifying health measurements, observations, and documents. It provides a common language to unambiguously identify things you can measure or observe that enables the exchange and aggregation of clinical results for care delivery, outcomes management, and research.
Listed in the table below are the LOINC with links to the LOINC detail pages. Please note when you click on the hyperlinked code, you are leaving Testing.com and accessing Loinc.org.
| LOINC | LOINC Display Name |
|---|---|
| 31372-6 | EBV nuclear Ab Qn (S) |
| 22296-8 | EBV nuclear Ab Ql (S) |
| 20432-1 | EBV nuclear Ab IF Ql (S) |
| 22297-6 | EBV nuclear Ab (S) [Titer] |
| 21260-5 | EBV nuclear Ab IF (S) [Titer] |
| 31374-2 | EBV nuclear IgG Qn (S) |
| 30083-0 | EBV nuclear IgG IA Qn (S) |
| 40753-6 | EBV nuclear IgG IF Qn (S) |
| 7883-2 | EBV nuclear IgG Ql (S) |
| 5156-5 | EBV nuclear IgG IA Ql (S) |
| 5155-7 | EBV nuclear IgG IF Ql (S) |
| 22298-4 | EBV nuclear IgG (S) [Titer] |
| 12212-7 | EBV nuclear IgG IF (S) [Titer] |
| 24007-7 | EBV early IgG Qn (S) |
| 22295-0 | EBV early IgG Ql (S) |
| 40752-8 | EBV early IgG IA Ql (S) |
| 6814-8 | EBV early IgG IF Ql (S) |
| 23971-5 | EBV early IgG (S) [Titer] |
| 23995-4 | EBV early IgG IF (S) [Titer] |
| 22293-5 | EBV early Ab Qn (S) |
| 16823-7 | EBV early Ab IA Qn (S) |
| 7882-4 | EBV early Ab Ql (S) |
| 5153-2 | EBV early Ab IA Ql (S) |
| 5154-0 | EBV early Ab IF Ql (S) |
| 22294-3 | EBV early Ab (S) [Titer] |
| 14083-0 | EBV early Ab IF (S) [Titer] |
| 50969-5 | EBV early diffuse IgG Qn (S) |
| 59183-4 | EBV early diffuse IgG Ql (S) |
| 47434-6 | EBV early diffuse Ab Ql (S) |
| 13236-5 | EBV early diffuse Ab IF Ql (S) |
| 30137-4 | EBV capsid IgM spec 2 Ql (S) |
| 7886-5 | EBV capsid IgM Qn (S) |
| 5159-9 | EBV capsid IgM IA Qn (S) |
| 30340-4 | EBV capsid IgM Ql (S) |
| 24115-8 | EBV capsid IgM IA Ql (S) |
| 40751-0 | EBV capsid IgM IF Ql (S) |
| 20491-7 | EBV capsid IgM (S) [Titer] |
| 5160-7 | EBV capsid IgM IF (S) [Titer] |
| 32843-5 | EBV capsid IgG spec 1 Qn (S) |
| 32828-6 | EBV capsid IgG spec 1 IA Qn (S) |
| 32845-0 | EBV capsid IgG 1st specimen/2nd specimen (S) [Ratio] |
| 32830-2 | EBV capsid IgG 1st specimen/2nd specimen IA (S) [Ratio] |
| 32844-3 | EBV capsid IgG spec 2 Qn (S) |
| 32829-4 | EBV capsid IgG spec 2 IA Qn (S) |
| 30136-6 | EBV capsid IgG spec 2 Ql (S) |
| 69949-6 | EBV capsid IgG avidity IA Ql (S) |
| 81119-0 | EBV capsid IgG avidity IA (S) [Ratio] |
| 7885-7 | EBV capsid IgG Qn (S) |
| 5157-3 | EBV capsid IgG IA Qn (S) |
| 30339-6 | EBV capsid IgG Ql (S) |
| 24114-1 | EBV capsid IgG IA Ql (S) |
| 40750-2 | EBV capsid IgG IF Ql (S) |
| 20490-9 | EBV capsid IgG (S) [Titer] |
| 5158-1 | EBV capsid IgG IF (S) [Titer] |
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