Serologic Antibody Patterns


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EBV_titer_patterns.png


No Infection-
Primary Acute Infection-
Established Infection---
Convalescence-----
Past (remote) Infection--
Heterophile Ab-----
(monospot)))

+
+
Decreasing

VCA-IgM
(viral capsid antigen)
0 or <1:10
+ >1:10
+ or >1:10
Decreasing
0 or ≤1:10
VCA-IgG
(viral capsid antigen)
0 or <1:10
– (+ early)
+ or >1:10
Increasing
+ or ≥1:10
EA-IgM
(early antigen anti-D)

+
+
Decreasing

EA-IgG
(early antigen anti-D)

– (+ early)
+
Decreasing
+
EBNA-IgG
(Epstein-Barr nuclear antigen)
0 or <1:5
0 or <1:5
0 or <1:5
Increasing
+ or ≥1:5

EBV Infection Status
-----IgM-VCA-----
-----IgG-VCA-----
-----EBNA-----
-----Anti-EA-----
No current or prior EBV infection




Acute primary EBV infection
++
++++

++
Recent past EBV infection (<6 mo)
+
+++

++
Convalescent/post-EBV infection

+++
+
±
Chronic or reactivation infection
±
++++
±
+++
EBV-associated malignancies

++++
±
+++


Note:
  • Acute primary EBV infection is indicated by ≥1 of these serologic findings:
    • IgM-VCA that is found early and later declines
    • High titer (≥1:320) or ≥4× rise in IgG-VCA titer during the illness
    • Transient rise in anti-D titer (≥1:10)
    • Early IgG-VCA without EBNA and later appearance of EBNA
  • Acute or primary EBV infection is excluded when IgG-VCA and EBNA titers are unchanged in acute and convalescent serum samples.
  • Current or recent infection is indicated by IgM anti-VCA or IgM/IgG early antigen with low or absent EBNA antibodies.
  • Persistence of early antigen and IgG-VCA in high titer indicate chronic EBV infection.


References