EBV lab result question

I've been feeling worn down since mid-August when I had a really bad cough and fatigue which was diagnosed as a viral URI.  I had labs done this week to find out if there was anything else contributing to the tiredness, and I'm trying to wrap my head around the following results (any help would be greatly appreciated!):

EBV VCA (IgM) = < .90 Negative
EBV VCA (IgG) = 3.46 H High
EBV (EBNA) (IgG) = < .90 Negative

The message I got from the provider was that this is suggestive of a recent EBV infection.  

Since the EBV EBNA value is low, does that mean it's VERY recent, and this value just hasn't showed up yet?  And for the VCA IgG how high is "High"???

Thanks,
Stellah

[Joni686]

In general, rising VCA-IgG levels tend to indicate an active EBV infection, while falling concentrations tend to indicate a recent EBV infection that is resolving. However, care must be taken with interpreting EBV antibody concentrations as the amount of antibody present does not correlate with the severity of the infection or with the length of time it will last. High levels of VCA-IgG may be present and may persist at that concentration for the rest of your life.

Below, results are provided in table form.

Test results most likely indicate the following:
EBV ANTIBODY TEST
SUSCEPTILE TO EBV
CURRENT EBV INFECTION
PAST EBV INFECTION
COMMENTS
VCA-IgM
+
+
Appears first, gone in 4-6 weeks
VCA-IgG – + + If negative susceptible, it appears within a week of infection, then present for life
EBNA-IgG

+ Becomes positive in 2 – 4 months, then present for life
EA-D IgG + + Positive in about a week, usually gone in 2 weeks, persists in 20% of people
Heterophile IgM (Mono test) + Associated with Mono, false positives with other conditions, false negatives common in children
^ Back to top

Is there anything else I should know?
There are at least two other antibodies that arise during an EBV infection - 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.

[sporque]

I'm sorry..These test results are of little diagnostic value. Like your provider said "they are suggestive".  The reason is because the primary clinical manifestation of EBV is mononucleosis..And that manifestation only happens in a percent of people as it is.  There's no way to do a retro test to see if you had Mono at the time..The mononucleosis diagnosis is made in part by symptoms as well..Fatigue alone, with EBV antibodies show, or prove nothing more then you've been infected with EBV like the rest of the population..

[sporque]

I guess a better way to put it is there's no way to say whether or not this is the cause of your fatigue..It could be a possibility your recovering from mononucleosis it may not be..There's no way to tell other then continuing to rule out other causes and keep on watchful eye on anything changing or new.

[stellahgreen]

Thanks for your comments.  I'm glad to know I wasn't missing something with the results there!  I'll get some extra rest and see if the tiredness passes.  The labs also showed a couple of vitamin deficiencies (D & B12), which I'm addressing with supplements.  Either way, I'm hoping to bounce back soon.

[9DodgeFan]

Hi, it sounds like you're taking very good steps toward helping yourself recover from this (extra rest, vitamins).  However, I'm just wondering, did your doctor have you take a monospot test?  I find it kind of strange that he wouldn't test for that, especially considering that the results suggest a recent infection.  Either way, hope you start feeling better soon!

[stellahgreen]

She didn't recommend the monospot test.  She recommended all the vitamins to address the mineral deficiencies, and told me to rest a lot to address the recent URI, which would also help with the EBV infection. Should I request the monospot?  Will it help me know if the infection was recent?

Thanks for your help!

[sporque]

the monospot would be negative..It's only positive during the acute part of the illness.

[Joni686]

In general, rising VCA-IgG levels tend to indicate an active EBV infection, while falling concentrations tend to indicate a recent EBV infection that is resolving. However, care must be taken with interpreting EBV antibody concentrations as the amount of antibody present does not correlate with the severity of the infection or with the length of time it will last. High levels of VCA-IgG may be present and may persist at that concentration for the rest of your life.

Below, results are provided in table form.

Test results most likely indicate the following:
EBV ANTIBODY TEST
SUSCEPTILE TO EBV
CURRENT EBV INFECTION
PAST EBV INFECTION
COMMENTS
VCA-IgM
+
+
Appears first, gone in 4-6 weeks
VCA-IgG – + + If negative susceptible, it appears within a week of infection, then present for life
EBNA-IgG

+ Becomes positive in 2 – 4 months, then present for life
EA-D IgG + + Positive in about a week, usually gone in 2 weeks, persists in 20% of people
Heterophile IgM (Mono test) + Associated with Mono, false positives with other conditions, false negatives common in children
^ Back to top

Is there anything else I should know?
There are at least two other antibodies that arise during an EBV infection - 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.

[stellahgreen]

Hi Joni686,

This is so very helpful!  From your notes above, it looks like the key points are:

-infection was probably at least 4-6 weeks old at time of test due to IgM being absent
-IgG indicates infection may have been recent or long term
-If a follow-up test is done and EBNA-IgG finally shows up, it may suggest that the infection occurred fairly recently (within 2-4 months).  Also, I read that ~10% of infected population never tests positive for this one...

Thanks, I appreciate all the knowledgeable folks chiming in!

stellah

[stellahgreen]

Thanks for the tip on the monospot test.  I wasn't sure which antibody this addressed, and whether or not to pursue it.  Glad to have clarity on it!

[Joni686]

You're welcome Stellah.  I'm glad I could help.
Just thought I would tell you I have some experience with this.  I evidently had mono at some point in my life and didn't know it.  I also had chicken pox when I was a child and the mumps.  Well, I am 48 now and i have had the diagnosis of lupus for three years.  If I am checked for viral infections I come back positive for EBV, Chicken Pox, Measles, (not mumps which is weird) and cytomeglovirus which goes with EBV.  My immune system is so confused.  I have none of those presently.  Interesting huh?
Joni

[stellahgreen]

Very interesting, indeed!  How is your day to day life going, in light of all of this?

[Joni686]

It has changed my life completely.  Three years ago I had to quit a job I loved and stay home.  It began with fatigue and I thought I was just worn out so I was drinking 2-3 Starbucks a day to keep going.  One day I was out showing a house ( I worked in a model home for a builder ) and I realized I could not walk up those stairs no matter what.  I played oit off and told the buyer to go on and look around while I turn lights on downstairs.  The next day I gave in and called a doctor.  One thing led to another and I had to take a 30 day leave being told I had Mono.  Then when it didn't go away I went doctor to doctor until I found a very good Neurologist in the Medical Center that did a full viral panel and found a positive ANA which means an autoimmune disease.  It took about eight to get a lupus diagnosis.  Now I take it day by day.

[stellahgreen]

Wow, that's intense.  I don't know much about lupus, but I wold imagine it would involve being very vigilant about taking care of yourself, lifestyle, etc. I have a good friend with RA, and she has pretty specific treatment strategies in place to manage her wellness & flares.

[VforVictorious]

OMG, I've often had low D & B12 levels too! I wonder if this could be another way to help diagnose it. How many other people have had low levels of these 2 as well? I often have had to take high doses of D too for 10 wks I take 50,000 iu's of D ea wk in 1 pill. It seemed to help. The B vits make me soooooo thirsty that I can only take every other day. I also had low calcium levels. I just always thought these were low cuz of some other meds I take that were leaching the vitamins out of my system. But if it could be EBV doing this during active states, then I wonder how common this is? Can anyone who's had low B12 & D levels leave a comment, so I can hopefully get an idea of how common this is? I tend to accumulate date like this ( I do research) & it often helps my dr to figure things out. Since not a lot is known about EBV it may help to get an idea of this.

[stellahgreen]

I just did a quick Google of Vitamin D deficiency and EBV, and there were lots of entries that came back.  One from Dr. Oz's website was interesting, stating that over 76% of his audience tested was Vitamin D deficient. . . http://www.drozfans.com/dr-ozs-advice/dr-oz-epstein-barr-virus-is-contagious-exhausting-deadly/

I'm on the 50,000 iu weekly of Vit D, as well, plus 1,000 mcg Vitamin B12 daily.  I'm beginning to feel like getting off the couch a bit more now, but I still nap pretty much every day, even when rested.  Some of that might also be related to frequent work travel.  It's hard to keep a regular schedule away from home.

[thanksgiving]

My D levels were also low, and my ortho doc said everybody in my state (ga.) has low
D.Everybody I know that has been tested, my husband who does construction and is outside a lot, was low, my son's who is 34 was very low. But it definitely did make me feel better, didn't believe that it would make that much difference.