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World J Virol . Feb 12, 2012; 1(1): 31-43
Published online Feb 12, 2012. doi: 10.5501/wjv.v1.i1.31
Serological diagnosis of Epstein-Barr virus infection: Problems and solutions
Massimo De Paschale, Pierangelo Clerici
Massimo De Paschale, Pierangelo Clerici, Microbiology Unit, Hospital of Legnano, 20025 Legnano (MI), Italy
Author contributions: De Paschale M and Clerici P solely contributed to this paper.
Correspondence to: Massimo De Paschale, PhD, Microbiology Unit, Hospital of Legnano, Via Giovanni Paolo II, 20025 Legnano (MI), Italy.
Telephone: +39-331-449319 Fax: +39-331-449758
Received: July 27, 2011
Revised: October 19, 2011
Accepted: October 28, 2011
Published online: February 12, 2012

Serological tests for antibodies specific for Epstein-Barr virus (EBV) antigens are frequently used to define infection status and for the differential diagnosis of other pathogens responsible for mononucleosis syndrome. Using only three parameters [viral capsid antigen (VCA) IgG, VCA IgM and EBV nuclear antigen (EBNA)-1 IgG],it is normally possible to distinguish acute from past infection: the presence of VCA IgM and VCA IgG without EBNA-1 IgG indicates acute infection, whereas the presence of VCA IgG and EBNA-1 IgG without VCA IgM is typical of past infection. However, serological findings may sometimes be difficult to interpret as VCA IgG can be present without VCA IgM or EBNA-1 IgG in cases of acute or past infection, or all the three parameters may be detected simultaneously in the case of recent infection or during the course of reactivation. A profile of isolated EBNA-1 IgG may also create some doubts. In order to interpret these patterns correctly, it is necessary to determine IgG avidity, identify anti-EBV IgG and IgM antibodies by immunoblotting, and look for heterophile antibodies, anti-EA (D) antibodies or viral genome using molecular biology methods. These tests make it possible to define the status of the infection and solve any problems that may arise in routine laboratory practice.

Keywords: Epstein-Barr virus infection, Serology, Immunoblotting, Avidity IgG, Epstein-Barr virus-DNA