ANA/EBV panel results help

[SwanRonson]

My G.I. specialist did a lot of testing and two came back abnormal (EBV and ANA) :

EBV AB to VIRAL CAPSID AG, IGG Result: 373 (range: 0-22)
EBV AB to VIRAL CAPSID AG, IGM Result: <10 (range: 0-44)
EBV AB to NUCLEAR AG, IGG Result: 478 (range: 0-22)
EBV AB to EARLY (D) AG, IGG Result: 5.2 (range: 0-11)

He said he thinks that IGG indicates prior infection vs. IGM would indicate active infection, but he wasn't positive. I did have a pretty bad cased of mono as a teenager.

On the ANA test it just says "Result: equivocal" and status is "Abnormal". There is no explanation listed and he didn't mention it. Shouldn't that require more followup testing?

Everything else was fine: AAT, liver, copper, smooth muscle, mitochondrial, ceruplasmin, alk phos, ammonia

Thanks for any help!

 

[Ema]

The Early Antigen is the one that differentiates between a reactivated and a past infection. Your EA is not elevated, so I would say these represent a past infection as well.

ANA is nonspecific. All you can do is test for autoantibodies in areas that present symptoms (thyroid, for example). You could do the Cyrex labs autoimmunity profile as it is much more sensitive and comprehensive but it's also quite expensive.

 

[halcyon]

Sounds like just an ANA screen test. What you'll possibly want to follow that up with, given the equivocal result, is an IFA titer reflex test. This will report a titer and also a specific pattern which can be useful to determine what specific type of antibodies might be present.

 

[Oredogg]

Hi there. The ANA result report is a bit confusing. The gold standard approach for ANA testing, I believe the method endorsed by American College of Rheumatology, is the older immunofluorescence assay (IFA). This should result in an ANA reported as a titer... 1:40, 1:80, etc.. Different labs have different cut-offs for what titer is considered 'positive'. In addition, the anti-nuclear fluorescence pattern sometimes can provide clues as to the underlying pathology. You may have had the test done as an ELISA. I don't have as much experience with that platform, and it may be just fine, though have heard anecdotal stories of true positives that were missed on ELISA. Might be worthwhile looking into how that test was performed. Personally, I would want my ANA performed by immunofluorescence at a large, reputable lab that performs these regularly.

 

[SwanRonson]

Thanks for those replies. He GI ordered the test so would it best to get a referral to a rheumatologist or immunologist for further testing?

 

[minkeygirl]

Try to get a referral to a clinical immunologist if possible. I've seen 2 allergist /immunologists and they are completely uninterested in anything else that is going on with me re: viruses etc.

The current one is willing to rx immunoglobulin if I get a cognitive assessment. Yes. What does that have to do with my immune system?

I'm hoping to get a referral to an infectious disease doc.

 

[Oredogg]

I think a decent rheumatologist would be a great thought as well. They'd likely have set laboratories they use for reliable and high quality testing, including IFA ANA, and they'd be familiar with how to interpret the results.

 

[soxfan]

I saw Dr. Komaroff in Boston a few years back and he did the same testing. He also told me that EA is the one that represents present infection or reactivation.

I also had extremely high IgG levels and according to him it meant past infection even though I have never had mono in my life...I think I was probably exposed at some point when my son had it but I never actually came down with the infection.

But then again I also had a positive ELISA and he said it meant nothing....

 

[Eeyore]

Your EBV test just shows that you are positive for the virus. The vast majority of the adult population is - probably between 95% and 100%. You do not show signs of a new EBV infection. You show normal signs of antibodies against EBV, indicating immune exposure and control of the virus. There are some studies that suggest that ME patients may have an impaired response to EBV in that they have elevated VCA IgG titers but low or absent EBNA titers - this might reflect an impaired immune response to EBV. You, however, do not have this pattern. As should happen with a long term EBV infection, you have antibodies both to the VCA (Viral Capsid Antigen - the outside of the virus) and EBNA (Epstein-Barr Nuclear Antibody - some other protein or something that EBV makes, not really sure, but important for long term control of the virus).

Thus your EBV testing looks normal to me. You are positive for the virus, but that's also "normal" - most people are. Remember, herpes viruses are for life, always. There is no such thing as past infection or past exposure leading to antibody response but no current infection. A new infection would be accompanied generally by increased IgM and EA (early antigen). You don't have these, suggesting the infection is not new. Reactivation an also cause an elevation in these - but not necessarily. Either way, your tests show no evidence of reactivation. If the titers increased significantly versus a baseline, that *might* be something one could interpret as a sign of reactivation, but it could also just be random fluctuation or a generalized, polyclonal immune activation.

An equivocal ANA may mean nothing, or it could be a sign of autoimmune disease. A substantial portion of the healthy population has low-positive ANA test results and no resulting disease. If you want to be sure, you can repeat the test at a later time. If you persistently test equivocal, it could just be that you're in the 5% or so of the population that has elevated ANA w/o consequence. Tests should never be interpreted in the absence of clinical signs and symptoms - if you have other symptoms of autoimmune disease, an equivocal ANA is more concerning. It could still, however, be a red herring. Interpretation is tricky in these cases, and you should ask a rheumatologist if you are concerned. Equivocal is just that - we can't tell just from the test if there is a problem.

While healthy controls can have sometimes have elevated ANA titers, it's uncommon or even perhaps very rare to see extremely elevated ANA titers in healthy controls.

 

[Eeyore]

I would also consider testing for system markers of inflammation, such as CRP, ESR, and ferritin. Many (but not all) rheumatic diseases show elevations in these systemic inflammatory markers.

ME frequently shows very low ESR. I know some people here report elevated ESR with ME, and I can't explain that. In general though, most ME practitioners, and Medscape, suggest that an elevated ESR is not consistent with ME - and in fact, anything but a very low ESR (0-3) should cause one to suspect another condition besides ME.

CRP is generally a better marker of cytokine-mediated inflammatory conditions - but both are useful, as is ferritin. They can each be elevated or reduced to different degrees in different disorders.

Based on symptoms, there are other, more specific tests that can be ordered for autoantibodies. Generally you don't run them all - you try to figure out clinically what you suspect and order relevant tests. Reference ranges are not absolutes, and diagnosis is as much an art as a science - test results must always be correlated with clinical signs and symptoms, and testing randomly for everything will tend to yield false positives that don't mean anything (normal variants). If a test really reflects a problem, there should be a symptoms or sign or something else you can look at clinically that makes a given diagnosis seem likely. Obviously this isn't completely true for all tests - some serological tests can find illnesses long before there are clinical signs or symptoms (e.g. HIV testing), but rheumatology is much more nuanced. Doctors are looking for patterns that make sense rather than a single test result that is increased (especially if it's not persistent or only borderline abnormal).

 

[Eeyore]

@SwanRonson

I should add that elevated ANA is NOT something that would generally be caused by ME. Mine is normal and has always been so when tested.

Many members of this forum, however, DO have elevated ANA. Many here believe that there is an autoimmune component to ME, or perhaps some ME but not all ME - and this does make sense, and offers a plausible mechanism for the self-perpetuating cycle of the disease.

Still, an elevated ANA is not something that you should assume is ME-related. Most ME patients have normal ANA.