EBV test results - significant?

[keepswimming]

Hi all,

I have been searching through past posts to try to understand my test results for EBV, but it's a little confusing! I want to know if my results have any significance... To give you the background, I had EBV back in January of this year. It's left me with fatigue which doesn't seem to be improving, which is why I am investigating CFS.

My results are:

IgG - Detected
EBNA - Detected
IgM - Detected but not strong
PCR - Negative

From some posts I've read on here I drew the conclusion that it can be quite common for people with CFS to test positive for antibodies, but negative for an active infection - have I got this right? So on that basis I wondered if these results have any significance - or if they are just normal after having an infection ten months ago.

My doctor has just said the antibodies are still there from when I had the infection, and has told me to go back in January (when it's been a year since having EBV) if I'm still not better. But I wondered if there were any different views on this.

I will be interested to hear people's opinions and experiences... Thank you.

 

[Tammy]

What I think is significant is that you havn't felt well since getting EBV in January. EBV isn't always running around in the bloodstream where it can be detected as active infection. It can go into your liver, spleen, CNS and even glands and still cause continuing symptoms. EBV can be at the root cause of CFS for many.

 

[Hip]

Dr Martin Lerner says ME/CFS patients have an active EBV infection if there are high antibody levels in the VCA IgM and/or EA IgG diffuse tests. Source: here.

 

[Melissa89]

Dr Martin Lerner says ME/CFS patients have an active EBV infection if there are high antibody levels in the VCA IgM and/or EA IgG diffuse tests. Source: here.

Hi Hip!
I’m going on to my 4th month now and I have similar results to @keepswimming - I just read the article by Dr Martin Lerner.

- EBV EA diffuse: positive 160 (I didn’t even get a reference range so I’m not sure what 160 means!)
- Monospot is positive, blood smear showed a moderate amount of atypical lymphocytes. HIGH monocytes & lymphocytes.
- EBV iGM: positive
- EBV iGg: positive
- EBNA: Negative
- PCR: not detected

(These tests were repeated 4 times to avoid the possibility of false positives & I do keep coming back with the same results from different labs - so I’m certain the beast I’m fighting is EB)

Should I be concerned that EBNA is still negative? The doctors haven’t said too much re: that. Just that I’m on the road to recovery and not to worry. Looking for some advice My original concern was CAEBV but now that the PCR is negative I am a bit relieved.

 

[keepswimming]

Dr Martin Lerner says ME/CFS patients have an active EBV infection if there are high antibody levels in the VCA IgM and/or EA IgG diffuse tests. Source: here.

Thanks so much for that link Hip, I've read through it and it was really helpful and interesting

 

[Hip]

Should I be concerned that EBNA is still negative?

I don't know enough about EBV to answer that.

My original concern was CAEBV but now that the PCR is negative I am a bit relieved.

If PCR is negative, then you do not have a traditional active EBV infection.

But the EBV infections in ME/CFS are usually not of this traditional type, and if you satisfy the criteria given by Dr Lerner, then he would usually treat with Valtrex (if you only have EBV), or Valcyte (if you have EBV plus other herpesvirus infections of cytomegalovirus or HHV-6).

 

[Melissa89]

@Hip thank you so much! I’ve checked for cmv but only the igg was positive. I’ll have a look at hhv-6 antibody testing as well

 

[Hip]

I’ve checked for cmv but only the igg was positive.

How positive? What was your cytomegalovirus IgG antibody level, and what was the lab report range for negative?

 

[Melissa89]

How positive? What was your cytomegalovirus IgG antibody level, and what was the lab report range for negative?

They don’t tell us anything over here - they just said CMV was active in the past. And ebv is now active.

I haven’t received any levels or titres. Just positive or negative.

 

[Hip]

I haven’t received any levels or titres. Just positive or negative.

Did you get a copy of your lab test report? It's on that you will see antibody levels, either expressed as an index number or expressed as a titer (titers are numbers like 1:320),

 

[Art Vandelay]

Did you get a copy of your lab test report? It's on that you will see antibody levels, either expressed as an index number or expressed as a titer (titers are numbers like 1:320),

Australian labs generally don't report viral titers. They just say whether it's positive or negative.

 

[Tella]

Did you get a copy of your lab test report? It's on that you will see antibody levels, either expressed as an index number or expressed as a titer (titers are numbers like 1:320),

In England they just say positive or negative too

 

[Hip]

In England they just say positive or negative too

I probably depends on the lab. When I got tested for EBV at The Doctor's Laboratory in London, they provided my antibody levels as index numbers.

 

[Tella]

I probably depends on the lab. When I got tested for EBV at The Doctor's Laboratory in London, they provided my antibody levels as index numbers.

Could u share what’s considered high?

 

[Hip]

Could u share what’s considered high?

For IgM antibodies, the threshold for positive (for an active infection) is given on the lab report. If you are above the threshold, and the lab report says "results suggest an active primary or reactivated infection" or words to that effect, then it indicates active infection.


For IgG antibodies it's more complicated, and for ME/CFS purposes, the threshold for an active infection you cannot get from your lab report.

It's only individual ME/CFS doctor's that have that IgG threshold info. And the threshold depends on the lab used, as it changes from lab to lab (each lab uses its own numerical range).

But as a very rough guide, I have suggested here that if your IgG antibodies levels are at least 16 times higher than the IgG threshold level for negative written in your lab test report, that is an indication of a chronic active infection.

So for example, if the lab IgG threshold for negative is say < 3.0 U/ml, then an active infection would be if your antibodies levels are 48 U/ml or higher (because 16 x 3 = 48).


Dr Martin Lerner says ME/CFS patients have an active EBV infection if there are high antibody levels in the VCA IgM and/or EA IgG diffuse tests.

So for the VCA IgM antibodies, you just use the threshold for positive given on the lab report.

Just what "high" means in the EA IgG diffuse test is not clear. Dr Martin Lerner did not provide any details in his published articles or studies. But you can use the 16 times rule to get a rough idea.

 

[Hip]

By the way, for coxsackievirus B and echovirus, it is much easier, we know the precise threshold for a positive infection, as Dr Chia has provided those figures: on the ARUP lab tests for CVB and echovirus, antibody titers of 1:160 or higher indicate a chronic active infection, according to Dr Chia's research. Details in the mini roadmap.

 

[Tella]

For IgM antibodies, the threshold for positive (for an active infection) is given on the lab report. If you are above the threshold, and the lab report says "results suggest an active primary or reactivated infection" or words to that effect, then it indicates active infection.


For IgG antibodies it's more complicated, and for ME/CFS purposes, the threshold for an active infection you cannot get from your lab report.

It's only individual ME/CFS doctor's that have that IgG threshold info. And the threshold depends on the lab used, as it changes from lab to lab (each lab uses its own numerical range).

But as a very rough guide, I have suggested here that if your IgG antibodies levels are at least 16 times higher than the IgG threshold level for negative written in your lab test report, that is an indication of a chronic active infection.

So for example, if the lab IgG threshold for negative is say < 3.0 U/ml, then an active infection would be if your antibodies levels are 48 U/ml or higher (because 16 x 3 = 48).


Dr Martin Lerner says ME/CFS patients have an active EBV infection if there are high antibody levels in the VCA IgM and/or EA IgG diffuse tests.

So for the VCA IgM antibodies, you just use the threshold for positive given on the lab report.

Just what "high" means in the EA IgG diffuse test is not clear. Dr Martin Lerner did not provide any details in his published articles or studies. But you can use the 16 times rule to get a rough idea.

Thanks a lot. Trying to figure out something for another person, translating test results into English it says:
Anti-ebv igg-ea: negative
Anti-ebv igg-ebna positive (coefficient positivity 17.02). Doesn’t give a range.
Anti-ebv igm: negative.

this only means a past infection doesn’t it? Not sure what this 17.02 mean?

 

[Hip]

Anti-ebv igg-ea: negative
Anti-ebv igg-ebna positive (coefficient positivity 17.02). Doesn’t give a range.
Anti-ebv igm: negative.

If the last of those three items means the EBV VCA IgM, then yes it would be a negative result for chronic active infection, by Dr Lerner's standards.

Note that in EBV testing:
EA = early antigen
VCA = virus capsid antigen (also denoted by CA)
EBNA = Epstein-Barr nuclear antigen

 

[Tella]

If the last of those three items means the EBV VCA IgM, then yes it would be a negative result for chronic active infection, by Dr Lerner's standards.

Note that in EBV testing:
EA = early antigen
VCA = virus capsid antigen (also denoted by CA)
EBNA = Epstein-Barr nuclear antigen

Thanks so much

 

[Garz]

its also worth noting that there is significant cross reactivity in serological testing between EBV and Borrelia Burgdorferi

such that with serological testing alone it can be very difficult to differentiate the two
there is also significant symptom overlap

PCR testing ( PCR is not great for lyme but is pretty good for active viral infections ) could be used to help differentiate