Epstein-Barr Virus Serology: Markers & Interpretation

Instructor: Lori Haag

Lori has teaching experience in the health care setting. She has an associate's degree in Nursing and a bachelor's degree in Psychology.

In this lesson you will learn about the Epstein-Barr virus, serological markers indicative of infection, and how to interpret them. You will also learn about other abnormal lab values that may coexist with EBV infection.

Chloe Can't Go

Chloe was desperately trying to pay attention to her math teacher, but she could barely keep her head up. She had been feeling so tired lately, and no matter how much coffee she drank, it didn't help. She had noticed that her throat was beginning to feel a little scratchy, so she had been sucking on cough drops all day hoping that would make it go away. Chloe was determined not to get sick. That weekend she had a date with Zach, one of the hottest guys in her school.

By the end of the day, Chloe felt awful. Her throat was on fire. Her neck seemed like it was swollen, and she just wanted to go home and go to bed. She thought she might be running a slight fever, too. When the bus dropped her off after school, Chloe crawled into bed and immediately fell asleep.

Chloe was not feeling any better the next morning, so her mom took her to the medical clinic. The doctor did a thorough physical exam, taking note of her slightly elevated temperature, swollen lymph nodes in her neck, and the exudate in the back of her sore throat. ''I believe you have mono,'' said the doctor, ''but I would like to draw some blood just to make sure.''

Chloe's laboratory tests revealed that she did indeed have mono. Needless to say, Chloe was not able to go on her date.

The Epstein-Barr Virus can cause mononucleosis.

The Epstein-Barr Virus

Mononucleosis or ''mono'' is an infection caused by the Epstein-Barr virus (EBV). The Epstein-Barr virus is one of the herpes viruses and occurs only in humans. It can affect people of all ages, but infection with the typical clinical manifestations of fatigue, sore throat, lymphadenopathy, and fever usually occurs in adolescents and young adults.


Antigens are foreign substances or toxins that can cause illness in a person. In the event of an infection caused by the Epstein-Barr Virus, antibodies to the viral capsid antigen (VCA), the early antigen (EA), and the EVB nuclear antigen (EBNA) will be present in the blood.


The first antibody to appear in the blood is the anti-VCA IgM. Detection of this antibody is generally indicative of a primary EBV infection, especially since antibodies to the EBNA do not appear during the acute phase of an illness.

The anti-VCA IgG antibody appears during the acute phase of an EBV infection. This antibody usually peaks at around 2-4 weeks. It then decreases, but remains present in the body for the rest of one's life. When no antibody to EBNA is present, the presence of anti-VCA IgM and rising levels of anti-VCA IgG strongly suggest a primary infection. People who do not have antibodies to the viral capsid antigen (VCA) are considered susceptible to the virus because they have no immunity.

Anti-EA IgG also occurs during the acute phase of infection and may become undetectable after 3-6 months. The presence of this antibody may indicate an active infection, but up to 20% of healthy people may have anti-EA IgGs for years.

The EBNA antibody begins to appear two to four months after the onset of an EBV infection. It is not present during the acute phase of illness. This antibody also persists for the rest of a person's life. The presence of EBNA antibodies and both VCA antibodies suggests a past infection.

White blood cell counts may be elevated during EBV infections.
White Blood Cells

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