Search for Anti-EA(D) Antibodies in Subjects with an “Isolated VCA IgG” Pattern

Massimo De Paschale,Teresa Cerulli,Arianna Gatti,Maria Teresa Manco,Pierangelo Clerici,Debora Cagnin,Carlo Agrappi,Cristina Rescaldani,Paola Mirri

doi:10.1155/2010/695104

Massimo De Paschale, Teresa Cerulli + Show 7 more

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https://doi.org/10.1155/2010/695104

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Abstract

The presence of an “isolated viral capsid antigen (VCA) IgG” pattern in serum is not easy to interpret without the aid of further tests, such as specific immunoblotting or a virus genome search, that often give rise to organisational and economic problems. However, one alternative is to use an enzyme-linked immunosorbent assay (ELISA) to detect anti-early antigen (EA) antibodies, which can be found in about 85% of subjects with acute Epstein-Barr virus (EBV) infections. The purpose of this work was to search for anti-EA(D) antibodies in 130 samples with an isolated VCA IgG pattern at ELISA screening and classified as being indicative of past (102 cases) or acute (28 cases) infection on the basis of the immunoblotting results. Thirty-seven samples (28.5%) were positive for anti-EA(D), of which 25 (89.3%) had been classified by immunoblotting as indicating acute and 12 (11.8%) past EBV infection. This difference was statistically significant (P < .01). The results of our search for anti-EA(D) antibodies correctly identified nearly 90% of acute (presence) or past EBV infections (absence). When other tests are not available, the search for anti-EA antibodies may therefore be helpful in diagnosing patients with an isolated VCA IgG pattern at screening tests.

Highlights

The most common manifestation of primary Epstein-Barr virus (EBV) infection is acute infectious mononucleosis, a self-limited clinical syndrome that most frequently affects adolescents and young adults
One alternative is to use an enzyme-linked immunosorbent assay (ELISA) to detect anti-early antigen (EA) antibodies, which can be found in about 85% of subjects with acute Epstein-Barr virus (EBV) infections
The presence of viral capsid antigen (VCA) IgG and VCA IgM in the absence of EBNA-1 IgG is indicative of acute infection, whereas the presence of VCA IgG and EBNA-1 IgG in the absence of VCA IgM is typical of past infection

Summary

Introduction

The most common manifestation of primary Epstein-Barr virus (EBV) infection is acute infectious mononucleosis, a self-limited clinical syndrome that most frequently affects adolescents and young adults. The picture is made even more complicated by the fact that 5% of patients produce no EBNA IgG after EBV infection [5, 6] and, even when it is produced, it may be lost over time especially in the case of immunosuppression [5, 7, 8] In such cases, in addition to following up the patient in order to evaluate possible variations in antibody titres, it is useful to perform further laboratory tests such as immunoblotting for various specific IgG antibodies, a VCA IgG avidity test, or searches for heterophile antibodies or viral genome using molecular biology techniques [9]. Immunoblotting [13] using recombinant antigens such as p72 (EBNA-1), p18 (VCA), p23 (VCA), p54 (EA), p138

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