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Real-Time Epstein-Barr Virus PCR for the Diagnosis of Primary EBV Infections and EBV Reactivation

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Abstract

Background: The serological diagnosis of primary Epstein-Barr virus (EBV) infections is often difficult, whereas the relevance of elevated immunoglobulin G (IgG) antibodies against early antigen (EA) for the diagnosis of EBV reactivation has increasingly become a matter of dispute. Recently, EBV PCR has been added as a diagnostic tool. Positive EBV PCR has been demonstrated in the serum of patients with primary EBV infections and EBV reactivation.

Objectives: To compare classical serological diagnosis of primary EBV infection and EBV reactivation with real-time EBV PCR.

Study design: Sera from 45 patients were selected with detectable immunoglobulin M (IgM) antibodies against EBV viral capsid antigen (VCA), and 62 sera were selected with a reactivation profile. A real-time EBV PCR was performed with DNA extracted from these sera.

Results: Based on serological data, the diagnosis of primary EBV infection was established for 24 of the 45 IgM VCA-positive patients. By performing PCR, seven extra cases of primary infection were diagnosed for which no heterophilic antibodies could be detected. In five cases of primary infection, no EBV DNA could be detected by PCR. Only in two of the 62 sera with a reactivation seroprofile could EBV DNA be detected.

Conclusions: Based on these data, we suggest that for the diagnosis of primary infections, EBV PCR could lead to an increase of >16% in the number of positive diagnoses by confirming a positive IgM VCA in the absence of heterophilic antibodies. Furthermore, EBV PCR is positive in only 3% of sera with elevated antibodies against EA, raising doubt as to the utility of EA titers for diagnosing EBV reactivation.

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Acknowledgements

No sources of funding were used to assist in conducting this study. The authors have no conflicts of interest that are directly relevant to the content of the study.

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Authors and Affiliations

  1. Unit Molecular Diagnostics, Diakonessenhuis Utrecht, Bosboomstraat 1, Utrecht, 3582 KE, The Netherlands

    Rianne Luderer

  2. Department of Medical Microbiology, Diakonessenhuis Utrecht, Utrecht, The Netherlands

    Marieke Kok & Steven F. T. Thijsen

  3. Department of Virology, University Medical Center Rotterdam, Rotterdam, The Netherlands

    Hubert G. M. Niesters

  4. Department of Virology,Eijkman-Winkler Institute for Microbiology, Infectious Diseases and Inflammation, University Medical Center Utrecht, Utrecht, The Netherlands

    Rob Schuurman

  5. Department of Hematology, St Antonius Hospital, Nieuwegein, The Netherlands

    Okke de Weerdt

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  1. Rianne Luderer
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  2. Marieke Kok
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  3. Hubert G. M. Niesters
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  6. Steven F. T. Thijsen
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Correspondence to Rianne Luderer.

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Luderer, R., Kok, M., Niesters, H.G.M. et al. Real-Time Epstein-Barr Virus PCR for the Diagnosis of Primary EBV Infections and EBV Reactivation. CNS Drugs 9, 195–200 (2005). https://doi.org/10.1007/BF03260091

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  • DOI: https://doi.org/10.1007/BF03260091

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