[CIS PIDD] [cis-pidd] EBV infections

[CIS-PIDD]

Hi Cindy, since EBNA only becomes positive during convalescence (and remains so thereafter), is it not possible that she never had a primary EBV infection at all, but a related herpes family or other viral illness with false positive EBV IgM due to cross-reactivity? In a related interesting discussion on this list in 2013 on persistently elevated IgM, Dewton Vasconcelos shared a useful reference: Woods CR. False - positive results for immunoglobulin M serologic results: explanations and examples. J. Ped Infect Dis (2013) doi: 10.1093/jpids/pis I33.

Regards,

Stan Ress
Specialist Physician & Clinical Immunologist,
Emeritus Associate Professor of Medicine, UCT
UCT Private Academic hospital
Observatory, Cape Town
Tel: 021-4421966<tel:021-4421966>/1816
Cell: 0833115482<tel:0833115482>
Fax: 0865173095<tel:0865173095>
Email: Stan.ress at uct.ac.za<mailto:Stan.ress at uct.ac.za>

Sent from my iPhone

On 26 Sep 2016, at 8:52 PM, CIS-PIDD <cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>> wrote:


Greetings,

I recently saw a 14-year-old girl who has had classical/typical EBV infection on 2 occasions (the latter with only an equivocal EBV VCA IgM though).  She is now back to her normal healthy state.  Past medical history is otherwise notable only for mild persistent asthma, allergic rhinitis, and molluscum contagiosum on a few occasions.

What seems odd to me is that she does not have any protective antibodies to EBV >3 months after the last infection.  I am reaching out to see if I am missing something?


  *   Infection #1.
     *   11/2014:  EBV VCA IgM positive, EBV Early Antigen IgG positive. Rest negative including EBV VCA IgG, EBV Nuclear Antigen IgG.
  *   Infection #2.
     *   5/17/16: EBV VCA IgM 38.9 (equivocal).  Rest negative including EBV Early Antigen IgG, EBV VCA IgG, EBV Nuclear Antigen IgG.  CBC and CMP unremarkable.
     *   5/26/2016:  EBV VCA IgM 39.7 (equivocal), EBV VCA IgG 26.6 (positive). Others were negative including EBV Early antigen IgG and EBV Nuclear Antigen IgG.  IgG 1106, IgA 176, IgM316,and IgE 14.
  *   Present time/healthy.
     *   9/22/16:  Negative EBV VCA IgM and IgG, EBV Nuclear Antigen IgG negative.  Early antigen not done.

I am very grateful in advance for any thoughts on how to interpret this scenario and next step to take (if any).


Cindy Salm Bauer, MD
Division of Allergy and Immunology, Department of Pediatric Pulmonology
Phoenix Children's Hospital
Clinical Assistant Professor, Department of Child Health, University of Arizona College of Medicine
1919 East Thomas Road
Phoenix, AZ  85016
Office:  602-933-4063
Fax:  602-933-2423

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