[CIS PIDD] [cis-pidd] EBV infections

Tue Sep 27 13:56:57 EDT 2016

I agree.  False positive EBV-IgM is notorious, although the detection of anti-EA and -VCA on those different occasions do support that she has had exposure to EBV.  I think much better to rely on direct pathogen detection by EBV-PCR virus load than antibody to document infection in perplexing or complicated cases. There are 2 serotypes (A,B) which could explain 2 separate episodes of clinical disease.  Antibody is not protective for EBV infection.  Perhaps this is sacrilegious, but if she is well/otherwise healthy, I personally would not be fussed by the inability to detect EBNA.  Less is more.   anne

Anne Junker, MD
Associate Professor, Pediatrics (Immunology)
BC Children's Hospital and University of British Columbia
4480 Oak Street
Vancouver, BC. Canada
ajunker at cw.bc.ca
604-875-3591
________________________________________
From: CIS-PIDD [cis-pidd at lists.clinimmsoc.org]
Sent: Tuesday, September 27, 2016 1:37 AM
To: CIS-PIDD
Subject: Re: [cis-pidd] EBV infections

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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