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Journal of Clinical Microbiology, October 2009, p. 3204-3210, Vol. 47, No. 10
0095-1137/09/$08.00+0     doi:10.1128/JCM.00164-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

Evidence-Based Approach for Interpretation of Epstein-Barr Virus Serological Patterns {triangledown}

J. S. Klutts,1,2 B. A. Ford,3 N. R. Perez,3 and A. M. Gronowski3*

Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa,1 Pathology and Laboratory Medicine, Veteran's Affairs Medical Center, Iowa City, Iowa,2 Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University School of Medicine, St. Louis, Missouri3

Received 26 January 2009/ Returned for modification 22 May 2009/ Accepted 29 July 2009

Diagnosis of Epstein-Barr virus (EBV) infection is based on clinical symptoms and serological markers, including the following: immunoglobulin G (IgG) and IgM antibodies to the viral capsid antigen (VCA), heterophile antibodies, and IgG antibodies to the EBV early antigen-diffuse (EA-D) and nuclear antigen (EBNA-1). The use of all five markers results in 32 possible serological patterns. As a result, interpretation of EBV serologies remains a challenge. The purpose of this study was to use a large population of patients to develop evidence-based tools for interpreting EBV results. This study utilized 1,846 serum specimens sent to the laboratory for physician-ordered EBV testing. Chart review was performed for more than 800 patients, and diagnoses were assigned based on physician-ordered testing, clinical presentation, and patient history. Testing for all five EBV antibodies was performed separately on all serum samples using the Bio-Rad BioPlex 2200 system. Presumed EBV diagnosis (based on previous publications) was compared to EBV diagnosis based on a medical record review for each serological pattern. Interestingly, of the 32 possible serological patterns, only 12 occurred in ≥10 patients. The remaining 20 patterns were uninterpretable because they occurred with such infrequency. Two easy-to-use tables were created to interpret EBV serological patterns based on whether three (EBV VCA IgG, IgM, and heterophile) or five markers are utilized. The use of these two tables allows for interpretation of >95% of BioPlex serological results. This is the first evidence-based study of its kind for EBV serology.

* Corresponding author. Mailing address: Department of Pathology and Immunology, Washington University School of Medicine, 660 S. Euclid, Box 8118, St. Louis, MO 63110. Phone: (314) 362-0194. Fax: (314) 362-1461. E-mail: gronowski{at}wustl.edu

{triangledown} Published ahead of print on 5 August 2009.

Journal of Clinical Microbiology, October 2009, p. 3204-3210, Vol. 47, No. 10
0095-1137/09/$08.00+0     doi:10.1128/JCM.00164-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.





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