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| It primarily affects young adults and children, although in children it is usually so mild that it is often overlooked. Signs & Symptoms Acute EBV Infection. Symptoms of mononucleosis mimic those of other infectious diseases, including hepatic dusfunction (hepatitis), rubella and toxoplasmosis. Early symptoms include headache, malaise, and fatigue followed by a triad of symptoms: sore throat, cervical lymphadenopathy, and temperature fluctuations / fever. When such an illness lasts more than 6 months, it is frequently called chronic EBV infection. However, valid laboratory evidence for continued active EBV infection is seldom found in these patients. This process includes ruling out other causes of chronic illness or fatigue. In patients with symptoms compatible with infectious mononucleosis, a positive Paul-Bunnell heterophile antibody test result is diagnostic, and no further testing is necessary. Because the antibody response in primary EBV infection appears to be quite rapid, in most cases testing paired acute- and convalescent-phase serum samples will not demonstrate a significant change in antibody level. Effective laboratory diagnosis can be made on a single acute-phase serum sample by testing for antibodies to several EBV-associated antigens simultaneously. In addition, differentiation of immunoglobulin G and M subclasses to the viral capsid antigen can often be helpful for confirmation. When the "mono spot" test is negative, the optimal combination of EBV serologic testing consists of the antibody titration of four markers: IgM and IgG to the viral capsid antigen, IgM to the early antigen, and antibody to EBNA. IgG to the viral capsid antigen appears in the acute phase, peaks at 2 to 4 weeks after onset, declines slightly, and then persists for life. In many people, detection of antibody to the early antigen is a sign of active infection, but 20% of healthy people may have this antibody for years. A number of healthy people with no symptoms have antibodies to the EBV early antigen for years after their initial EBV infection. |
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