Serological diagnosis of Epstein-Barr virus infection: Problems and solutions

Table 6 Additional tests in the case of a simultaneous Epstein-Barr virus nuclear antigen 1 IgG, viral capsid antigen IgG and IgM positive pattern

Tests	Advantages	Disadvantages
EBV IgM immunoblotting	Useful only in verifying the specificity of EBV IgM	Not useful in distinguishing late primary infection (transient) from reactivation; expensive
HCMV IgM Parvovirus IgM	Useful in verifying the specificity of EBV IgM	Not useful in distinguishing late primary infection (transient) from reactivation
EBV IgG immunoblotting	Only useful in verifying the specificity of EBNA-1 IgG	Not useful in distinguishing late primary infection (transient) from reactivation; expensive
IgG avidity	Useful in distinguishing primary infection (transient) from reactivation	Individual maturation
Molecular biology	Useful for EBV reactivation follow-up	Difficult to distinguish late primary infection (transient) from reactivation in a single sample; expensive; organisational problems
Heterophile antibodies	Useful in distinguishing late primary infection (transient) reactivation when positive; inexpensive and simple	Not very sensitive (especially in children)
Anti-EA(D) IgG	Useful for EBV reactivation follow-up	Not useful in distinguishing late primary infection (transient) from reactivation in a single sample
CLIA for EBV antibodies with differential cut-off values	Useful in distinguishing primary infection (transient) from past infection; can be used for screening	Requires further study

EBV: Epstein-Barr virus; EBNA: EBV nuclear antigen; CLIA: Chemiluminescence immunoassay.