تحليل EBV & CMV

ماذا تعرف عن تحليل EBV & CMV

تحاليل خاصه بالمناعة يطلب اجراه في الحالات الاصابات الفيروسية

 

EBV IgM and IgG

تشخيص للاصابه القديمه G والحديثه M لفيروس الابيشتين وده نوع من انواع الفيروسات وتقريبا تبع عائلة الــ

Herpes

بيصيب الاطفال والكبار والحوامل

اعراضه منها واهمها اللتهاب ف الحلق والغدد الليمفاويه وقد يؤثر ف مراحل متأخره ع الكبد وغيره وقد يكون هناك ارتفاع ف درجة الحراره .

 

اما الـ CMV IgM :

فالدكتور عاوز يشوف الاصابه الحاليه بفيروس السيتو ميجالو

الدم والمنى وافرازات اللعاب والمهبل والبول من اهم مصادر العدوى

اعراضه على البالغين لاتذكر الا ارتفاع بسيط ف درجة الحراره اما وصول العدوى الى الجنين عن طريق الام يسبب الصفراء وتضخم الكبد … الخ

 

وده لينك لموضوع ممكن يفيد عن حاجات مشابهه : https://www.facebook.com/groups/Medical.analysise/doc/240894905952119

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EBV

………………….

Also known as: EBV Antibodies; EBV VCA-IgM Ab; EBV VCA-IgG Ab; EBNA-IgG Ab; EA-D IgG Ab

Formal name: Epstein-Barr Virus Antibody to Viral Capsid Antigen, IgM; Epstein-Barr Virus Antibody to Viral Capsid Antigen, IgG; Epstein-Barr Virus Antibody to Nuclear Antigen, IgG; Epstein-Barr Virus Antibody to Early D Antigen, IgG; Heterophile Antibodies

Related tests: Mono; Complete Blood Count; White Blood Cell Count

 

At a Glance

Why Get Tested?

To help diagnose mononucleosis (Mono); to help evaluate susceptibility to EBV infection; to distinguish between an EBV infection and another illness with similar symptoms

When to Get Tested?

When you have symptoms of Mono but a negative Mono test; when a pregnant woman has flu-like symptoms; sometimes when an asymptomatic person has been exposed to Mono

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?

None

 

The Test Sample

What is being tested?

Epstein-Barr virus (EBV) antibodies are a group of tests that are ordered to help diagnose a current, recent, or past EBV infection. EBV is a member of the herpes virus family. Passed through the saliva, the virus causes an infection that is very common. According to the Centers for Disease Control and Prevention (CDC), as many as 95% of people in the United States will have been infected by EBV by the time they are 40 years old. After exposure to the virus, there is an incubation period of several weeks. EBV then causes an acute primary infection, followed by resolution and dormancy. Latent EBV remains in the person’s body for the rest of his life, reactivating intermittently, but causing few problems unless the person’s immune system is significantly compromised.

Most people are infected by EBV in childhood and experience few or no symptoms, even in the acute phase of the infection. However, when the initial infection is delayed until adolescence, EBV causes infectious mononucleosis (Mono) in about 35 – 50% of those infected. Mono is a condition that is associated with fatigue, fever, sore throat, swollen lymph nodes, an enlarged spleen, and, sometimes, an enlarged liver. Those who have it are usually symptomatic for a month or two before the initial infection resolves.

Patients with Mono are diagnosed by their symptoms and the findings of a complete blood count (CBC) and a Mono test (which tests for a heterophile antibody). A certain percentage of those who have mono will have a negative mono test; this is especially true with children. EBV antibodies can be used to determine whether or not the symptoms these patients are experiencing are due to a current infection with the EBV virus.

It can be important to distinguish EBV from other illnesses. For instance, the enlarged spleen of those with a Mono infection is vulnerable to rupture. Patients who have Mono should not be involved in contact sports for several weeks to months after infection, as a ruptured spleen can cause a medical emergency. Also, pregnant women with symptoms of a viral illness need to be able to distinguish a primary EBV infection, which has not been shown to affect the baby, from a cytomegalovirus (CMV), herpes simplex virus, or toxoplasmosis infection, as these illnesses can cause complications during the pregnancy and may damage the fetus. It can also be important to rule out EBV and to look for other causes for the symptoms. Patients with strep throat, for instance, need to be identified and treated with antibiotics. A patient may have strep throat instead of Mono, or they may have both conditions at the same time.

There are several EBV antibodies. They are proteins produced by the body in an immune response to several different Epstein-Barr virus antigens. They include IgM and IgG antibodies to the viral capsid antigen (VCA), IgG antibodies to the D early antigen (EA-D), and antibodies to the nuclear antigen (EBNA). During a primary EBV infection, each of these EBV antibodies appears independently on its own time schedule. The VCA-IgM antibody appears first and then tends to disappear after about 4 to 6 weeks. The VCA-IgG antibody emerges, is at its maximum at 2 to 4 weeks, then drops slightly, stabilizes, and is present for life. The EA-D antibody appears during the acute infection phase and then tends to disappear within 3 to 6 months, but about 20% of those infected will continue to have detectible quantities of the EA-D antibody for several years after the EBV infection has resolved. The EBNA antibody does not usually appear until the acute infection has resolved. It usually develops about 2 to 4 months after the initial infection and is then present for life. Using a combination of these EBV antibody tests, a doctor is able to detect an EBV infection and to determine whether it is a current, recent, or past infection.

 

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm.

NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.

Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

The Test

  1. How is it used?
  2. When is it ordered?
  3. What does the test result mean?
  4. Is there anything else I should know?

How is it used?

Epstein-Barr Virus (EBV) antibodies are used to help diagnose Mono if you are symptomatic but have a negative Mono test. The Centers for Disease Control and Prevention (CDC) recommend ordering:

  • Viral capsid antigen (VCA)-IgM, VCA-IgG and D early antigen (EA-D) — to detect a current or recent infection
  • VCA-IgG and Epstein Barr nuclear antigen (EBNA) — to detect a previous infection

In pregnant women with symptoms of a viral illness, one or more of these EBV antibodies may be ordered along with tests for CMV, toxoplasmosis, and other infections (sometimes as part of a TORCH screen) to help distinguish between EBV and conditions that may cause similar symptoms. Occasionally, a VCA-IgG or other EBV antibody may be repeated 2-4 weeks after the first test, either to see if a test changes from negative to positive or to measure changes in antibody concentrations to see if they rise or fall.

A VCA-IgG test, and sometimes an EBNA test, may be ordered on an asymptomatic patient to see if that person has been previously exposed to EBV or is susceptible to a primary EBV infection. This is not routinely done, but it may be ordered when a patient, such as an adolescent or an immune compromised patient, has been in close contact with a person who has Mono.

 

When is it ordered?

 

EBV antibodies may be ordered when you have symptoms suggesting Mono, but a negative Mono test and when a pregnant woman has flu-like symptoms and the doctor wants to determine whether the symptoms are due to EBV or another microorganism. Signs and symptoms may include:

  • Fatigue
  • Fever
  • Sore throat
  • Swollen lymph glands
  • Sometimes enlarged spleen and/or liver

VCA-IgG and EBNA may be ordered whenever your doctor wants to establish previous exposure. Testing may occasionally be repeated when your doctor wants to track antibody concentrations and/or when the first test was negative, but your doctor still suspects that your symptoms are due to EBV.

 

What does the test result mean?

If you have positive VCA-IgM antibodies, then it is likely that you have a current, or had a very recent, EBV infection. If you also have symptoms associated with Mono, then it is most likely that you will be diagnosed with Mono, even if your Mono test was negative. If you also have positive VCA-IgG and EA-D IgG concentrations, then it is highly likely that you have, or recently had, an EBV infection.

If the VCA-IgM is negative but the others and an EBNA antibody are positive, then it is likely that you had a previous EBV infection. If you are asymptomatic and are negative for VCA-IgG, then you have not been previously exposed to EBV and are vulnerable to infection. In general, rising VCA-IgG levels tend to indicate an active EBV infection, while falling concentrations tend to indicate a recent EBV infection that is resolving. However, care must be taken with interpreting EBV antibody concentrations as the amount of antibody present does not correlate with the severity of the infection or with the length of time it will last. High levels of VCA-IgG may be present and may persist at that concentration for the rest of your life.

Below, results are provided in table form.

 

Is there anything else I should know?

 

There are at least two other antibodies that arise during an EBV infection – an IgA antibody to the EBV viral capsid antigen (EBV VCA-IgA) and an IgG antibody to the EBV early antigen restricted (EA-R IgG). While it is possible to test for these antibodies as part of the EBV diagnostic workup, it is rarely necessary to do so.

The most common complication of Mono is a ruptured spleen. Other complications of EBV infection that can occur include trouble breathing due to a swollen throat, strep throat at the same time, and, rarely, jaundice, skin rashes, pancreatitis, seizures, and/or encephalitis. EBV is also associated with, and may play a role in, several rare forms of cancer, including Burkitt’s lymphoma and nasopharyngeal carcinoma.

Reactivation of the virus is rarely a health concern unless the patient is significantly and persistently immune compromised, as may happen in those who have HIV/AIDS or in those who have received an organ transplant. Primary infections in these patients can be more severe, and some may experience chronic EBV-related symptoms.

 

 

Common Questions

  1. How is EBV infection/Mono treated?
  2. Do adults get Mono?
  3. Do EBV infection and Mono occur throughout the world?
  4. Can EBV be prevented?
  5. If I have had EBV infection, can I still get Mono?
  6. Why is Mono sometimes called “the kissing disease”?
  7. Are there other types of tests available for EBV?

1.  How is EBV infection/Mono treated?

Care is largely supportive, rest, treating the symptoms, and avoiding any contact sports or heavy lifting for several weeks to months to avoid spleen rupture. There are no anti-viral medications or vaccines available to speed healing or prevent infection.

 

2.  Do adults get Mono?

They do, but it is rare because most have already been infected at an earlier age. When they do, they tend to have less lymph node swelling and sore throat and more liver enlargement and jaundice.

 

3.  Do EBV infection and Mono occur throughout the world?

Yes. In less developed nations, however, Mono is not as common because most of the population is infected with EBV earlier in life when symptoms are minimal.

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4.  Can EBV be prevented?

Not at this time. It is too common in the population and, because the virus will reactivate intermittently in a previously infected person, usually without causing any symptoms, almost everyone is infectious at one time or another.

 

5.  If I have had EBV infection, can I still get Mono?

No. Once you have had an EBV infection, you will not get Mono. You could, however, experience similar symptoms from another viral illness.

 

6.  Why is Mono sometimes called “the kissing disease”?

This is because EBV does not pass through the air; it is present in saliva and is passed through mouth-to-mouth contact and, in the case of children, through saliva transfer to hands and/or toys, etc.

 

7.  Are there other types of tests available for EBV?

Yes. There are molecular tests that can detect and measure EBV DNA. They can be helpful in diagnosing and monitoring EBV-related diseases such as Burkitt’s lymphoma, Hodgkin’s lymphoma and post-transplant lymphoproliferative disease (PTLD).

 

 

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CMV

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Formal name: Cytomegalovirus Antibody, IgG and IgM; Cytomegalovirus by PCR

Related tests: Epstein Barr Virus (EBV), Herpes Simplex Virus, Varicella Zoster Virus (VZV or chickenpox), Antibody Tests, TORCH

 

 

At a Glance

Why Get Tested?

If your doctor suspects you presently have, or recently had, a cytomegalovirus (CMV) infection or if it is important to know if you have ever had a CMV infection – such as prior to receiving an organ transplant

When to Get Tested?

When a young adult, a pregnant woman, or an immune-compromised person has flu-like symptoms that suggest a CMV infection; when a newborn has multiple congenital abnormalities, unexplained jaundice or anemia, and/or when an infant has seizures or developmental problems that may be due to CMV; prior to receiving an organ transplant

Sample Required?

A blood sample drawn from a vein in your arm for CMV antibody testing; to detect the virus itself, the sample may be blood, urine, sputum, amniotic fluid, cerebrospinal fluid, duodenal fluid, or other body tissue

Test Preparation Needed?

None

 

 

The Test Sample

What is being tested?

Cytomegalovirus (CMV) is a common virus that occurs widely throughout the population but rarely causes symptoms. In the United States, as many as 50-85% of adults have been infected with CMV. Most people are infected as children or as young adults and do not experience any significant symptoms or health problems.

CMV is found in many body fluids during an active infection, including saliva, urine, blood, breast milk, semen, vaginal secretions, and cerebrospinal fluid. It is easily transmitted to others through close physical contact or by contact with infected objects, such as diapers or toys. After the initial “primary” infection has resolved, CMV becomes dormant or latent – like other members of the herpes family. Cytomegalovirus remains in a person for the rest of his life without causing any symptoms, unless the person’s immune system is significantly weakened. If this happens, the virus can reactivate.

CMV can cause notable health problems in three situations:

  • In young adults, primary CMV infection may cause a flu-like or mononucleosis-type illness. This condition, which causes symptoms such as extreme fatigue, fever, chills, body aches and/or headaches, usually resolves within a few weeks.
  • In infants, primary CMV infection may cause serious physical and developmental problems. This occurs when women are infected for the first time (primary infection) during pregnancy and then pass the infection to the developing baby across the placenta. Most newborns (about 90%) that are infected appear healthy at birth but may develop hearing or vision problems, pneumonia, seizures, and/or delayed mental development a few months later. A few babies may be stillborn, while others may have symptoms at birth such as jaundice, anemia, an enlarged spleen or liver, and a small head.
  • In those with weakened immune systems, CMV could cause serious illness and death. This includes those with HIV/AIDS, those who have had organ or bone marrow transplants, and those undergoing chemotherapy treatment for cancer. People with compromised immune systems who become infected for the first time (primary infection) might experience the most severe symptoms, and their CMV infection may remain active. Those who have been exposed to CMV previously may reactivate their infection. This could affect their eyes (causing inflammation of the retina, which can lead to blindness), digestive tract (causing bloody diarrhea and abdominal pain), lungs (causing pneumonia with a non-productive cough and shortness of breath), and brain (causing encephalitis). There can also be spleen and liver involvement, and those who have had organ or bone marrow transplants may experience some degree of rejection. Active CMV also further depresses the immune system, allowing other secondary infections, such as fungal infections, to occur.

CMV testing involves either a measurement of CMV antibodies, immune proteins created in response to CMV exposure, or by the detection of the virus itself. The virus can be identified during an active infection by culturing CMV or by detecting the virus’s genetic material (its DNA) in a fluid or tissue sample.

How is the sample collected for testing?

The sample required depends on the type of testing. Antibody testing requires a blood sample, obtained by inserting a needle into a vein in the arm. Viral detection may be done on a variety of samples, including urine, blood, or sputum. Some samples may require a special procedure to collect, such as amniotic fluid, duodenal fluid, cerebrospinal fluid, or body tissue (biopsy).

NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.

Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

 

 

The Test

  1. How is it used?
  2. When is it ordered?
  3. What does the test result mean?
  4. Is there anything else I should know?

How is it used?

 

Cytomegalovirus (CMV) testing is used to determine whether someone with signs and symptoms has an active infection. Sometimes it may be ordered to help determine whether someone had a prior infection and is therefore immune to a primary infection.

There are a few different methods of detecting a CMV infection:

 

Antibody testing

Antibody testing can be used to determine if someone has had recent or past exposure. There are two types of CMV antibodies that are produced in response to a CMV infection, IgM and IgG, and one or both may be detected in the blood.

  • IgM antibodies are the first to be produced by the body in response to a CMV infection. They are present in most individuals within a week or two after the initial exposure. IgM antibody production rises for a short time period and then declines. After several months, the level of CMV IgM antibody usually falls below detectable levels. Additional IgM antibodies are produced when latent CMV is reactivated.
  • IgG antibodies are produced by the body several weeks after the initial CMV infection and provide protection from primary infections. Levels of IgG rise during the active infection, then stabilize as the CMV infection resolves and the virus becomes inactive. After a person has been exposed to CMV, he or she will have some measurable amount of CMV IgG antibody in their blood for the rest of their life. CMV IgG antibody testing can be used, along with IgM testing, to help confirm the presence of a recent or previous CMV infection.

CMV antibody testing may be used to determine immunity to primary CMV infections in people prior to organ or bone marrow transplantation and in a person diagnosed with HIV/AIDS. Since CMV infection is widespread and causes few problems to those with healthy immune systems, general population screening is rarely done.

Antibody testing and viral CMV detection may be used to help diagnose primary CMV infection in young adults, pregnant women, and some immune-compromised people with flu- or mononucleosis-like symptoms. By comparing the absence or presence of IgG and IgM antibodies in the same sample or the amount of antibody present in samples collected on different days, the doctor may be able to distinguish between active and latent CMV.

Testing for IgM antibodies may be used to detect a congenital infection in a newborn. Tests that detect the virus directly must be performed to confirm the diagnosis.

 

Viral detection

Viral detection involves determining the presence of CMV in a blood, fluid, or tissue sample. This can be done either by culturing the virus or by detecting the virus’s genetic material (CMV DNA).

Viral culture is the traditional method of virus detection. Presence of the virus (positive cultures) can often be determined in as little as 1 to 2 days, but cultures that are negative for the virus must be held for 3 weeks to confirm the absence of CMV because the virus may be present in very low numbers in the original sample and/or the CMV strain may be slow-growing.

Molecular methods may be used to detect and measure the amount of viral DNA in a person’s sample. Testing can be qualitative, determining the presence or absence of CMV, or quantitative, measuring the amount of virus present.

The choice of tests and samples collected depends on the age of the person, their general health status and symptoms, and on the doctor’s clinical findings and suspicions of organ involvement. For instance, a newborn’s urine may be cultured to detect CMV, while a pregnant woman may have IgG and IgM blood testing to identify the presence of antibodies and to distinguish between a current primary infection and a previous infection.

Immune-compromised people with active CMV may be monitored using a variety of CMV tests. Often doctors want a quantifiable viral test to be able to track the amount of virus present (viral load). They can use a quantitative test to monitor a person’s response to antiviral therapy.

 

When is it ordered?

 

CMV tests may be ordered, along with tests for influenza, mononucleosis (mono), and EBV (Epstein Barr virus), when a young adult, a pregnant woman, or an immune-compromised person has flu- or mono-like signs and symptoms such as:

  • Fatigue, weakness
  • Sore throat
  • Swollen lymph nodes
  • Fever
  • Headache
  • Muscle aches

Other less common but more serious symptoms include inflammation of the lungs, eyes, liver, spleen, and/or digestive tract.

One or more CMV tests may be ordered at intervals when a doctor is monitoring the effectiveness of antiviral therapy.

CMV testing may be done on a newborn with jaundice, anemia, an enlarged spleen and/or liver, and a small head; or on an infant with hearing and vision problems, pneumonia, seizures, and/or signs of delayed mental development.

When a person is a candidate for an organ or bone marrow transplant, CMV antibody testing may be ordered as a screening test to determine if the person has been exposed to CMV in the past.

 

What does the test result mean?

Care must be taken when interpreting the results of CMV testing. The doctor evaluates the results in conjunction with clinical findings, including signs and symptoms. It can sometimes be difficult to distinguish between a latent, active or reactivated CMV infection. This is due to several reasons, including:

  • A healthy person who has been infected with CMV at one time will continue to harbor the virus. The CMV can reactivate intermittently, often sub-clinically, shedding small amounts of virus into body fluids but not causing symptoms.
  • An immune-compromised person may not have a strong antibody response to the CMV infection – their IgM and IgG levels may be lower than expected even though they have an active case of CMV.
  • The virus may not be present in sufficient number in the particular fluid or tissue tested to able to be detected.

 

Antibody testing

If both CMV IgG and IgM are present in a symptomatic person, then it is likely that he has either recently been exposed to CMV for the first time or that a previous CMV infection has been reactivated. This can be confirmed by measuring IgG levels again 2 or 3 weeks later. A high level of IgG is not as important as a rising level. If there is a 4-fold increase in IgG between the first and second sample, then the person has an active CMV infection (primary or reactivated).

If only IgM is present, then the person may have very recently been infected. If someone is symptomatic but has low or undetectable levels of IgG and/or IgM, it may mean that they either have a condition other than CMV or that their immune system is not responding normally – not producing an adequate amount of antibody even if CMV is present.

 

 

Viral detection

If a person is symptomatic and the culture is positive for cytomegalovirus, then the person likely has an active CMV infection. If the culture is negative, then the person’s symptoms may be due to another cause or the amount of CMV virus in the sample is too low to detect.

If a test for CMV DNA is positive, then CMV is present and the person has an active infection. High levels of viral DNA tend to indicate a more invasive infection accompanied by serious symptoms while low levels indicate a CMV infection, usually one with no symptoms or ones that are mild. Like culture, negative results on a DNA test do not rule out CMV infection – the virus may be present in very low numbers or may not be present in the body sample tested.

When used to monitor effectiveness of treatment, decreasing viral loads reflect a response to antiviral treatment. Levels that do not drop in response to antiviral treatment might reflect a resistance to the therapy being used.

 

Is there anything else I should know?

 

CMV is one of the conditions included in a “TORCH” testing panel. This group of tests screens for a group of infectious diseases that can cause illness in pregnant women and may cause birth defects in their newborns. TORCH is an acronym for: Toxoplasmosis, Rubella, Cytomegalovirus, and Herpes simplex virus.

When blood transfusion is needed, certain patients, such as CMV-negative HIV/AIDS patients and CMV-negative heart/lung transplant candidates, should receive cellular blood products that have been tested negative for CMV antibodies (so-called CMV seronegative blood products).

 

Common Questions

  1. How can I tell if my CMV has reactivated?
  2. If I have or had CMV, can I spread it to others?
  3. Is there any way to prevent getting CMV?

1.  How can I tell if my CMV has reactivated?

If you are a reasonably healthy person, you will probably not have a symptomatic reactivation or may have mild flu-like symptoms. If you are immune-compromised, you may have more serious symptoms associated with your lungs, digestive tract, or eyes. In this case, it is important to talk to your doctor about your health concerns.

 

2.  If I have or had CMV, can I spread it to others?

If you have a new or prior infection with CMV, you can spread it to others even if you aren’t showing signs or symptoms. Nevertheless, you must be in close contact with others in order to transmit the virus. It can be spread through several types of body fluids, including saliva, breast milk, vaginal fluids, semen, urine, and blood.

 

3.  Is there any way to prevent getting CMV?

Careful hygiene can help prevent transmission of the virus. But, since CMV is very common, is present in most body fluids, and is passed through close contact, most people are infected when they are babies. It has been estimated that as many as 70% of children in daycare have been exposed to CMV.

 

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