Other Tests to detect Heterophile Antibodies1. Rapid Slide Tests that make use of slides or cards

rather than tubes

2. Formats that use solid phase to which antigen is affixed

Examples: ●Equipar

→ purified antigens from bovine red cells are coated onto latex particles

●Seradyn Color Slide II Mononucleosis test → aka Alexon Trend

→ use disposable cards and color-enhanced horse RBCs

KEN MYER ABANSI KEN MYER ABANSI

Anti-VCA IgM

Anti-VCA IgG

Anti-VCA IgA

Anti EA-D

Anti EA-R

Anti EBNA-IgG

Heterophile

No previous exposure

- - - - - - -

Recent( acute) infection

+ ++ +/- + - - +

Convalescent Period

- + - - +/- + +/-

Reactivation of latent infection

+/- + +/- +/- + +/-

Chronic active infection

- +++ +/- + ++ +/- -

Past Infection

- + - - - + -

No exposure , no Antigen stimulation, no Antibody production

appears during acute phase of infxn (IgM)

Persist 'til Convalescent Period

May/May Not be Produced

Marker ang IgG here

Positive only if VCA Ag is positive

Anti-VCA IgM

Anti-VCA IgG

Anti-VCA IgA

Anti EA-D

Anti EA-R

Anti EBNA-IgG

Heterophile

Post-transplant lymphoproliferative disease

- ++ +/- + + +/- -

Burkitt's lymphoma

- +++ - +/- ++ + -

Nasopharyngeal carcinoma

- +++ + ++ +/- + -

detect high titers good marker

detect high titers, good marker

EBV-specific Antibodies in I M* Anti-VCA IgM

→ usually detectable early in the course of infection, but low in concentration, disappears within 2-4 months

*Anti-VCA IgG → usually detectable within 4-7 days after onset of S/S

and persist for an extended period

*Anti-EA-D-IgG → highly indicative of acute infection , but not detectable

in 10-20% of patients with IM. It disappears in about 3 months; however a rise in titer is demonstrated during reactivation of latent EBV infection

EBV-specific Antibodies in I M

* Anti-EA-R-IgG → not usually found in young adults during acute phase.

Appears transiently in the later convalescent phase

*Anti EBNA IgG → appears only when the patient has entered the

convalescent period . Antibodies are almost always present in serum containing anti-VCA IgG unless the patient is in EA phase. Patients with severe immunologic defects or immunosuppresive disease may not have EBNA antibodies , even if VCA antibodies are present

EBV-specific Antibodies in I M

* Antibodies to NA remains at moderate measurable level indefinitely because of the persistent viral carrier state established after primary EBV infection

*Most healthy individuals have titers to EBNA ranging from 1:10-1:160

EBV-specific Antibodies in I M

*in EBV associated malignancies, the levels of EBNA antibodies are usually high in patients with nasopharyngeal carcinoma and variable in patients with Burkitt's lymphoma

EBV-specific Antibodies in I M

COMMON METHOD: Indirect Immunofluorescence PRINCIPLE: Antigen substrate slide containing EBV infected B-cells + patient serum incubate addition of fluorescent conjugated → →antihuman IgG or IgM

*ELISA to detect anti-EBNA, using asynthetic peptide Antigen to determine relative amounts of IgM and IgG antibodies in patient serum; reported with 99% specificity.