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Epstein-Barr Virus Infection (cont.)

When Should Someone Seek Medical Care for an Epstein-Barr Virus Infection?

Mild symptoms of EBV infection may be treated at home. See a doctor if experiencing prolonged fever, abdominal pain, severe headache, difficulty breathing, and/or jaundice (a yellowish discoloration of the skin or eyes).

What Specialists Treat Epstein-Barr Virus Infections?

You may be treated by a primary care provider (PCP), such as a family practitioner, an internist, or a child's pediatrician, for Epstein-Barr virus.

If the symptoms of EBV become chronic, you may be referred to an infectious-disease specialist or an immunologist (also called an allergist/immunologist).

You may need to see a neurologist for EBV-related neurological complications. If the spleen becomes enlarged, one may be referred to a hematologist, and if EBV leads to cancer, you may see an oncologist.

What Tests Do Doctors Use to Diagnose an Epstein-Barr Virus Infection?

The diagnosis of mononucleosis starts with a detailed history and physical examination. The doctor will look for fever, an inflamed or sore throat, swollen lymph nodes in the neck, and an enlarged spleen. Red dots (petechiae) may be seen on the palate. Up to half of infected people will have an enlarged spleen, and 10% will have an enlarged liver on abdominal examination. People with suspected mononucleosis will have a blood sample drawn for blood counts and a "mono spot" test. If the mono spot is positive, the diagnosis is confirmed. Mono spots may be falsely negative in children under 4 years of age or in the elderly. Repeating the test at a later date may be helpful in these cases. Other viruses and pathogens may cause an illness that is similar to mononucleosis (for example, cytomegalovirus, adenovirus, and Toxoplasma), so additional blood may be drawn to test for other pathogens.

In infected people, the number of normal lymphocytes (B cells) in the blood is usually increased and the cells may look unusual or "atypical" under the microscope. Approximately 1%-3% of people develop anemia, which is caused by destruction of the red blood cells (hemolysis). Platelet counts may be low in up to half of patients, although this does not usually result in bleeding. In some cases, blood cells may be destroyed by other blood cells (hemophagocytic syndrome). Mild elevations in liver enzymes in the blood are common.

Several antibody tests are available to determine if a person has had a past infection or a current/recent infection with EBV. Some antibodies occur early and are transient, thus indicating new or "acute" infection. These include IgM antibody to the viral capsid antigen (VCA). Some antibodies develop immediately and persist for life, such as the IgG antibody to the viral capsid antigen. Other antibodies develop three to four weeks into the illness and persist for life, including antibodies to the nuclear antigen (EBNA). Antibodies to early antigen (EA-IgG) may arise during acute infection and may persist, go away, or recur. PCR tests that detect EBV DNA are available in some laboratories.

Many physicians use three laboratory criteria (lymphocytosis, 10% or more lymphocytes are atypical on a peripheral blood smear, and a positive serologic test for EBV) along with the history and physical findings listed above to confirm a diagnosis of acute infectious mononucleosis. About 90% of adults have antibodies indicating that they had infections in the past.

Medically Reviewed by a Doctor on 9/5/2017

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