Understanding EBV/Mononucleosis Symptoms & Persistent Illness

Question
Hello Samantha: I am a 37 year old female who is not pregnant and has never had mono (to my knowledge). Since the first of December I have been experiencing fatigue, nasal congestion, sore throat, cough, bronchitis, sweating, and low-grade fever that comes and goes. I have been treated with five rounds of various antibiotics and steroids with little to no results.

I was referred to an ENT who found nothing more than a deviated septum after doing sinus x-rays and a CT scan of my sinuses. But saw lots of different colored congestion when he looked into my nasal passages. Being a little perplexed, he sent me for a CBC, EBVCA (IgG/M), and mononucleosis tests.

The CBC shows elevated WBC (15.5), high neutrophils (82), low lymphs (12), and high neutrophils (absolute) (12.7).

The EBV Ab VCA IgM is normal at 0.5 and the EBV Ab VCA IgG is high at >8.0 with a handwritten note that reads "past infection" written by the ENT. The mono test just states "negative".

So do/did I have mono or not? If not, could the high IgG reading be an indicator of what my issue is? Or am I back to square one trying to figure it out? Thanks for your assistance.

Answer
Hi Amber.  I only have general knowledge of lab tests, so I can't really interpret results (as a doctor would), but I will try and give you basic information about the EBV (Epstein-Barr Virus) test.  The major EBV virus that doctors look for is, of course, mononucleosis.  The EBV Ab VCA-IgM will show a current or very recent infection.  The EBV Ab VCA IgG will show a past infection.  This antibody (Ab), when positive, will normally stay positive for life.  As in your case, when the EBV Ab IgM is negative but the EBV Ab VCA IgG antibody are positive, then it is likely that you had a previous EBV infection.  But how long ago you had the infection is not known, that's the tricky part.  Your doctor could look for other signs of mono, such as an enlarged spleen and/or liver, or he/she could just diagnose you based on your symptoms.  If you're not feeling better, 'd check back with your doctor.

Samantha