Epstein-Barr IgM is positive, but undetectable in PCR. Still, I am sick, could it be chronic fatigue?

Hello,

Welcome to icliniq.com.

I have gone through your query, and I can understand your concerns.

1. The brief history you have described suggest a possibility of past infection with EBV (Ebstein-Barr virus). Probably you had an episode of IMN( infectious mononucleosis) in the childhood, which is quite common in the developing world.
2. EBV remains dormant in few cells and blood for a long time and probably for lifelong. And it can cause reactivation as in your case. Serological will be positive lifelong due to the dormant virus in the blood.
3. Fatigue, malaise and a headache are quite common with reactivated EBV infection, and you do not need to worry regarding this.
4. Patients with chronic fatigue syndrome may have high titers of antibody to EBV, but not different from healthy EBV-positive individuals. Persistent EBV infection is not a cause of chronic fatigue syndrome.
5. A heterophile antibody test is a confirmatory test for EBV. Cross-reactivity with CMV (Cytomegalovirus) is very common because both contain similar components on their surface. It might be the reason for false positive CMV in your case. False positive results are also obtained with connective tissue diseases, malaria, and viral hepatitis. You can go for VCA (viral antigen assay) which is more specific.
6. The high rate of monoclonal gammopathy is common with EBV infection, and it will revert to normal in three or four weeks.
7. If you noticed any swollen lymph node especially around your neck area, a biopsy might be needed to rule out Hodgkin's lymphoma, which can arise out of EBV infection.

I suggest you consult a general physician with special interest in infectious disease, for a detailed evaluation.

I hope I have answered your query. Please feel free to contact if you have any further queries.

Hi,

Welcome back to icliniq.com.

1. Do not worry regarding antibody test, and it may remain positive lifelong.
2. Positive Lyme antibody could be due to mere cross-reactivity. No need to worry as long as you do not have any symptoms suggestive of Lyme disease.
3. Your faint monoclonal band is also normal finding in your case and is not at all important.
4. The fatigue and malaise need to be evaluated thoroughly. We have to rule out some diseases like diabetes, Addison's disease, Cushing's disease, hematologic diseases like leukemia and lymphomas, etc.
5. The other possibility is anxiety. Consult a physician and get evaluated, you have to do a series of blood investigation, and the bone marrow also has to be ruled out of any malignancies.

Hi,

Welcome back to icliniq.com.

Since you are so concerned, I will try to explain elaborately.

1. About IgM and IgG: Antibodies against viral antigen can remain positive lifelong. But the pattern is inconsistent, as you said IgM appear first and goes away after few months but IgG persists for life. Generally, after an acute infection or on a reactivation, IgM appear first elevated during 4 to 5 months. You got a positive IgM after one year may be due to minor undetected reactivation or other mild infection caused cross-reactivity. To confirm the EBV, we have to do a VCA or EBNA (Epstein-Barr nuclear antigen).
2. About the faint monoclonal band: It is quite common for EBV infection and does not signify any disease. You have to do a peripheral smear and bone marrow test to rule out conditions like hematological malignancies like leukemia, lymphoma, and multiple myeloma. MGUS (monoclonal gammopathy of undetermined significance) is a harmless condition, and no treatment is required, but annual protein electrophoresis may be needed.
3. About symptoms and fatigue: Patients with chronic fatigue syndrome (CFS) may show positive results with EBV. It might be the reason for your test results. EBV-infected patients can present with similar symptoms as you have mentioned, but a year duration is quite long and very unlikely. So we have to rule out CFS first by a set of guidelines. There is no test to confirm CFS.

I suggest you consult a general physician for detailed evaluation. If EBV causes it, it will go away by the end of six months with supportive measures.

Hi,

Welcome back to icliniq.com.

Exactly, annual follow-up with electrophoresis would be better. Consult hemato-oncologist for expert opinion

Hello,

Welcome back to icliniq.com.

Yes, the positive IgM just indicates a minor reactivation.

The other possibility is chronic fatigue syndrome. Some patients with CFS show laboratory findings as in EBV infection. It might be a possible reason for positive IgM. It does not mean that the EBV had triggered CFS. CFS is not synonymous with chronic EBV infection or chronic infectious mononucleosis.

Unfortunately, there is no definitive treatment for both EBV and CFS. We have only supportive therapy for it. That is what I meant by support.

You can go for the following supportive measures.

1. Cognitive behavioral therapy and counseling.
2. A healthy diet and adequate sleep.
3. Avoid use of any recreational drugs if you have a habit of it.
4. Antidepressants may be needed in some cases.
5. Consult a general physician and get evaluated for CFS.

The thing you should have a serious look is the increased risk of hematological malignancies in EBV-infected patients. So, if you feel a swollen lymph node in your neck kindly get evaluated.

Hi,

Welcome back to icliniq.com.

1. The faint monoclonal band is quite normal in EBV. It does not cause any harm.
2. Another possibility is MGUS, it is also a harmless condition, and no treatment is required, only yearly electrophoresis is recommended.

You can go for bone marrow tests to rule out cancers like multiple myeloma.