Blood test for Epstein-Barr virus for antibodies and PCR: how to take it, the norm

By herpes we are used to understand unaesthetic painful blisters on the face in the area of the lips, which subsequently form brown crusts. Alas, this is only one of the faces of the herpes virus, which a person can meet in 8 hypostases. What we usually call herpes is a type 1 virus, or a herpes simplex virus. The second type of virus causes genital herpes, the third type - "chickenpox" and shingles, the 4th - infectious mononucleosis and several other quite dangerous pathologies, etc. This list can be continued, but we will focus on herpesvirus type 4, which is otherwise called the Epstein-Barr virus. Let's try to figure out what the herpesvirus type 4 virus is, what it is dangerous for, when and why they conduct an analysis for the Epstein-Barr virus and what the results of laboratory studies say.

What is the type 4 herpes virus?

Herpesvirus type 4, as one of the varieties of herpesvirus infection, was described 53 years ago by the English virologist Michael Epstein. In the work on the project the professor was assisted by his graduate student Yvonne Barr. It is to these people that the virus owes its name. However, already 15 years after getting acquainted with the virus, his scientific name was changed to human herpesvirus 4, and a year ago the virus was called human gamma virus type 4.

But what is the Epstein-Barr virus? Like any other virus, the virion (virus clock) of herpesvirus type 4 consists of a genetic material (in this case a double-stranded DNA) and the surrounding protein coat (capsid). Further, the virus is surrounded by a membrane that helps it to easily fit inside the host cells.

Any virus is an non-cellular form that is an infectious factor and can not develop and multiply outside the cells of a living organism. The preferred habitat of herpesvirus type 4 is epithelial cells of the nasopharynx. They also do not disdain leukocytes, preferring one of their varieties, called B-lymphocytes. It is the B cells that actively participate in the immune system of the body. Upon contact with the antigen, which in our case is the herpesvirus type 4 virus (more precisely, its antigens), B-lymphocytes produce antibodies (proteins-immunoglobulins). It is them that can be detected in the patient's blood by analyzing the Epstein-Barr virus (VEB).

The fourth type of herpesvirus isolates 4 antigens, which appear strictly in a certain sequence:

• EA is an early antigen that appears at the initial stage of the disease, when viral particles are in the synthesis stage (primary acute infection or reactivation of the lurking virus with reduced immunity),
• VCA is a capsid antigen, which is contained in the protein coat and also belongs to the early, because clinically the disease in this period may not even manifest itself,
• MA - membrane antigen, appears when the virion is already formed,
• EBNA - A nuclear (polypeptide or nuclear) antigen refers to a number of late antigens, antibodies to which can be detected even a few months after the disease and remain in the blood throughout life.

Herpesvirus type 4 is very tricky. Since the virus is inactive outside the living organism, it can only be infected from the person who is the source of the infection. And it does not have to be that all the symptoms of the disease are found out, the infection can have an erased form, disguised as usual fatigue. For example, the syndrome of chronic fatigue is in most cases associated with the Epstein-Barr virus.

Individual virions can be found in the blood, saliva, semen, vaginal secretions, tissues of various organs. Particles of the virus, along with saliva and blood, can not get to the objects around us, where they will be in an inactive state, until somehow they get into the human body. In the overwhelming majority of cases, infection occurs by airborne or contact (through kisses) through. But intrauterine transmission of the virus from mother to fetus is also possible, infection during the procedure of blood transfusion (if the donor's blood contained virus virions), during sexual intercourse.

After entering the body and implanting into the cellular structures, it can take from 5 to 50 days before the disease reminds itself. But it may not recall, leaking in a hidden form, as it happens in most cases.

Yes, according to studies, about 90% of adults at least once in their life suffered a herpetic infection associated with VEB. Most people did not even know it, because their body was able to cope with the virus attack. But this does not always happen.

How does the Epstein-Barr virus manifest itself?

Most often, doctors have to face in their practice with the following types of course of herpesviral infection of type 4:

• Chronic form (occurs after the acute phase of the disease, has some common symptoms of ill health),
• Latent or latent form (no symptoms, but the virus remains active and released into the environment),
• The slow form (occurs less often, the symptoms occur one at a time for a long period, ends with the death of the patient).

For the first time a person is infected with the Epstein-Barr virus mainly in childhood and adolescence. The peak incidence falls on the age of 14 to 18 years.

Primary viral infection has 3 different forms:

• asymptomatic (no clinical manifestations),
• Respiratory (symptoms of respiratory infection: fever, nasal discharge, general weakness, etc.)
• infectious mononucleosis with a triad of the main symptoms: high fever, signs of sore throat with yellowish crusts on the tonsils, an increase in organs such as the liver and spleen; with an increase in the level of leukocytes and an increase in lymph nodes.

There are several options for getting out of the acute phase of the disease:

• full recovery,
• the symptoms of the disease disappear, but the virus remains in the body and develops, although it does not lead to any noticeable changes in the cells (virus carrier),
• there are no symptoms of the disease, the virus does not leave the body, but also shows special activity (latent form),
• re-activation (reactivation) of the virus from the latent form,
• chronic course of infection (with recurrence of the disease, chronic active form, generalized with lesions of organs and body systems).

Result of long stay of a virus in an organism can become:

• Chronic form of infectious mononucleosis.
• Hematophagocytic syndrome : stable fever, decreased blood components (increased coagulability), enlarged liver and spleen, bleeding of mucous membranes, jaundice (due to liver disorders), enlarged lymph nodes, neurological symptoms.
• Erased form with the development of secondary immunodeficiency : hyperthermia for a long time, general weakness, increase and soreness of the lymph nodes, muscle and joint pain, frequent infectious diseases.
• The development of autoimmune pathologies in the form of lupus erythematosus, rheumatoid arthritis, etc.
• Manifestations of the syndrome of chronic fatigue with deterioration of general well-being and working capacity.
• A generalized form of chronic infection with CNS, myocardial heart, kidney, liver, lung disease.
• The development of cancer (lymphatic leukemia and lymphoma), in which there is a pathological increase in the number of cells of the lymphatic system. The herpesvirus type 4 does not destroy the carrier cells, but forces them to multiply actively, as a result of which new growths from the lymphoid tissue are detected.

As you can see, the Epstein-Barr virus is not as harmless as it seems at first glance, and therefore, it is not worth it to be treated lightly. Especially since herpesvirus type 4 is characterized by frequent episodes of virus carrying and latent form, not to mention the various forms of chronic infection, when a person remains the source of infection, without knowing it.

Determine the presence of an infectious agent in the body in this case is possible only with the help of a special analysis of the Epstein-Barr virus, the biomaterial for which blood usually serves.

Indications for the procedure of the analysis for the Epstein-Barr virus

Since herpesvirus infection of type 4 is sometimes not easy to identify, suspicion of it does not always fall. But there are certain signs on which the doctor can suspect the presence of the virus in the body:

• a severely weakened immune system (in the at-risk group there are patients with HIV infection and AIDS, patients after organ transplantation or chemotherapy),
• an increase in regional lymph nodes in the chin and occipital part of the head and their soreness, especially if this is observed after a blood transfusion or organ transplant from a donor.
• acute respiratory viral infection (ARVI), taking place against a background of very high temperatures (38-40 degrees),
• the appearance of signs of infectious mononucleosis, which most often occurs under the influence of the Epstein-Barr virus.

Even if the above signs are not present in a person, the suspicion of a specialist may cause some results of conventional tests (general analysis and blood biochemistry), as well as studies of the immune status.

A general blood test for the Epstein-Barr virus can show:

• an increase in the number of lymphocytes,
• low hemoglobin, indicating a decrease in the level of erythrocytes,
• increased blood coagulability due to a large number of platelets,
• the appearance of virotsitov (atypical lymphocytes, similar in structure to monocytes).

Biochemical blood test, which provides information on the state of internal organs, will show changes in the functioning of the liver and spleen.

Immune analysis for VEB can show a change in the number of specific lymphocytes, a mismatch in the number of immunoglobulins of different classes (dissymunoglobulinemia), deficiency of immunoglobulin G, which indicates the weakness of the immune system and its inability to curb the onslaught of the virus.

Such results of nonspecific analyzes can alert doctors, but to say exactly what they are dealing with is not yet possible. All will remain at the stage of assumptions and preliminary diagnosis. In most cases, doctors suspect a latent form of infectious mononucleosis, although other viral pathologies (influenza, hepatitis, etc.) may also manifest themselves in the same way.

In connection with the high prevalence of hepatitis type 4 and the possibility of transferring it from mother to child, the analysis for the Epstein-Barr virus will prove useful in the planning of pregnancy. If the mother had already had an infection before, her body developed antibodies to her. Repeated infection is usually excluded due to the formation of persistent immunity, and if it does, it will not have the consequences that are possible at the first encounter with the virus. Immunity will inhibit the activity of the virus throughout life, although the virus itself will remain inside the body, like any of the herpesviruses.

If the future mother picked up the herpes virus during pregnancy, it is fraught with miscarriages and premature birth, or the virus will negatively affect the intrauterine development of the baby.

The analysis on VEB can be appointed by the oncologist with suspicion of Burket's lymphoma or diagnosis of tumor processes in people with HIV. The therapist can resort to such an analysis in the diagnosis of herpetic infections (differential diagnosis to clarify the type of virus). Sometimes the analysis is also carried out to evaluate the effectiveness of the treatment.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Preparation

Depending on the type of study, biomaterial for it can be blood, saliva, urine, sputum, amniotic fluid sample, scraping, which is taken from the cervical canal or urethra, cerebrospinal fluid (cerebrospinal fluid). Most often, doctors resort to the study of blood, which is considered the most informative.

It is clear that some points may adversely affect the quality and quantity of biomaterial, so the day before it is necessary to adhere to certain rules:

• Any tests (especially blood tests) should be taken in the morning on an empty stomach. The last meal should be no later than 12 hours before taking blood, so it's better to drink water for dinner.
• Venous blood is considered to be the most suitable material for analysis of the Epstein Barr virus, and a 15-minute rest is always recommended before giving blood from the vein if a person has just come to the laboratory,
• To take blood without any consequences and the result of the analysis was reliable, it is not recommended to perform active physical work and play sports, drink alcohol and smoke for 12 hours before the procedure.
• The results of tests may affect the intake of medications. From drugs should be abandoned at least 2 days before the analysis. If this can not be done, it is necessary to notify the laboratory nurse about the preparations taken.
•  At pregnancy before research on VEB the analysis on a toxoplasmosis is carried out to exclude false positive reaction.
• If the blood test for the Epstein-Barr virus is made to a child under 5 years of age, half an hour before manipulation, the baby should be given plenty of boiled water in relatively small portions.

If another biomaterial is taken for analysis, the physician should specify in advance all the nuances of preparation for analysis, depending on the material used.

[10], [11], [12],

Technique of the analysis for the Epstein-Barr virus

An important role in the diagnosis of type 4 herpes and infectious mononucleosis is given to physicians by specific assays that help to identify the DNA of the virus or unique antibodies in the patient's biomaterial. The main types of laboratory studies used to detect the Epstein-Barr virus in the human body include enzyme immunoassay (ELISA) and PRC diagnostics. Let us consider in more detail the essence of both methods and the peculiarities of their conduct.

Immunoenzyme analysis on VEB

ELISA is a study (analysis) of the venous blood of patients on antibodies to the Epstein-Barr virus. As a result of diagnostics in the blood of patients with VEB, immunoglobulins of the IgG or IgM type (total of 5 species) are detected to one of the 3 antigens of the virus (early, capsid or nuclear).

The analysis is carried out in the immunological laboratory, where the patient takes about 10 ml of blood from the vein. Next, the biomaterial is left at room temperature for a quarter of an hour, during which the blood folds. The clot is neatly separated from the liquid portion. The liquid is centrifuged and a clean serum (serum) of blood is obtained. It is her that is subjected to further research.

The idea of the method arose on the basis of data that in our body specific antibodies are produced to each of the types of viruses and bacteria that penetrate the body from the outside. The organism recognizes the alien in them and destroys them with the help of unique antibodies that adhere firmly to the antigen.

The essence of the ELISA analysis is based precisely on this reaction. Antibodies with labels attached to them are combined with antigens. The label is applied to a substance that reacts with a special enzyme to change the color of the sample. The more such "chains", the more intense the color of the biomaterial.

Immunoenzyme analysis can be carried out in three ways:

• Direct IFA. The test fluid is placed in wells and left for about half an hour so that the antigens can attach to the walls of the well. To the sorbed antigens is added a liquid with labeled antibodies. After the required time (from half an hour to 5 hours), when the antibodies are detected and contacted with antigens, the liquid is drained, the wells are gently washed and the enzyme is added thereto. By the method of coloration, the concentration of the virus in a unit of blood is determined.
• Indirect EIA. In this method, the serum of the blood and the labeled antibodies are added to the antigens sorbed on the surface of the wells. As a result, 2 types of ligaments are obtained, some of which are obtained labeled. The result depends on the concentration of antigens in the test sample. The more unlabeled antibodies, the fewer compounds labeled with the enzyme.

Further, a special reagent is added to the washed composition, according to which the enzymatic activity of the antigen-antibody complexes is determined.

• "Sandwich". It differs from the indirect method in that initially antigens, rather than antibodies, are sorbed on the surface. To them, a solution containing the antigens to be studied is added. After washing the carrier, antibodies with enzymatic labels are added. The surplus of antibodies is again removed and a colored substance is obtained using hydrogen peroxide, which is studied by the spectrometric method.

This type of analysis allows not only to identify specific antibodies and determine the concentration of antigens, but also to clarify the stage of the disease. The matter is that different antigens of the virus of the Enstein-Barr virus appear at various stages of herpetic infection, and therefore antibodies to them are produced in a certain period of the disease.

Thus, IgG antibodies to the early antigen (IgG EA) appear in the blood 1-2 weeks after infection, when the disease is in the acute stage or the stage of reactivation of the virus. Disappear immunoglobulins of this type in 3-6 months. In the chronic course of a viral infection, such antibodies are especially numerous, and at an atypical form they are absent altogether.

IgG antibodies to the capsid antigen (IgG VCA) also appear early, during the first 4 weeks of the disease, but most are determined by the second month of infection. In the acute phase, they are found in most patients, but they may not appear in children. In the chronic course of the disease, especially during periods of reactivation of the virus, the amount of IgG VCA is particularly high. These antibodies in a person in the blood remain forever, like the virus itself, which indicates a formed immunity to the infectious agent.

Antibodies of IgM to the capsid antigen (IgM VCA) may appear even before the first signs of the disease appear. Their concentration (titers) is especially great in the first 6 weeks of the disease. This type of antibody is characteristic of acute infection and reactivation of chronic. IgM VCA disappeared after 1-6 months.

IgG antibodies to a nuclear gene (IgG EBNA) may indicate that a person has previously directly encountered a herpetic infection. In the acute phase of the disease, they are extremely rare, usually appearing in the recovery period (3-10 months). In their blood, they can be found several years after the infection.

Identification of individual antigens does not give a complete picture of the disease, therefore, tests for different antibodies should be carried out in combination. For example, if only IgM VCA is present and IgG EBNA is not detected, it is a primary infection.

Alas, to identify the primary herpetic infection or congenital pathology of enzyme immunoassay is often not enough. In the latter case, antibodies can not be detected at all. As a confirmatory test in the primary disease, a molecular study of blood or other biological material on the Epstein-Barr virus is used.

PRC analysis for the Epstein-Barr virus

This analysis is carried out at the stage of acute primary infection, otherwise its result will be incorrect.

The essence of the PRC method (poly-dimensional chain reaction) boils down to the fact that each infectious agent has its own set of genes encapsulated in a DNA molecule. The DNA of the pathogen is contained in small amounts taken for the study of the biomaterial (viruses themselves have microscopic dimensions), so it's very difficult to assess the situation. But if you conduct a specific reaction, the amount of genetic material will increase significantly, which will give the opportunity to name the causative agent by name.

With the help of disposable instruments take material for molecular research, which is placed in a special apparatus for analysis. The device is a thermostat with a special program - a thermal cycler or an amplifier. In the apparatus, a full cycle of the PRC (about 2-3 minutes) is scrolled several tens of times, which has 3 stages:

• Denaturation (at a temperature of 95 degrees, the DNA strands disconnect).
• Annealing (at a temperature of 75 degrees, specially prepared "seeds" for VEB are inserted into the test material, which are attached to the DNA of the virus).
• Elongation or reproduction of genetic material (a special enzyme is attached to the seed at a temperature of 72 degrees, which recreates a new DNA chain, thereby increasing the amount of genetic material by half).

If the complete cycle of the poly-dimensional reaction is run out 50 times, the amount of material will increase 100 times. So, it will be much easier to identify the pathogen.

Analysis for the Epstein-Barr virus in a child

As we already know, the Epstein-Barr virus can cause many diseases. Once in the human body, he remains his permanent resident, and only the well-coordinated work of the immune system does not allow him to actively parasitize inside cells.

Almost 95% of the adult population of the planet lives with VEB inside, and most of them have met the virus since early childhood. Someone inherited it from his mother, while others received a virus from parents and relatives hurrying to a child with kisses, or airborne drops in a kindergarten or school (infectious diseases there usually acquire "universal" scales).

Little children in general tend to all pull in the mouth, and a greater number of virions is found in the saliva. And if in the garden one and the same toy is licked by several children, while the educators are busy with their own affairs, it is not surprising that the virus so actively spreads in large groups of kids.

VEB can easily be called a disease of children and youth, because in adolescence, already half of children have a virus in the body (and by 30 years and about 90% of adults). Children are sick at different age periods in their own way. Until a year, until the child actively communicates with people, the probability of getting sick from him is not high. The kid is older than a year, even if he does not go to kindergarten, becomes more sociable, plays with peers on the street, commits active shopping trips with his mom, etc., and the probability of capturing the virus becomes much higher.

But this is not an excuse to lock the child in 4 walls. At the age of 1-3 years the disease in the vast majority of cases occurs without any symptoms, except that with a slight rise in temperature and a slight rhinitis, reminding a cold. It turns out that the earlier a child gets acquainted with a virus, the easier it is to get acquainted with it.

It's not good if the child gets sick without the appearance of IgG VCA antibodies in the blood, which means that the immune system is not immune to the virus, and the virus can be reactivated as soon as the immune system gives slack. The reason is, most likely, the imperfection of the immune system of young children, which is in the formative stage for several years.

School life gives even more prerequisites for the disease, especially in the adolescent period, when young people actively practice in kisses. But in children older than 3 years, the disease is less likely to have asymptomatic treatment. In most cases, doctors face infectious mononucleosis with symptoms typical of it.

Despite the fact that the pathology can have a long course (about 2 months), it is not so dangerous and does not require the use of serious drugs. Doctors prescribe anti-inflammatory and antiviral drugs, if a bacterial infection joins, they seek help from antibiotics. By the way, penicillins in this case are not recommended because they can provoke the appearance of skin rashes.

Do not think that if a child or teenager gets infected with an infectious mononucleosis, then the Epstein-Barr virus has settled in his body. The disease has other less frequent pathogens, for example, cytomegalovirus (herpes virus type 5). To understand what the doctors are dealing with, they prescribe an analysis for the Epstein-Barr virus, and, if necessary, other laboratory tests.

It is also true that infectious mononucleosis is not the only manifestation of VEB in childhood. There are other diseases associated with this pathogen, but in our region they are rare.

So Burkitt's lymphoma (specifically, her VEB is due to her detection) is found mainly in children in African countries, very rarely in America, even less often in Europe (and only against AIDS). The jaw tumor with lesions of lymph nodes, kidneys and other organs is found in children 3-8 years old.

Nasopharyngeal cancer, a significant part of other lymphomas, hairy leukoplakia of the mouth are all manifestations of VEB against the background of greatly reduced immunity, which happens with HIV infection and its later stage of AIDS.

Congenital immunodeficiency and the attachment of the Epstein-Barr virus is a dangerous mixture that can lead to the development of a proliferative syndrome in a child. In this case, an increase in the number of B-lymphocytes leads to the appearance of a granulate in many organs, which prevents them from functioning normally. It is a disease with a high level of mortality, but against the background of normal immunity it does not develop.

We can say that in childhood, the Epstein-Barr virus is dangerous mainly in immunodeficiency due to the development of various complications. In most cases, everything is limited to infectious mononucleosis. And although he does not require special treatment, doctors prefer to establish the nature of the causative agent of the disease, for which the child is prescribed a general blood test, an enzyme immunoassay and a PRC.

Since in childhood there is mainly a primary infection, it is quite possible to confine ourselves only to OAK and PRC, which is quite informative in the newly diagnosed disease.

[13], [14], [15], [16], [17], [18], [19], [20], [21], [22],

Normal performance

The processing of the results of the PRC analysis is carried out by electrophoresis or with the use of labeled "primers". In the latter case, it is sufficient to add the reagent (chromogen) and determine by the color whether there are virions in the sample. A positive result of electrophoresis is said to be when DNA strands that are different in length are found in the sample.

In the incubation period of the disease and asymptomatic virus carrier, the PRC will give a negative result, as in the case of an absolute lack of a virus in the body. At the beginning of the development of the primary infection and in its early stages, the PRC in real time can give both positive and negative results, which in no way clarifies the situation.

But at the height of the disease (acute phase), with its chronic course or re-activation of the virus (exacerbation) and in the case of atypical forms, the analysis will be positive. If a person has been ill for a long time and the virus in his body is in an inactive state, the PRC analysis will give a negative result, i.e. The conduct of this analysis during this period is also inadvisable, as in too early a period of the disease.

It must be said that the exact results of this type of laboratory tests are possible only with the primary infection and the absence of virions of other viruses.

Now, with regard to the enzyme immunoassay for the Epstein-Barr virus. He has the same requirements. The presence of 5 or 6 types of herpesvirus, toxoplasmosis, as well as HIV infection, can distort the result no less than negligent attitude to the analysis or poor quality of the reagents used. In this case, additional studies may be required, taking into account possible causative agents of the disease.

The normal test results, which indicate the absence of a virus in the body, are considered negative for all 4 tests: IgG EA, IgM VCA, IgG VCA and IgG EBNA. Yes, each test is carried out separately, because antigens appear in different periods of the disease. Sometimes only single tests can be assigned, but in most cases it is necessary to do all 4 analyzes, but in different periods of the disease.

For example, in the incubation period of the disease, as in the absence of infection, none of the four types of antibodies is found in the blood. Such a result can not be considered sufficient, because it does not allow to differentiate a newly ill person from a healthy one.

At the beginning of the development of the primary disease, only antibodies IgM VCA appear in the blood. In the early stages of the disease, they are joined by IgG VCA.

The acute stage of primary infection occurs with the formation of three types of antibodies: IgG VCA, IgM VCA and IgG EA, with the most detectable antibody IgG to the capsid antigen. The same composition of antibodies persists and within half a year after the acute phase of the disease, but the amount of IgM VCA gradually decreases to zero.

Six months after the disease, antibodies of IgG EBNA appear in the blood, at the same time IgG EA immunoglobulins become less and IgM VCA are absent altogether.

In the chronic course of the disease or the reactivation of the virus, there may be different indicators. Most often, all four types of antibodies are found in the blood. But it may well be that immunoglobulins IgM VCA and IgG EBNA are not found.

The complication of viral infection by tumor processes occurs with the absence of IgM VCA antibodies, and IgG EBNA immunoglobulins are not detected in all cases.

But the enzyme immunoassay determines not only the presence of certain antibodies, but also their concentration, which allows us to judge with greater accuracy the stage of pathology, as well as its possible consequences. There is no need to talk about specific figures. After all, each laboratory analyzes one of the possible ways, using different reagents, therefore, in the digital design, the results of the analysis of different laboratories may differ.

The patient is obliged to issue a form, where the threshold (reference) values of the values will be indicated. If the result is below the threshold, this is considered a normal (negative) indicator. If the determined number is higher than the reference value, everything indicates a positive result, which means that the virus lives in the body. The value of the determined value indicates the stage of the disease and the population of the organism by VEB virions, i.e. About severity of pathology.

If ELISA gives a negative result, it only indicates that in the past, a person had no contact with VEB. But is there a virus present in the body at present to say with certainty impossible. A negative result can cause incubation of the pathogen in the body and asymptomatic virus carrying. Sometimes, in order to make sure that the virus is not infected by the body, it is necessary to perform a second series of tests after a while.

If the result of the enzyme immunoassay on the Epstein-Barr virus is only slightly higher than the reference values, the result is considered doubtful. The cause most often becomes the early stage of the disease or the presence in the body of the virions of another virus. In this case, after 2 weeks it is recommended to do a second test for VEB and possibly for other pathogens.

[23], [24], [25], [26], [27], [28], [29], [30],

As for the question of how much analysis is done for the Epstein-Barr virus and when it is possible to wait for results, then there are no special difficulties expected. In a serious well-equipped laboratory, the answer will have to wait no more than 2 days after the delivery of the biomaterial. In situations requiring urgent analysis, the answer can be obtained even after a couple of hours.

To conduct the analysis for the Epstein-Barr virus, it is necessary in a tested laboratory, where there are both quality reagents and qualified specialists. Still, the study costs money (and not small, the analysis for one type of antibodies costs around 150-170 UAH.), And I would not like to get a false result, but later it is possible to go back to another laboratory, for reanalysis. 

[31], [32], [33], [34], [35]