Difference between revisions of "Epstein-Barr Virus"

From Anthony Nolan Medical Guidelines
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• VCA-IgG
 
• VCA-IgG
  
• (EBNA-IgG)
+
    (EBNA-IgG)
 +
 
  
If VCA-IgM is positive, EBV-PCR should be undertaken
 
  
 
===Outcomes and recommended actions based on EBV serology and PCR:===
 
===Outcomes and recommended actions based on EBV serology and PCR:===
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1) VCA-IgM neg AND VCA-IgG pos or neg.
+
1) '''VCA-IgM neg AND VCA-IgG pos or neg.
 
 
OR
 
 
 
VCA-IgM-pos AND VCA-IgG pos AND EBV-PCR = negative
 
 
 
 
 
''Donor can be cleared - transplant centre should be informed for serological/PCR status''
 
 
 
  
 +
'''
  
2) VCA-IgM-pos AND VCA-IgG and/or EBNA weak or negative AND EBV-PCR=negative
+
''''Donor can be cleared - transplant centre should be informed for serological/PCR status''
  
''IgM could be non-specific or donor has  acute (inapperent) infection
+
''
  
 +
2) '''VCA-IgM-pos AND VCA-IgG and/or EBNA positive
 +
'''
  
The clinical picture (e.g. sore throat, swollen lymph glands) as well as laboratory parameters (lymphocytosis, atypical lymphocytes on blood smear) should be correlated with serology, and taken into account for reasons of donor safety. Consider more specific immunoblots to validate the serology results.  Results should be communicated with transplant centre.'' 
+
Inform the TC and proceed donation without EBV-DNA PCR
  
  
 +
3)'''VCA-IgM-pos AND VCA-IgG and/or EBNA weak or negative
  
3) EBV-PCR = positive
+
Request EBV-DNA PCR  
  
 +
a) If EBV-DNA PCR negative--> inform the TC and proceed donation
  
''Donor cannot be cleared at the current timepoint. Inform transplant centre and repeat EBV-PCR in one month
+
b) If EBV-DNA PCR positive --> inform the TC, donation will have to be postponed and EBV serology repeated after 1 month.
  
 
==Justification for guidance==
 
==Justification for guidance==

Latest revision as of 14:22, 10 January 2020

Condition

Herpes virus causing glandular fever (infectious mononucleosis).

Individual at risk

Recipient (and ?donor)


Guidance at RECRUITMENT

ACCEPTABLE


Guidance at CT

ACCEPTABLE


Guidance at Work-up

The following serological tests should be obtained

• VCA-IgM

• VCA-IgG

• (EBNA-IgG)


Outcomes and recommended actions based on EBV serology and PCR:

Potential serology/PCR combinations:


1) VCA-IgM neg AND VCA-IgG pos or neg.

''Donor can be cleared - transplant centre should be informed for serological/PCR status

2) VCA-IgM-pos AND VCA-IgG and/or EBNA positive

Inform the TC and proceed donation without EBV-DNA PCR


3)VCA-IgM-pos AND VCA-IgG and/or EBNA weak or negative

Request EBV-DNA PCR

a) If EBV-DNA PCR negative--> inform the TC and proceed donation

b) If EBV-DNA PCR positive --> inform the TC, donation will have to be postponed and EBV serology repeated after 1 month.

Justification for guidance

Primary EBV infection or reactivation in a transplant recipient is associated with post-transplant lymphoproliferative disease, amongst other morbidity.

References

Buisson, M., Fleurent, B., Mak, M., Morand, P., Chan, L., Ng, A., … Seigneurin, J. M. (1999). Novel Immunoblot Assay Using Four Recombinant Antigens for Diagnosis of Epstein-Barr Virus Primary Infection and Reactivation. Journal of Clinical Microbiology, 37(8), 2709–2714. [1]

APA Recommendations of the Center for International Blood and Marrow Transplant Research (CIBMTR®), the National Marrow Donor Program (NMDP), the European Blood and Marrow Transplant Group (EBMT), the American Society of Blood and Marrow Transplantation (ASBMT), the Canadian Blood and Marrow Transplant Group (CBMTG), the Infectious Disease Society of America (IDSA), the Society for Healthcare Epidemiology of America (SHEA), the Association of Medical Microbiology and Infectious Diseases Canada (AMMI), and the Centers for Disease Control and Prevention (CDC), Tomblyn, M., Chiller, T., Einsele, H., Gress, R., Sepkowitz, K., … Boeckh, M. A. (2009). Guidelines for Preventing Infectious Complications among Hematopoietic Cell Transplant Recipients: A Global Perspective. Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, 15(10), 1143–1238. doi:10.1016/j.bbmt.2009.06.019 [2]


Version

Version 2, Edition 1

Date of Last Update

3 March 2016