How accurate are diagnostic tools for Epstein-Barr virus (EBV) to establish causal association of an uncommon clinical condition with EBV?

UNLABELLED: Epstein-Barr virus (EBV) infection has been implicated as a possible cause of a wide range of clinical conditions in children and young adults. In uncommon clinical conditions, where clinical experience is missing, it is important to evaluate both the biological plausibility and the virological basis that substantiates their causal association with EBV. By reviewing the diagnostic procedures performed in the diagnosis of EBV infection in case reports concerning uncommon clinical conditions causally related to EBV infection in children and young adults, the aim of the present study was to discuss the limitations of the diagnostic procedure used to establish EBV diagnosis, which may cause false-positive results and compromise the reliability of such a diagnosis. We should be aware not only of the nuances of serological tests and virus detection tests for latent viruses such as EBV, but also of the risk of using them alone or in combination with molecular methods as the sole mean for establishing a causal relation between EBV infection and an uncommon clinical condition. Accurate laboratory tests for EBV detection, strict criteria for EBV infection diagnosis, and a cumulative clinical experience coupled with biological plausibility and experimental data are needed to avoid a possible coincidental association between several clinical manifestations, mainly uncommon clinical conditions, and EBV infection. KEYWORDS: Epstein-Barr virus; diagnostics; uncommon condition.