To the Editor.—
Based on eight years of clinical experience and having performed many thousands of Epstein-Barr virus (EBV) serological assays with emphasis on IgG anti-early antigen I cannot agree with the conclusion of Hellinger et al1 that the antibody to EBV early antigen is not helpful in the clinical evaluation of patients with chronic fatigue syndrome. The initial suspicion of a direct etiologic link between EBV and chronic fatigue syndrome has yielded to the probability that EBV reactivation is a secondary phenomenon related to a primary, transient immune dysfunction, the cause of which is currently unknown.In contrast to all other EBV serological markers, which reflect only previous infection, anti-early antigen does rise and fall with clinical activity of the signs and symptoms used to define the chronic fatigue syndrome.2 Although not diagnostic, it is a useful therapeutic marker when initially found in significant elevation (ie, ≥1:80).
Hermann WJ. The Epstein-Barr Virus and Chronic Fatigue Syndrome. JAMA. 1989;261(9):1277–1278. doi:10.1001/jama.1989.03420090041017
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