From the Guidelines
The Monospot test is recommended as the initial diagnostic tool for infectious mononucleosis due to its speed and convenience, but EBV-specific antibody tests should be used to confirm the diagnosis and determine the infection stage, especially if the Monospot test is negative or in patients with a high risk of false negatives, such as children under 12 and immunocompromised individuals. The Monospot test (heterophile antibody test) is a rapid screening tool that detects heterophile antibodies produced during mono infection, providing results within minutes 1. It's widely available, inexpensive, and convenient for initial diagnosis, but has limitations including false negatives, particularly in children under 12 and during early infection. EBV-specific antibody tests, on the other hand, directly detect antibodies against the Epstein-Barr virus, which causes most mono cases, and are more specific and sensitive, can determine the stage of infection (acute, recent, or past), and are effective across all age groups 1. Some key points to consider when choosing between the Monospot test and EBV-specific antibody tests include:
- The Monospot test has a high false-negative rate, especially in children under 12 and during early infection 1
- EBV-specific antibody tests are more expensive and take longer to process, but provide more accurate and detailed information about the infection stage 1
- The diagnosis of EBV infection should be based on symptoms and/or signs consistent with the disease, together with detection of EBV by an appropriate method applied to a specimen from the involved tissue 1
- In patients with a high risk of false negatives, such as children under 12 and immunocompromised individuals, EBV-specific antibody tests should be used to confirm the diagnosis and determine the infection stage.
From the Research
Mono Spot Test vs EBV
The mono spot test, also known as the heterophile antibody test, is used to diagnose infectious mononucleosis (IM) caused by the Epstein-Barr virus (EBV) 2. Here are some key points to consider:
- The mono spot test has an accuracy of 71% to 90% for diagnosing IM, but it has a 25% false-negative rate in the first week of illness 2.
- The test is used to detect heterophile antibodies, which are present in 90% of patients with IM 3.
- EBV-specific immunoglobulin M (IgM) antibodies can also be used to confirm infection, but this test is more costly and results take longer than the mono spot test 2.
EBV Infection Diagnosis
Diagnosing EBV infection can be challenging, and multiple tests are often used in combination to determine the infection status. Some key points to consider:
- The use of multiple serological markers, including viral capsid antigen (VCA) IgG and IgM, and EBV nuclear antigen 1 (EBNA-1) IgG, can help to distinguish between acute and past infection 4, 5, 3.
- The plasma EBV-DNA test has a higher diagnostic value than the VCA-IgG avidity test in children under 6 years old, especially those under 3 years old 6.
- The peripheral lymphocyte test and plasma EBV-DNA test are suitable for the early stage of the disease, while the VCA-IgG avidity test is more suitable for use after 7 days of the disease 6.
Interpretation of EBV Serological Patterns
Interpreting EBV serological patterns can be complex, and multiple tests are often used in combination to determine the infection status. Some key points to consider:
- The use of easy-to-use tables can help to interpret EBV serological patterns based on the results of multiple tests 4.
- Determining IgG avidity, identifying anti-EBV IgG and IgM antibodies by immunoblotting, and looking for heterophile antibodies, anti-EA (D) antibodies, or viral genome using molecular biology methods can help to solve problems that may arise in routine laboratory practice 3.
- The Architect EBV antibody panel has been shown to perform well for EBV antibody detection and correctly categorize clinically relevant EBV infection states 5.