Materiały źródłowe

• #1

  https://bpac.org.nz/bt/2012/october/glandular.aspx

  Glandular fever (infectious mononucleosis) is a common, potentially debilitating illness that is most frequently seen in adolescents and young adults. A diagnosis of glandular fever can usually be made clinically, but laboratory testing is indicated if the clinical picture is unclear or where the risks of morbidity are high. The most appropriate testing regimen is dependent on age, history and symptoms. […] Laboratory investigation of glandular fever may not be necessary where the patients clinical features suggest a diagnosis. Testing is recommended, however, wherever the clinical picture is unclear or an incorrect diagnosis has the potential to cause significant morbidity. […] When testing is indicated, the recommended tests are a full blood count (FBC) and a heterophile antibody test, followed by serology if the diagnosis remains unclear.

• #2 Mononucleosis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/mononucleosis/diagnosis-treatment/drc-20350333

  Your doctor may suspect mononucleosis based on your signs and symptoms, how long they’ve lasted, and a physical exam. He or she will look for signs such as swollen lymph nodes, tonsils, liver or spleen, and consider how these signs relate to the symptoms you describe. […] If there’s a need for additional confirmation, a monospot test may be done to check your blood for antibodies to the Epstein-Barr virus. This screening test gives results within a day. But it may not detect the infection during the first week of the illness. A different antibody test requires a longer result time, but can detect the disease even within the first week of symptoms. […] Your doctor may use other blood tests to look for an elevated number of white blood cells (lymphocytes) or abnormal-looking lymphocytes. These blood tests won’t confirm mononucleosis, but they may suggest it as a possibility. […] What tests do I need?

• #3 Mononucleosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470387/

  Fever, sore throat, fatigue, and tender lymph nodes are classic findings on history-taking in infected individuals with mononucleosis. […] The classical triad is fever, pharyngitis, and lymphadenopathy. […] Laboratory evaluation most commonly will reveal lymphocytosis, with a lymphocyte differential often greater than 50%. Atypical lymphocytosis of greater than 10% can be seen on blood smear. […] The monospot (or heterophile antibody) test for mononucleosis is the diagnostic test of choice and is nearly 100% specific for the disease. The sensitivity of this test is closer to 85%. […] The diagnostic test of choice for mononucleosis is the heterophile antibody (monospot) test. This can be occasionally falsely negative in early disease and require repeat testing later in the course of the illness.

• #4 Mononucleosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470387/

  Fever, sore throat, fatigue, and tender lymph nodes are classic findings on history-taking in infected individuals with mononucleosis. […] The classical triad is fever, pharyngitis, and lymphadenopathy. […] Laboratory evaluation most commonly will reveal lymphocytosis, with a lymphocyte differential often greater than 50%. Atypical lymphocytosis of greater than 10% can be seen on blood smear. […] The monospot (or heterophile antibody) test for mononucleosis is the diagnostic test of choice and is nearly 100% specific for the disease. The sensitivity of this test is closer to 85%. […] The diagnostic test of choice for mononucleosis is the heterophile antibody (monospot) test. This can be occasionally falsely negative in early disease and require repeat testing later in the course of the illness.

• #5 Infectious mononucleosis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/123

  Infectious mononucleosis is characterised by the classic triad of fever, pharyngitis, and lymphadenopathy, along with atypical lymphocytosis. […] Positive heterophile antibody test and serological test for antibodies against EBV are usually diagnostic. […] IM typically manifests in adolescents and young adults as a febrile illness with sore throat and enlarged lymph nodes. Atypical lymphocytosis and a positive heterophile antibodies test are usually observed. […] Key diagnostic factors include presence of risk factors, fever, pharyngitis, cervical or generalised lymphadenopathy, and malaise. […] 1st investigations to order include FBC, heterophile antibodies, Epstein-Barr virus (EBV)-specific antibodies, and LFTs. […] Investigations to consider include real-time polymerase chain reaction (PCR), ultrasonography of abdomen, and CT of abdomen.

• #6 Infectious mononucleosis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/123

  Infectious mononucleosis (IM), also known as glandular fever, is a clinical syndrome most commonly caused by Epstein-Barr virus (EBV) infection in 80% to 90% of cases. […] The diagnosis „infectious mononucleosis” is primarily used when the syndrome is caused by EBV; „mononucleosis syndrome” should be used when the syndrome is caused by a non-EBV etiology. […] Key diagnostic factors include fever, pharyngitis, cervical or generalized lymphadenopathy, and malaise. […] 1st investigations to order include CBC, Epstein-Barr virus (EBV)-specific antibodies, and LFTs. […] Investigations to avoid include serum Monospot for EBV infection and ultrasonography of abdomen. […] Investigations to consider include real-time polymerase chain reaction (PCR) and CT of abdomen.

• #7 Glandular fever | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/infections-and-poisoning/glandular-fever/

  Glandular fever is a type of viral infection that mostly affects young adults. It normally gets better without treatment, but it can make you feel very ill. It normally lasts for 2 to 3 weeks, but in some cases you can feel ill for months. […] To diagnose glandular fever, your GP will first ask about your symptoms. They will carry out a physical examination. Theyll look for signs of glandular fever, like swollen glands, tonsils, liver and spleen. […] Your GP may also recommend a blood test to help confirm the diagnosis and rule out infections that can cause similar symptoms.

• #8 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diagnosis-of-glandular-fever.aspx

  Diagnosis of glandular fever is primarily based on history of signs and symptoms of the infection, physical examination and is confirmed by blood tests. […] History taking is followed by a detailed physical examination. The physician detects classical features like an inflamed throat, swollen lymph nodes and tonsils and enlarged spleen and liver. […] Blood tests to detect glandular fever include different types of antibody tests. […] Antibody tests are usually positive during the phase where glands are enlarged. Initially during the fever and sore throat phase of the infection the antibody test may be negative. If glandular fever is suspected then the test should be repeated after the glands are swollen. […] An antibody test may be directed towards heterophile antibodies. […] Patients with infectious mononeucleosis commonly (85-90%) have heterophile antibodies.

• #9 Infectious mononucleosis – Wikipedia

  https://en.wikipedia.org/wiki/Infectious_mononucleosis

  The disease is diagnosed based on: […] Mono is primarily diagnosed based on the symptoms and can be confirmed with blood tests for specific antibodies. […] The heterophile antibody test, or monospot test, works by agglutination of red blood cells from guinea pigs, sheep and horses. This test is specific but not particularly sensitive (with a false-negative rate of as high as 25% in the first week, 5-10% in the second, and 5% in the third). […] When negative, these tests are more accurate than the heterophile antibody test in ruling out infectious mononucleosis. When positive, they feature similar specificity to the heterophile antibody test. Therefore, these tests are useful for diagnosing infectious mononucleosis in people with highly suggestive symptoms and a negative heterophile antibody test. […] The presence of an enlarged spleen, and swollen posterior cervical, axillary, and inguinal lymph nodes are the most useful to suspect a diagnosis of infectious mononucleosis. […] The monospot test is not recommended for general use by the CDC due to its poor accuracy.

• #10 Epstein-Barr Virus Infectious Mononucleosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1001/p1279.html

  Infectious mononucleosis should be suspected in patients 10 to 30 years of age who present with sore throat and significant fatigue, palatal petechiae, posterior cervical or auricular adenopathy, marked adenopathy, or inguinal adenopathy. […] An atypical lymphocytosis of at least 20 percent or atypical lymphocytosis of at least 10 percent plus lymphocytosis of at least 50 percent strongly supports the diagnosis, as does a positive heterophile antibody test. […] Hoaglands criteria for the diagnosis of infectious mononucleosis are the most widely cited: at least 50 percent lymphocytes and at least 10 percent atypical lymphocytes in the presence of fever, pharyngitis, and adenopathy, and confirmed by a positive serologic test. […] The presence of splenomegaly, posterior cervical adenopathy, axillary adenopathy, and inguinal adenopathy is most useful in considering the possibility of infectious mononucleosis, while the absence of cervical adenopathy and fatigue is most helpful in dismissing the diagnosis.

• #11 Epstein-Barr Virus Infectious Mononucleosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1001/p1279.html

  Infectious mononucleosis should be suspected in patients 10 to 30 years of age who present with sore throat and significant fatigue, palatal petechiae, posterior cervical or auricular adenopathy, marked adenopathy, or inguinal adenopathy. […] An atypical lymphocytosis of at least 20 percent or atypical lymphocytosis of at least 10 percent plus lymphocytosis of at least 50 percent strongly supports the diagnosis, as does a positive heterophile antibody test. […] Hoaglands criteria for the diagnosis of infectious mononucleosis are the most widely cited: at least 50 percent lymphocytes and at least 10 percent atypical lymphocytes in the presence of fever, pharyngitis, and adenopathy, and confirmed by a positive serologic test. […] The presence of splenomegaly, posterior cervical adenopathy, axillary adenopathy, and inguinal adenopathy is most useful in considering the possibility of infectious mononucleosis, while the absence of cervical adenopathy and fatigue is most helpful in dismissing the diagnosis.

• #12 Infectious Mononucleosis: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2023/0100/infectious-mononucleosis.html

  Infectious mononucleosis is a viral syndrome characterized by fever, pharyngitis, and posterior cervical lymphadenopathy. […] Cost-effective, efficient initial laboratory testing for acute infectious mononucleosis includes complete blood count with differential (to assess for greater than 40% lymphocytes and greater than 10% atypical lymphocytes) and a rapid heterophile antibody test. […] Initial testing for acute infectious mononucleosis should include complete blood count with differential and rapid heterophile antibody testing. […] Laboratory testing is crucial in confirming infectious mononucleosis. […] The heterophile antibody latex agglutination test (monospot) is an inexpensive, rapid test with 87% sensitivity and 91% specificity reported in a systematic review. […] The absence of atypical lymphocytosis supports the accuracy of a negative heterophile antibody test result. […] Viral capsid antigen (VCA) immunoglobulin G (IgG) and IgM testing can be helpful if heterophile antibody test results are negative but clinical suspicion is high. […] Routine imaging is not indicated in the diagnosis of infectious mononucleosis.

• #13

  https://bpac.org.nz/bt/2012/october/glandular.aspx

  Glandular fever (infectious mononucleosis) is a common, potentially debilitating illness that is most frequently seen in adolescents and young adults. A diagnosis of glandular fever can usually be made clinically, but laboratory testing is indicated if the clinical picture is unclear or where the risks of morbidity are high. The most appropriate testing regimen is dependent on age, history and symptoms. […] Laboratory investigation of glandular fever may not be necessary where the patients clinical features suggest a diagnosis. Testing is recommended, however, wherever the clinical picture is unclear or an incorrect diagnosis has the potential to cause significant morbidity. […] When testing is indicated, the recommended tests are a full blood count (FBC) and a heterophile antibody test, followed by serology if the diagnosis remains unclear.

• #14 Epstein-Barr Virus (EBV) Infectious Mononucleosis (Mono) Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/222040-workup

  Accurate diagnosis requires correlating serological and molecular test results with clinical presentation. For instance, the presence of anti-VCA IgM and absence of anti-EBNA IgG suggest a primary EBV infection. Conversely, the presence of anti-EBNA IgG indicates past infection. […] If heterophile antibody tests are negative and EBV-specific antibodies are not indicative of acute infection, consider other causes of mononucleosis-like symptoms, such as cytomegalovirus (CMV), toxoplasmosis, or human herpesvirus 6 (HHV-6). […] The complete blood cell (CBC) count is more valuable for ruling out alternative diagnoses that mimic infectious mononucleosis than for providing specific diagnostic information. While leukocytosis is typical in infectious mononucleosis, a normal or decreased white blood cell (WBC) count suggests an alternative diagnosis. Lymphocytosis often accompanies infectious mononucleosis, peaks during the first few weeks of illness, and gradually returns to normal. Similarly, atypical lymphocytes follow the same timeline as lymphocytosis. A relative atypical lymphocyte counts of 20% in patients with fever, pharyngitis, and lymphadenopathy strongly suggests Epstein-Barr virus (EBV) infectious mononucleosis.

• #15 Infectious Mononucleosis – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/herpesviruses/infectious-mononucleosis

  Diagnosis of Infectious Mononucleosis […] Heterophile antibody test […] Sometimes EBV serologic testing […] Infectious mononucleosis should be suspected in patients with typical symptoms and signs. Exudative pharyngitis, anterior cervical lymphadenopathy, and fever may be clinically indistinguishable from those caused by group A beta-hemolytic streptococci. However, posterior cervical or generalized adenopathy or hepatosplenomegaly suggests infectious mononucleosis. Moreover, detection of streptococci in the oropharynx does not exclude infectious mononucleosis. […] Laboratory diagnosis usually involves a complete blood count and EBV serologic testing. Lymphocytes that are morphologically atypical account for up to 30% of the white blood cells. Although individual lymphocytes may resemble leukemic lymphocytes, lymphocytes are heterogeneous, which is unlikely in leukemia. Atypical lymphocytes may also be present in HIV or CMV infection, hepatitis B, influenza B, rubella, or other viral illnesses, so diagnosis requires serologic testing. However, very high atypical lymphocyte counts are typically seen only in primary EBV and CMV infection.

• #16 Epstein-Barr Virus Infectious Mononucleosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1001/p1279.html

  Infectious mononucleosis should be suspected and a diagnostic evaluation obtained in febrile patients who have sore throat plus splenomegaly, palatal petechiae, or posterior, axillary, or inguinal adenopathy. […] The accuracy of diagnostic tests for infectious mononucleosis is summarized in the tables. […] More sensitive tests have been developed that detect VCA-IgG and VCA-IgM. […] A white blood cell count with differential or a heterophile antibody test should be obtained in these patients, as well as a rapid test for streptococcal pharyngitis. […] If the patient has more than 20 percent atypical lymphocytes or more than 50 percent lymphocytes with at least 10 percent atypical lymphocytes, infectious mononucleosis is quite likely, and further confirmation of the diagnosis is not needed. […] A positive result of a heterophile antibody test also is strong evidence in favor of a diagnosis of infectious mononucleosis. […] A negative result of an antibody test, particularly during the first week of illness, may indicate that the patient does not have infectious mononucleosis.

• #17 Diagnosing and Treating Mononucleosis

  https://www.uspharmacist.com/article/diagnosing-and-treating-mononucleosis

  Mono is primarily diagnosed based on the symptoms and can be confirmed with blood tests for specific antibodies. […] Epstein-Barr virus-induced IM should be suspected when an adolescent or young adult complains of sore throat, fever, and fatigue and also has lymphadenopathy and pharyngitis on physical examination. […] Supportive evidence of EBV infection is derived from the observation of lymphocytosis and increased circulating atypical lymphocytes along with a positive heterophile antibody test (a rapid test for antibodies produced against EBV). […] Patients with suspected IM based upon history and physical examination should have a white blood cell count with differential and heterophile tests. […] The first laboratory finding in association with IM is lymphocytosis, defined as an absolute count 4500/microliter or, on peripheral smear, a differential count 50%. […] Common laboratory findings include an absolute or relative lymphocytosis, an increased proportion of atypical lymphocytes, and elevated aminotransferases.

• #18 Epstein-Barr Virus (EBV) Infectious Mononucleosis (Mono) Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/222040-workup

  Accurate diagnosis requires correlating serological and molecular test results with clinical presentation. For instance, the presence of anti-VCA IgM and absence of anti-EBNA IgG suggest a primary EBV infection. Conversely, the presence of anti-EBNA IgG indicates past infection. […] If heterophile antibody tests are negative and EBV-specific antibodies are not indicative of acute infection, consider other causes of mononucleosis-like symptoms, such as cytomegalovirus (CMV), toxoplasmosis, or human herpesvirus 6 (HHV-6). […] The complete blood cell (CBC) count is more valuable for ruling out alternative diagnoses that mimic infectious mononucleosis than for providing specific diagnostic information. While leukocytosis is typical in infectious mononucleosis, a normal or decreased white blood cell (WBC) count suggests an alternative diagnosis. Lymphocytosis often accompanies infectious mononucleosis, peaks during the first few weeks of illness, and gradually returns to normal. Similarly, atypical lymphocytes follow the same timeline as lymphocytosis. A relative atypical lymphocyte counts of 20% in patients with fever, pharyngitis, and lymphadenopathy strongly suggests Epstein-Barr virus (EBV) infectious mononucleosis.

• #19 Epstein-Barr Virus Infectious Mononucleosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1001/p1279.html

  Infectious mononucleosis should be suspected in patients 10 to 30 years of age who present with sore throat and significant fatigue, palatal petechiae, posterior cervical or auricular adenopathy, marked adenopathy, or inguinal adenopathy. […] An atypical lymphocytosis of at least 20 percent or atypical lymphocytosis of at least 10 percent plus lymphocytosis of at least 50 percent strongly supports the diagnosis, as does a positive heterophile antibody test. […] Hoaglands criteria for the diagnosis of infectious mononucleosis are the most widely cited: at least 50 percent lymphocytes and at least 10 percent atypical lymphocytes in the presence of fever, pharyngitis, and adenopathy, and confirmed by a positive serologic test. […] The presence of splenomegaly, posterior cervical adenopathy, axillary adenopathy, and inguinal adenopathy is most useful in considering the possibility of infectious mononucleosis, while the absence of cervical adenopathy and fatigue is most helpful in dismissing the diagnosis.

• #20 Infectious Mononucleosis: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2023/0100/infectious-mononucleosis.html

  Infectious mononucleosis is a viral syndrome characterized by fever, pharyngitis, and posterior cervical lymphadenopathy. […] Cost-effective, efficient initial laboratory testing for acute infectious mononucleosis includes complete blood count with differential (to assess for greater than 40% lymphocytes and greater than 10% atypical lymphocytes) and a rapid heterophile antibody test. […] Initial testing for acute infectious mononucleosis should include complete blood count with differential and rapid heterophile antibody testing. […] Laboratory testing is crucial in confirming infectious mononucleosis. […] The heterophile antibody latex agglutination test (monospot) is an inexpensive, rapid test with 87% sensitivity and 91% specificity reported in a systematic review. […] The absence of atypical lymphocytosis supports the accuracy of a negative heterophile antibody test result. […] Viral capsid antigen (VCA) immunoglobulin G (IgG) and IgM testing can be helpful if heterophile antibody test results are negative but clinical suspicion is high. […] Routine imaging is not indicated in the diagnosis of infectious mononucleosis.

• #21 Mononucleosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470387/

  Fever, sore throat, fatigue, and tender lymph nodes are classic findings on history-taking in infected individuals with mononucleosis. […] The classical triad is fever, pharyngitis, and lymphadenopathy. […] Laboratory evaluation most commonly will reveal lymphocytosis, with a lymphocyte differential often greater than 50%. Atypical lymphocytosis of greater than 10% can be seen on blood smear. […] The monospot (or heterophile antibody) test for mononucleosis is the diagnostic test of choice and is nearly 100% specific for the disease. The sensitivity of this test is closer to 85%. […] The diagnostic test of choice for mononucleosis is the heterophile antibody (monospot) test. This can be occasionally falsely negative in early disease and require repeat testing later in the course of the illness.

• #22 Infectious Mononucleosis – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/herpesviruses/infectious-mononucleosis

  Two serologic tests are used to diagnose acute EBV infection: […] Heterophile antibody testing […] Specific EBV antibody testing […] Heterophile antibodies are measured using various agglutination card (monospot) tests. However, heterophile antibodies are present in only 50% of patients 5 years and in about 80 to 90% of adolescents and adults with infectious mononucleosis. Importantly, the heterophile antibody test may be false-positive in some patients with acute HIV infection. The titer and prevalence of heterophile antibodies rise during the 2nd and 3rd week of illness. Thus, if the diagnosis is suspected and the heterophile antibody test is negative early in clinical illness (in the first week), testing can be repeated approximately 7 days later. Due to the potential for false positive or negative results, the Centers for Disease Control and Prevention (CDC) does not recommend heterophile antibodies to diagnose primary EBV infection (see CDC: Laboratory Testing). However, a positive heterophile antibody test in the appropriate clinical situation is generally sufficient to confirm the diagnosis of primary EBV. Alternatively, EBV antibody testing can be performed.

• #23 Mono: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/mononucleosis

  Because other, more serious viruses such as hepatitis A can cause symptoms similar to mono, your doctor will work to rule out these possibilities. […] Age is one of the main factors for diagnosing mono along with the most common symptoms: fever, sore throat, and swollen glands. […] Sometimes your doctor will request a complete blood count. This blood test will help determine how severe your illness is by looking at your levels of various blood cells. For example, a high lymphocyte count often indicates an infection. […] A mono infection typically causes your body to produce more white blood cells as it tries to defend itself. A high white blood cell count cant confirm an infection with EBV, but the result suggests that its a strong possibility. […] One of the most reliable ways to diagnose mononucleosis is the monospot test (or heterophile test). This blood test looks for antibodies these are proteins your immune system produces in response to harmful elements.

• #24 Infectious Mononucleosis: Symptoms and Treatment | Doctor

  https://patient.info/doctor/infectious-mononucleosis

  Glandular fever is likely if monospot test positive or the FBC has more than 20% atypical or 'reactive’ lymphocytes, or more than 10% atypical lymphocytes and the lymphocyte count is more than 50% of the total white cell count. […] If monospot test negative or not supportive of infectious mononucleosis due to EBV, repeat the test in 5-7 days. […] If clinical features of glandular fever and negative monospot test, or if a rapid diagnosis needed (eg urgent return to contact sports desired), arrange blood tests for EBV viral serology. […] EBV IM can be diagnosed using a variety of unrelated non-EBV heterophile antibodies and specific EBV antibodies. […] Following IM caused by EBV, 70-90% of patients produce IM heterophile antibodies (antibodies against an antigen produced in one species that react against antigens from other species).

• #25 Infectious mononucleosis, Epstein Barr virus, glandular fever

  https://dermnetnz.org/topics/infectious-mononucleosis

  How is infectious mononucleosis diagnosed? The clinical features and a positive heterophile test are usually sufficient to diagnose infectious mononucleosis. […] Heterophile antibodies become positive 2-9 weeks after infection; the sensitivity is 70-92% in the first two weeks. […] Other blood tests include lymphocyte levels, immunoglobulin (Ig)M to viral capsid antigen (VCA), and liver function tests. […] Abdominal ultrasonography can evaluate hepatosplenomegaly.

• #26 Laboratory Testing for Epstein-Barr Virus (EBV) | Epstein-Barr Virus and Infectious Mononucleosis | CDC

  https://www.cdc.gov/epstein-barr/php/laboratories/index.html

  Laboratory testing can help distinguish whether someone is susceptible to EBV infection or has a recent or past infection. […] EBV antibody tests are not usually needed to diagnose infectious mononucleosis. However, specific antibody tests may be needed to for people who: […] The Monospot test is not recommended for general use. The antibodies detected by Monospot can be caused by conditions other than infectious mononucleosis. […] At best, the Monospot test may indicate that a person has a typical case of infectious mononucleosis but does not confirm the presence of EBV infection. […] The interpretation of EBV antibody tests requires familiarity with these tests and access to the patient’s clinical information. […] People are considered to have a primary EBV infection if they have anti-VCA IgM but do not have antibody to EBNA. […] The presence of antibodies to both VCA and EBNA suggests past infection (from several months to years earlier). […] Testing paired acute-phase and convalescent-phase serum samples is not useful to distinguish between recent and past EBV infections.

• #27 Infectious mononucleosis – Wikipedia

  https://en.wikipedia.org/wiki/Infectious_mononucleosis

  The disease is diagnosed based on: […] Mono is primarily diagnosed based on the symptoms and can be confirmed with blood tests for specific antibodies. […] The heterophile antibody test, or monospot test, works by agglutination of red blood cells from guinea pigs, sheep and horses. This test is specific but not particularly sensitive (with a false-negative rate of as high as 25% in the first week, 5-10% in the second, and 5% in the third). […] When negative, these tests are more accurate than the heterophile antibody test in ruling out infectious mononucleosis. When positive, they feature similar specificity to the heterophile antibody test. Therefore, these tests are useful for diagnosing infectious mononucleosis in people with highly suggestive symptoms and a negative heterophile antibody test. […] The presence of an enlarged spleen, and swollen posterior cervical, axillary, and inguinal lymph nodes are the most useful to suspect a diagnosis of infectious mononucleosis. […] The monospot test is not recommended for general use by the CDC due to its poor accuracy.

• #28

  https://bpac.org.nz/bt/2012/october/glandular.aspx

  A full blood count, when combined with findings from a clinical examination, can be highly suggestive of glandular fever. […] Heterophile antibody tests are used to confirm that glandular fever is due to acute EBV infection and to therefore rule out other causes of raised atypical lymphocyte counts. […] If an initial FBC and heterophile tests fail to indicate glandular fever, specific EBV serology may be requested. Alternatively, FBC and heterophile tests may be repeated after seven days, followed by EBV serology if results are inconclusive. […] Specific EBV serology and FBC are recommended as the first-line tests for women who are pregnant, people who are immunocompromised, children and older people. Heterophile antibody tests are not necessary (and are also not used in children).

• #29 Epstein-Barr Virus – EBV | Choose the Right Test

  https://arupconsult.com/content/epstein-barr-virus

  EBV-specific serology can also be used in the place of heterophile antibody testing as an initial test. […] Molecular evaluation by nucleic acid amplification (e.g., polymerase chain reaction [PCR]) and histologic examination with in situ hybridization (ISH) are used for the diagnosis and monitoring of EBV-related lymphoproliferative diseases and cancers. […] Heterophile antibody testing (also known as Monospot) is often used as a first-line test in the diagnosis of Epstein-Barr virus (EBV) infectious mononucleosis (IM). […] Negative heterophile antibody test results (in patients of any age) must be followed with EBV-specific serology testing. […] Serologic assays for EBV-specific antibodies are necessary to diagnose asymptomatic EBV infection and can confirm a diagnosis in symptomatic patients.

• #30 Infectious Mononucleosis – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/herpesviruses/infectious-mononucleosis

  EBV-specific antibody testing is highly sensitive. The presence of IgM antibodies to the EBV viral capsid antigen (VCA) indicates primary EBV infection (these antibodies disappear within 3 months after infection). IgG VCA (EBV VCA-IgG) also develops early in primary EBV infection, but these antibodies persist for life. EBV nuclear antigen (EBNA-IgG) antibodies develop later (after 2 to 4 months) in acute EBV infection and also persist for life. If EBV antibody titers are negative or indicate remote infection (ie, positive for IgG antibodies and negative for IgM antibodies), other diagnoses that can present with similar symptoms (eg, acute HIV infection, CMV infection) should be considered.

• #31 Laboratory Testing for Epstein-Barr Virus (EBV) | Epstein-Barr Virus and Infectious Mononucleosis | CDC

  https://www.cdc.gov/epstein-barr/php/laboratories/index.html

  Laboratory testing can help distinguish whether someone is susceptible to EBV infection or has a recent or past infection. […] EBV antibody tests are not usually needed to diagnose infectious mononucleosis. However, specific antibody tests may be needed to for people who: […] The Monospot test is not recommended for general use. The antibodies detected by Monospot can be caused by conditions other than infectious mononucleosis. […] At best, the Monospot test may indicate that a person has a typical case of infectious mononucleosis but does not confirm the presence of EBV infection. […] The interpretation of EBV antibody tests requires familiarity with these tests and access to the patient’s clinical information. […] People are considered to have a primary EBV infection if they have anti-VCA IgM but do not have antibody to EBNA. […] The presence of antibodies to both VCA and EBNA suggests past infection (from several months to years earlier). […] Testing paired acute-phase and convalescent-phase serum samples is not useful to distinguish between recent and past EBV infections.

• #32 Epstein-Barr Virus (EBV) – Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/23469-epstein-barr-virus

  It can be challenging for your healthcare provider to diagnose Epstein-Barr virus because the symptoms are similar to other common illnesses. Your healthcare provider will ask you about your symptoms, how long you’ve had them and if you’ve come into contact with anyone who might have the virus. Your provider might offer a blood test to confirm the diagnosis. […] To confirm your diagnosis, your provider will perform a blood test called Epstein-Barr virus antibody test. This test takes a sample of your blood to detect antibodies that cause EBV. Your provider may need to repeat the test between 10 days to two weeks after the first test because antibodies might not show up early in your diagnosis.

• #33 The Pathology Test – Epstein-Barr Virus Antibodies

  https://pathologytestsexplained.org.au/ptests-printer-version.php?q=Epstein-Barr%20Virus%20Antibodies

  This is a group of tests that detect Epstein-Barr Virus (EBV) antibodies and they are used to help diagnose infectious mononucleosis or glandular fever. […] Some people with glandular fever can be diagnosed through their symptoms together with a Full Blood Count test and a Monospot test. However, other people have a negative result to the Monospot and an antibody test is needed instead to make their diagnosis. […] People are typically diagnosed by their symptoms and a screening test known as a Monospot or Heterophile Antibody test. However, in some cases, especially in children, the Monospot test result is negative. This is when it is necessary to look for antibodies that are specific to the EBV virus. […] Using a combination of these EBV antibody tests and the clinical presentation, a doctor is able to diagnose an EBV infection and to assess whether it is a current, recent, or a past infection.

• #34 Laboratory Testing for Epstein-Barr Virus (EBV) | Epstein-Barr Virus and Infectious Mononucleosis | CDC

  https://www.cdc.gov/epstein-barr/php/laboratories/index.html

  Laboratory testing can help distinguish whether someone is susceptible to EBV infection or has a recent or past infection. […] EBV antibody tests are not usually needed to diagnose infectious mononucleosis. However, specific antibody tests may be needed to for people who: […] The Monospot test is not recommended for general use. The antibodies detected by Monospot can be caused by conditions other than infectious mononucleosis. […] At best, the Monospot test may indicate that a person has a typical case of infectious mononucleosis but does not confirm the presence of EBV infection. […] The interpretation of EBV antibody tests requires familiarity with these tests and access to the patient’s clinical information. […] People are considered to have a primary EBV infection if they have anti-VCA IgM but do not have antibody to EBNA. […] The presence of antibodies to both VCA and EBNA suggests past infection (from several months to years earlier). […] Testing paired acute-phase and convalescent-phase serum samples is not useful to distinguish between recent and past EBV infections.

• #35 The Pathology Test – Epstein-Barr Virus Antibodies

  https://pathologytestsexplained.org.au/ptests-printer-version.php?q=Epstein-Barr%20Virus%20Antibodies

  If you have positive VCA-IgM antibodies it is likely that you have a current or very recent EBV infection. If you also have symptoms associated with glandular fever it is likely that you will be diagnosed with an EBV infection even if your monospot test was negative. […] If the VCA-IgM is negative but the other antibodies including EBNA antibody are detected it is likely that you had a previous EBV infection. […] A VCA-IgG test, and sometimes an EBNA test, may be ordered for someone who does not have symptoms to decide if they have been previously exposed to EBV or have an EBV infection. This is not routinely requested but may be ordered when someone such as an adolescent or an immune-compromised person, has been in close contact with someone with glandular fever.

• #36 Epstein-Barr Virus (EBV) Infectious Mononucleosis (Mono) Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/222040-workup

  Accurate diagnosis requires correlating serological and molecular test results with clinical presentation. For instance, the presence of anti-VCA IgM and absence of anti-EBNA IgG suggest a primary EBV infection. Conversely, the presence of anti-EBNA IgG indicates past infection. […] If heterophile antibody tests are negative and EBV-specific antibodies are not indicative of acute infection, consider other causes of mononucleosis-like symptoms, such as cytomegalovirus (CMV), toxoplasmosis, or human herpesvirus 6 (HHV-6). […] The complete blood cell (CBC) count is more valuable for ruling out alternative diagnoses that mimic infectious mononucleosis than for providing specific diagnostic information. While leukocytosis is typical in infectious mononucleosis, a normal or decreased white blood cell (WBC) count suggests an alternative diagnosis. Lymphocytosis often accompanies infectious mononucleosis, peaks during the first few weeks of illness, and gradually returns to normal. Similarly, atypical lymphocytes follow the same timeline as lymphocytosis. A relative atypical lymphocyte counts of 20% in patients with fever, pharyngitis, and lymphadenopathy strongly suggests Epstein-Barr virus (EBV) infectious mononucleosis.

• #37 Infectious Mononucleosis: Symptoms and Treatment | Doctor

  https://patient.info/doctor/infectious-mononucleosis

  IgM antibodies directed against the VCA of EBV are useful in differentiating recent infection from previous infection. […] False positive VCA antibody titre results may occur with other herpes viruses (eg, CMV) or with unrelated organisms (eg, T. gondii). However, false-positive cross-reactivity to specific EBV antibodies is very rare. […] A real-time polymerase chain reaction identifying EBV DNA has been developed. This may be useful in cases of diagnostic doubt or where rapid diagnosis is helpful, such as in patients with a high risk of splenic rupture.

• #38 Epstein-Barr Virus (EBV) Infectious Mononucleosis (Mono) Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/222040-workup

  Mild transient thrombocytopenia is common in EBV infectious mononucleosis. However, severe or persistent thrombocytopenia should prompt consideration of alternative diagnoses, such as acute HIV or other viral infections. […] The erythrocyte sedimentation rate (ESR) can help differentiate group A streptococcal pharyngitis from EBV infectious mononucleosis. While ESR is elevated in most patients with EBV infectious mononucleosis, it typically remains normal in group A streptococcal pharyngitis. However, an elevated ESR cannot distinguish EBV from other heterophile-negative causes of mononucleosis-like illness. […] Abnormal liver function tests (LFTs) are observed in more than 90% of EBV infectious mononucleosis cases.

• #39 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diagnosis-of-glandular-fever.aspx

  During the initial six weeks of the disease, chances of a negative result are high as there are more specific antibodies. […] Results may be falsely negative in children less than 12 years of age and in the elderly. […] If results for heterophile antibodies are negative up to six weeks into the disease, EBV specific antibodies need to be tested. […] Antibodies to EBNA are not detectable until six to eight weeks after the onset of the disease. […] Routine blood cell counts help to detect the presence of an infection. White blood cell counts are raised. […] This blood picture may be a transient feature and changes during the course of the disease. […] Tests for other viruses that cause glandular fever include those for rubella, cytomegalovirus and toxoplasma. […] Other tests include liver function tests to assess the liver health.

• #40 Infectious mononucleosis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/infectious-mononucleosis/

  There is no standardized diagnostic approach to infectious mononucleosis. […] Infectious mononucleosis can be diagnosed clinically, but laboratory studies are usually performed. […] EBV serology is the most reliable way to diagnose infection but is usually slow and expensive. […] Staged testing is often performed as an alternative: Order supportive laboratory studies (e.g., CBC, monospot test). […] Request EBV serology if findings are inconclusive. […] Additional studies (i.e., diagnostics for CMV, HIV testing) are performed if: Patient is pregnant. […] EBV serology is inconclusive. […] Manifestation is atypical. […] Patient is immunocompromised. […] If concurrent bacterial tonsillitis is suspected, consider diagnostics for acute tonsillitis. […] EBV serology is the most reliable laboratory study to diagnose infectious mononucleosis.

• #41 Infectious mononucleosis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/123

  Infectious mononucleosis is characterised by the classic triad of fever, pharyngitis, and lymphadenopathy, along with atypical lymphocytosis. […] Positive heterophile antibody test and serological test for antibodies against EBV are usually diagnostic. […] IM typically manifests in adolescents and young adults as a febrile illness with sore throat and enlarged lymph nodes. Atypical lymphocytosis and a positive heterophile antibodies test are usually observed. […] Key diagnostic factors include presence of risk factors, fever, pharyngitis, cervical or generalised lymphadenopathy, and malaise. […] 1st investigations to order include FBC, heterophile antibodies, Epstein-Barr virus (EBV)-specific antibodies, and LFTs. […] Investigations to consider include real-time polymerase chain reaction (PCR), ultrasonography of abdomen, and CT of abdomen.

• #42 Infectious Mononucleosis: Symptoms and Treatment | Doctor

  https://patient.info/doctor/infectious-mononucleosis

  IgM antibodies directed against the VCA of EBV are useful in differentiating recent infection from previous infection. […] False positive VCA antibody titre results may occur with other herpes viruses (eg, CMV) or with unrelated organisms (eg, T. gondii). However, false-positive cross-reactivity to specific EBV antibodies is very rare. […] A real-time polymerase chain reaction identifying EBV DNA has been developed. This may be useful in cases of diagnostic doubt or where rapid diagnosis is helpful, such as in patients with a high risk of splenic rupture.

• #43

  https://bpac.org.nz/bt/2012/october/glandular.aspx

  A full blood count, when combined with findings from a clinical examination, can be highly suggestive of glandular fever. […] Heterophile antibody tests are used to confirm that glandular fever is due to acute EBV infection and to therefore rule out other causes of raised atypical lymphocyte counts. […] If an initial FBC and heterophile tests fail to indicate glandular fever, specific EBV serology may be requested. Alternatively, FBC and heterophile tests may be repeated after seven days, followed by EBV serology if results are inconclusive. […] Specific EBV serology and FBC are recommended as the first-line tests for women who are pregnant, people who are immunocompromised, children and older people. Heterophile antibody tests are not necessary (and are also not used in children).

• #44 Glandular fever: Symptoms, treatment, causes, and diagnosis

  https://www.medicalnewstoday.com/articles/167390

  The doctor will perform a physical examination to detect swollen lymph nodes and assess the tonsils, liver, and spleen. […] If they suspect glandular fever, they also may order some tests. An antibody test can detect antibodies developed specifically to combat EBV. […] During pregnancy, tests can show whether rubella or toxoplasmosis are present. The EBV does not harm a fetus or an embryo.

• #45 Epstein-Barr Virus – EBV | Choose the Right Test

  https://arupconsult.com/content/epstein-barr-virus

  EBV-specific serology testing may also be used to diagnose EBV IM in place of a heterophile antibody test. […] Molecular evaluation by nucleic acid amplification (e.g., polymerase chain reaction [PCR]) is often preferred over serology testing in cases of reactivation, but serologic assays may be more sensitive and specific in cases of acute EBV infection. […] The heterophile antibody test (Monospot) is a standard diagnostic test for EBV IM in patients with symptoms of IM. […] Negative results should be followed by serologic assays to identify specific EBV antigens and to confirm the presence of EBV infection. […] EBV-specific antibody testing for immunoglobulin G (IgG)- and IgM-class antibodies to viral capsid antigen (VCA) and Epstein-Barr nuclear antigen (EBNA) can be used to follow up on negative or positive heterophile antibody test results.

• #46

  https://bpac.org.nz/bt/2012/october/glandular.aspx

  Glandular fever (infectious mononucleosis) is a common, potentially debilitating illness that is most frequently seen in adolescents and young adults. A diagnosis of glandular fever can usually be made clinically, but laboratory testing is indicated if the clinical picture is unclear or where the risks of morbidity are high. The most appropriate testing regimen is dependent on age, history and symptoms. […] Laboratory investigation of glandular fever may not be necessary where the patients clinical features suggest a diagnosis. Testing is recommended, however, wherever the clinical picture is unclear or an incorrect diagnosis has the potential to cause significant morbidity. […] When testing is indicated, the recommended tests are a full blood count (FBC) and a heterophile antibody test, followed by serology if the diagnosis remains unclear.

• #47 Infectious Mononucleosis: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2023/0100/infectious-mononucleosis.html

  Infectious mononucleosis is a viral syndrome characterized by fever, pharyngitis, and posterior cervical lymphadenopathy. […] Cost-effective, efficient initial laboratory testing for acute infectious mononucleosis includes complete blood count with differential (to assess for greater than 40% lymphocytes and greater than 10% atypical lymphocytes) and a rapid heterophile antibody test. […] Initial testing for acute infectious mononucleosis should include complete blood count with differential and rapid heterophile antibody testing. […] Laboratory testing is crucial in confirming infectious mononucleosis. […] The heterophile antibody latex agglutination test (monospot) is an inexpensive, rapid test with 87% sensitivity and 91% specificity reported in a systematic review. […] The absence of atypical lymphocytosis supports the accuracy of a negative heterophile antibody test result. […] Viral capsid antigen (VCA) immunoglobulin G (IgG) and IgM testing can be helpful if heterophile antibody test results are negative but clinical suspicion is high. […] Routine imaging is not indicated in the diagnosis of infectious mononucleosis.

• #48 Infectious Mononucleosis: Diagnosis and Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/infectious-mononucleosis-diagnosis-and-treatment/

  Classic Signs and Symptoms […] Laboratory Investigations […] Clinical diagnosis alone may be sufficient; consider the following investigations if a definitive diagnosis is desired. […] Heterophile antibody test (Monospot test) and a CBC with diff. […] EBV Antibody Test: Patients negative for anti-VCA IgM are highly unlikely to have EBV infection, and may require further testing for CMV, HHV-6, and HIV. […] False Negative Monospot: within the first week of symptom onset and if age <5 years old. [...] False Positive Monospot: Autoimmune disease, toxoplasmosis, rubella, lymphoma, cytomegalovirus, and acute HIV.

• #49 Infectious Mononucleosis: Symptoms and Treatment | Doctor

  https://patient.info/doctor/infectious-mononucleosis

  Glandular fever is likely if monospot test positive or the FBC has more than 20% atypical or 'reactive’ lymphocytes, or more than 10% atypical lymphocytes and the lymphocyte count is more than 50% of the total white cell count. […] If monospot test negative or not supportive of infectious mononucleosis due to EBV, repeat the test in 5-7 days. […] If clinical features of glandular fever and negative monospot test, or if a rapid diagnosis needed (eg urgent return to contact sports desired), arrange blood tests for EBV viral serology. […] EBV IM can be diagnosed using a variety of unrelated non-EBV heterophile antibodies and specific EBV antibodies. […] Following IM caused by EBV, 70-90% of patients produce IM heterophile antibodies (antibodies against an antigen produced in one species that react against antigens from other species).

• #50 Infectious mononucleosis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/infectious-mononucleosis/

  The presence of anti-VCA IgG without anti-VCA IgM indicates past infection. […] The following studies have low specificity but can support the diagnosis in patients with clinical features of infectious mononucleosis. […] Findings suggestive of infectious mononucleosis include: Absolute lymphocyte count 4 x 10^9/L. […] 50% lymphocytes. […] 10% atypical lymphocytes. […] Monospot (heterophile antibody) test: a latex agglutination rapid test that uses red blood cells from horses to detect heterophile antibodies against EBV. […] False negatives are more likely in: Adults tested within 1 week of symptom onset. […] Children of age. […] False positives are more likely in patients with previous infection, HIV, autoimmune disease, and viral hepatitis.

• #51 Infectious mononucleosis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/123

  Infectious mononucleosis is characterised by the classic triad of fever, pharyngitis, and lymphadenopathy, along with atypical lymphocytosis. […] Positive heterophile antibody test and serological test for antibodies against EBV are usually diagnostic. […] IM typically manifests in adolescents and young adults as a febrile illness with sore throat and enlarged lymph nodes. Atypical lymphocytosis and a positive heterophile antibodies test are usually observed. […] Key diagnostic factors include presence of risk factors, fever, pharyngitis, cervical or generalised lymphadenopathy, and malaise. […] 1st investigations to order include FBC, heterophile antibodies, Epstein-Barr virus (EBV)-specific antibodies, and LFTs. […] Investigations to consider include real-time polymerase chain reaction (PCR), ultrasonography of abdomen, and CT of abdomen.

• #52 Infectious mononucleosis – UpToDate

  https://www.uptodate.com/contents/infectious-mononucleosis

  Infectious mononucleosis (IM) is characterized by a triad of fever, tonsillar pharyngitis, and lymphadenopathy. […] The relationship between Epstein-Barr virus (EBV) and IM was established when a laboratory worker was infected with EBV and developed IM and a newly positive heterophile test. […] This topic will review IM caused by EBV infection in adults and adolescents, including diagnosis and treatment. […] Establishing the diagnosis includes EBV-specific antibodies, heterophile antibodies, and limited role for routine EBV PCR testing. […] Other infectious agents may also cause a mononucleosis syndrome that resembles IM caused by EBV.

• #53 Epstein-Barr Virus (EBV) Infectious Mononucleosis (Mono) Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/222040-workup

  Accurate diagnosis requires correlating serological and molecular test results with clinical presentation. For instance, the presence of anti-VCA IgM and absence of anti-EBNA IgG suggest a primary EBV infection. Conversely, the presence of anti-EBNA IgG indicates past infection. […] If heterophile antibody tests are negative and EBV-specific antibodies are not indicative of acute infection, consider other causes of mononucleosis-like symptoms, such as cytomegalovirus (CMV), toxoplasmosis, or human herpesvirus 6 (HHV-6). […] The complete blood cell (CBC) count is more valuable for ruling out alternative diagnoses that mimic infectious mononucleosis than for providing specific diagnostic information. While leukocytosis is typical in infectious mononucleosis, a normal or decreased white blood cell (WBC) count suggests an alternative diagnosis. Lymphocytosis often accompanies infectious mononucleosis, peaks during the first few weeks of illness, and gradually returns to normal. Similarly, atypical lymphocytes follow the same timeline as lymphocytosis. A relative atypical lymphocyte counts of 20% in patients with fever, pharyngitis, and lymphadenopathy strongly suggests Epstein-Barr virus (EBV) infectious mononucleosis.

• #54 Infectious Mononucleosis – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/herpesviruses/infectious-mononucleosis

  Diagnosis of Infectious Mononucleosis […] Heterophile antibody test […] Sometimes EBV serologic testing […] Infectious mononucleosis should be suspected in patients with typical symptoms and signs. Exudative pharyngitis, anterior cervical lymphadenopathy, and fever may be clinically indistinguishable from those caused by group A beta-hemolytic streptococci. However, posterior cervical or generalized adenopathy or hepatosplenomegaly suggests infectious mononucleosis. Moreover, detection of streptococci in the oropharynx does not exclude infectious mononucleosis. […] Laboratory diagnosis usually involves a complete blood count and EBV serologic testing. Lymphocytes that are morphologically atypical account for up to 30% of the white blood cells. Although individual lymphocytes may resemble leukemic lymphocytes, lymphocytes are heterogeneous, which is unlikely in leukemia. Atypical lymphocytes may also be present in HIV or CMV infection, hepatitis B, influenza B, rubella, or other viral illnesses, so diagnosis requires serologic testing. However, very high atypical lymphocyte counts are typically seen only in primary EBV and CMV infection.

• #55 Mononucleosis: A-to-Z Guide from Diagnosis to Treatment to Prevention | DrGreene

  https://www.drgreene.com/articles/mononucleosis

  Mono is suspected based on the history and physical examination. The liver and spleen are often enlarged, in addition to the swollen glands the family may have noticed. […] Mono is most often diagnosed with a blood test. Parents should know that the most common blood test for mono is usually negative in children under 4, even if they are actively infected. Also, the test is often negative during the first week of symptoms, at any age. […] About 1 in 20 children with mono also have strep throat at the same time. Mono should be suspected if proven strep throat does not improve quickly with antibiotics.

• #56

  https://bpac.org.nz/bt/2012/october/glandular.aspx

  Glandular fever (infectious mononucleosis) is a common, potentially debilitating illness that is most frequently seen in adolescents and young adults. A diagnosis of glandular fever can usually be made clinically, but laboratory testing is indicated if the clinical picture is unclear or where the risks of morbidity are high. The most appropriate testing regimen is dependent on age, history and symptoms. […] Laboratory investigation of glandular fever may not be necessary where the patients clinical features suggest a diagnosis. Testing is recommended, however, wherever the clinical picture is unclear or an incorrect diagnosis has the potential to cause significant morbidity. […] When testing is indicated, the recommended tests are a full blood count (FBC) and a heterophile antibody test, followed by serology if the diagnosis remains unclear.

• #57 Mononucleosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470387/

  Fever, sore throat, fatigue, and tender lymph nodes are classic findings on history-taking in infected individuals with mononucleosis. […] The classical triad is fever, pharyngitis, and lymphadenopathy. […] Laboratory evaluation most commonly will reveal lymphocytosis, with a lymphocyte differential often greater than 50%. Atypical lymphocytosis of greater than 10% can be seen on blood smear. […] The monospot (or heterophile antibody) test for mononucleosis is the diagnostic test of choice and is nearly 100% specific for the disease. The sensitivity of this test is closer to 85%. […] The diagnostic test of choice for mononucleosis is the heterophile antibody (monospot) test. This can be occasionally falsely negative in early disease and require repeat testing later in the course of the illness.

• #58

  https://bpac.org.nz/bt/2012/october/glandular.aspx

  A full blood count, when combined with findings from a clinical examination, can be highly suggestive of glandular fever. […] Heterophile antibody tests are used to confirm that glandular fever is due to acute EBV infection and to therefore rule out other causes of raised atypical lymphocyte counts. […] If an initial FBC and heterophile tests fail to indicate glandular fever, specific EBV serology may be requested. Alternatively, FBC and heterophile tests may be repeated after seven days, followed by EBV serology if results are inconclusive. […] Specific EBV serology and FBC are recommended as the first-line tests for women who are pregnant, people who are immunocompromised, children and older people. Heterophile antibody tests are not necessary (and are also not used in children).

• #59 Epstein-Barr Virus – EBV | Choose the Right Test

  https://arupconsult.com/content/epstein-barr-virus

  Given that antibodies often appear later in the course of illness, repeat testing in 10-14 days may be helpful if results are equivocal. […] Nucleic acid amplification testing such as PCR can offer high sensitivity and specificity and is used to detect and/or quantify EBV DNA. […] It may be preferred over serology in cases of reactivation, but serology may be more sensitive and specific in cases of acute EBV infection. […] Along with physical examination and imaging studies, diagnosis of EBV-associated lymphoproliferative diseases requires histologic examination of biopsy tissue by ISH for EBV-encoded RNA transcripts. […] In patients who have undergone HSCT, EBV viral load monitoring should begin no later than 4 weeks after HSCT, should continue for at least 4 months, and should be performed at least once per week in high-risk patients.

• #60 Epstein-Barr Virus – EBV | Choose the Right Test

  https://arupconsult.com/content/epstein-barr-virus

  Epstein-Barr virus (EBV), a pervasive virus that infects over 90% of the worlds population by adulthood, causes infectious mononucleosis (IM) in immunocompetent individuals and lymphoproliferative disease in immunocompromised patients. […] Early and accurate diagnosis of EBV IM is important so that a targeted treatment plan can be developed and the inappropriate use of antibiotics can be avoided. […] Several different tests and methods are available to diagnose EBV infection and the resulting diseases. Rapid heterophile antibody testing (also referred to as Monospot) is often used as a first-line test in the diagnosis of EBV IM because it is inexpensive and has a fast turnaround. […] However, false-negative results can occur in young children and early in the course of the illness, necessitating follow-up testing by EBV-specific serology.

• #61 Epstein-Barr Virus (EBV) Infectious Mononucleosis (Mono): Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/222040-overview

  There is no cure for mono; the virus resolves on its own. To manage symptoms, the following are recommended: Rest and hydrate. Use saltwater gargles or lozenges for sore throat relief. Take acetaminophen or ibuprofen for fever and pain. […] Most people recover within 2-4 weeks, but fatigue may persist longer. In rare cases, complications like anemia, liver inflammation, or nervous system problems may occur. EBV stays dormant in your body after infection and can reactivate without causing symptoms.

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