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Epstein–Barr virus and the nervous system
Published in Avindra Nath, Joseph R. Berger, Clinical Neurovirology, 2020
Alexandros C. Tselis, Kumar Rajamani, Pratik Bhattacharya
Acute EBV infection is usually confirmed by the detection of heterophile antibodies. During the acute disease, agglutinating antibodies reactive against sheep erythrocytes are detectable. The precise nature of the antigen on sheep cells is unknown. Normal serum can contain small amounts of nonspecific sheep cell agglutinins, and these nonspecific antibodies (Forssman antibodies) must be absorbed out of the serum, leaving the EBV-specific heterophile antibodies behind. Accordingly, serum to be tested for heterophile antibodies is first incubated with guinea pig kidney, which contains the Forssman antigen (which has been identified as lipopolysaccharide–protein complexes present on cell surfaces of many different tissues, particularly in guinea pig kidney cells and horse red cells). If the resultant serum can still agglutinate sheep cells, then the serum contains EBV-specific heterophile antibodies, and acute EBV infection is confirmed. Heterophile antibodies are present only in the acute infection and fall to undetectable levels over a few weeks. The phenomenon of heterophile antibody production in infectious mononucleosis is the basis of the monospot test, which is performed on commercially available prepared slides.
Laboratory Diagnostic Tests in the Evaluation of Fever
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
The heterophile antibody test (Paul-Bunnell) is positive in approximately 85% of patients with infectious mononucleosis, with most false-negative studies occurring among children. In such cases, specific antiviral antibody can still be demonstrated.
Benign Disorders of Leukocytes
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
Gene L. Gulati, Zoran Gatalica, Bong H. Hyun
Clinical findings are suggestive of infectious mononucleosis. Initial laboratory findings of slight leukocytosis, absolute lymphocytosis, many atypical lymphocytes, and left shift of neutrophils are also consistent with the suspected clinical diagnosis of infectious mononucleosis. The diagnosis of infectious mononucleosis was confirmed by the positive Mono test (a serologic test for heterophile antibody). The hemoglobin level of 6.1 g/dL, however, is not consistent with the sole diagnosis of infectious mononucleosis. Peripheral blood smear examination revealed marked agglutination of red cells and polychromasia, in addition to the presence of many atypical lymphocytes. In fact, the CBC results given above were obtained after incubating the blood specimen at 37°C for 15 min. These findings are indicative of cold-antibody-mediated hemolytic process, which was confirmed by a positive Coomb’s test, a reticulocyte count of 14%, bilirubin of 3 mg/dL, and the cold agglutinin titer of 1:1280. The antibody screen revealed anti-i antibody. Thus, the clinical and laboratory findings together led to the definitive diagnosis of infectious mononucleosis with autoimmune hemolytic anemia. Autoimmune hemolytic anemia develops as a complication of infectious mononucleosis in 5–10% of cases.
Presence of macroproteins on the measurement of vitamin B12: studying high vitamin B12 levels using polyethylene glycol and heterophile antibody blocking tubes
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2023
Heterophilic antibodies bind to animal antibodies used in immune measurements and cause interference in these tests. It has been reported that they generally cause falsely high results and sometimes false low results [18]. Although heterophile antibody interference is a rare condition; the geographic region in which individuals live is closely related to exposure to animals or animal products. Although they are present in 30-40% of serum samples, the probability of causing interference is 0.05% [36]. Heterophilic antibody interference can occur in all types of immune measurement methods, but it mostly affects noncompetitive immune measurements [18,37,38]. In the measurement of vitamin B12 with the competitive immune method used in this study, there was a denaturing stage with polyclonal antibodies aimed at reducing heterophile antibody interference. In addition, commercially available HBTs do not guarantee 100% success, and the absence of a meaningful result does not mean that there is no interference. The antibodies found in our patients may not have been recognized by the blocking antibody in HBT, or the presence of antibodies in very high titers may also eliminate the blocking feature of the tubes [39].
Infectious Mononucleosis: diagnosis and clinical interpretation
Published in British Journal of Biomedical Science, 2021
P Naughton, M Healy, F Enright, B Lucey
The population studies to date suggest that IM is a disease more commonly observed in adolescents, early adulthood and to a lesser degree older adults. However, it is unclear whether findings of group studies of IM cases to date are reflective of the actual case numbers or only the diagnosed cases bearing in mind that the appearance of the disease in younger patients (<10 years) may manifest differently and that the diagnosis of the disease in younger age groups may require separate criteria to unequivocally diagnose the disease. The heterophile antibody test is limited in its ability to diagnose heterophile positive IM cases only [11,31]. The disease may manifest differently in younger patients or atypical cases where a heterophile antibody response is often absent or significantly reduced [24,30].
Infectious mononucleosis-related tonsillar hyperplasia mimicking T-cell lymphoma on histopathology: A rare case and review
Published in Acta Oto-Laryngologica Case Reports, 2020
Usman Asad, Irfan Warraich, Winslo Idicula
Infectious mononucleosis (IM) is caused by Epstein-Barr virus, also known as human herpesvirus 4. It belongs to the herpesvirus family and infects more than 90% of the human population [1]. IM is transferred primarily through saliva but may also be acquired through semen, blood transfusion, organ transplantation, or hematopoietic cell transfusion [2]. It infects B-lymphocytes and persists as a lifelong, asymptomatic infection in most individuals. IM is characterized clinically by the presence of tonsillitis, pharyngitis, cervical lymphadenopathy, and fever [3]. Although it can manifest in any decade of life, its incidence begins to arise in adolescence and declines through adulthood [4]. Most cases of IM are diagnosed based on clinical presentation as well as laboratory findings. The best initial diagnosis of IM is made by a positive heterophile antibody test (monospot test), with a 71% to 90% accuracy rate. This test is fast, inexpensive, and has a high specificity rate. However, the test has a 25% false-negative rate in the first week of illness. If necessary, an EBV-specific viral capsid antigen immunoglobulin M antibody test can confirm the diagnosis [5]. Features of IM on microscopy in lymphoid tissues include lymphocytic proliferation and the presence of atypical CD8 T-lymphocytes known as Downey cells [6]. Treatment is mainly through supportive measures and symptomatic relief [5]. Antivirals and glucocorticoids, though potentially necessary to relieve airway obstruction and inflammation, do not reduce the length or severity of illness [5]. In this report, we present a patient who had signs and symptoms consistent with IM, which was confirmed through the monospot test, but whose tonsillar histopathology initially was interpreted that of T-cell lymphoma.