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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.
Acute tonsillitis
Published in S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague, ENT Head & Neck Emergencies, 2018
The monospot (heterophile antibody) test is commonly used to confirm EBV infection. While up to 92% sensitive and 100% specific, it is much less sensitive in the first 2 weeks of infection, after the acute infection has resolved and in younger children. This test is frequently negative in the presence of clinically diagnosed EBV infection. The monospot test is considered ‘not very useful’ by the US Centers for Disease Control. Where the diagnosis is in doubt, specific EBV serology is reliable, both for recent (IgM) and past (IgG) EBV infection.
Acute Infections of the Larynx
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Sanjai Sood, Karan Kapoor, Richard Oakley
The Monospot test and Paul-Bunnell test are types of heterophile antibody test. The Paul-Bunnell test is based on sheep red blood cell (RBC) agglutination, whereas the more sensitive and specific monospot test is based on latex agglutination using horse RBCs.44
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.
Apoptotic lymphocytes on peripheral smear and positional parameter values (VCS data) can suggest a diagnosis of infectious mononucleosis
Published in Infectious Diseases, 2019
Jayashree D. Kulkarni, Sanjay A. Pai
Fisher et al. [4] retrospectively evaluated smears of 27 patients with positive heterophile antibody test and found apoptosis in 24, whereas only 3 of 80 control smears showed rare apoptotic lymphocytes. Matsuoka et al. [5] found that one-third of IM cases had apoptotic cells along with atypical lymphocytes, while normal individuals had no apoptosis. Moreover, Lach-Szyrma and Britto-Babapulle [6] documented that lymphoid apoptotic cells were seen only in patients with IM. Lesesve and Troussard, as well as we, have made a diagnosis on a patient in the clinic, based on the finding of apoptotic lymphocytes in the PS [7,8].