Heterophile antibody test

Jump to navigation Jump to search

WikiDoc Resources for Heterophile antibody test

Articles

Most recent articles on Heterophile antibody test

Most cited articles on Heterophile antibody test

Review articles on Heterophile antibody test

Articles on Heterophile antibody test in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Heterophile antibody test

Images of Heterophile antibody test

Photos of Heterophile antibody test

Podcasts & MP3s on Heterophile antibody test

Videos on Heterophile antibody test

Evidence Based Medicine

Cochrane Collaboration on Heterophile antibody test

Bandolier on Heterophile antibody test

TRIP on Heterophile antibody test

Clinical Trials

Ongoing Trials on Heterophile antibody test at Clinical Trials.gov

Trial results on Heterophile antibody test

Clinical Trials on Heterophile antibody test at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Heterophile antibody test

NICE Guidance on Heterophile antibody test

NHS PRODIGY Guidance

FDA on Heterophile antibody test

CDC on Heterophile antibody test

Books

Books on Heterophile antibody test

News

Heterophile antibody test in the news

Be alerted to news on Heterophile antibody test

News trends on Heterophile antibody test

Commentary

Blogs on Heterophile antibody test

Definitions

Definitions of Heterophile antibody test

Patient Resources / Community

Patient resources on Heterophile antibody test

Discussion groups on Heterophile antibody test

Patient Handouts on Heterophile antibody test

Directions to Hospitals Treating Heterophile antibody test

Risk calculators and risk factors for Heterophile antibody test

Healthcare Provider Resources

Symptoms of Heterophile antibody test

Causes & Risk Factors for Heterophile antibody test

Diagnostic studies for Heterophile antibody test

Treatment of Heterophile antibody test

Continuing Medical Education (CME)

CME Programs on Heterophile antibody test

International

Heterophile antibody test en Espanol

Heterophile antibody test en Francais

Business

Heterophile antibody test in the Marketplace

Patents on Heterophile antibody test

Experimental / Informatics

List of terms related to Heterophile antibody test

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The mononuclear spot test or monospot test, a form of the heterophile antibody test,[1] is a rapid test for infectious mononucleosis due to Epstein–Barr virus (EBV). It is an improvement on the Paul-Bunnell test.[2] The test is specific for heterophile antibodies produced by the human immune system in response to EBV infection. Commercially available test kits are 70-92% sensitive and 96-100% specific, with a lower sensitivity in the first two weeks after clinical symptoms begin.[3][4] It will generally not be positive during the 4-6 week incubation period before the onset of symptoms. It will also not generally be positive after active infection has subsided, even though the virus persists in the same cells in the body for the rest of the carrier's life.

Process

The test relies on the agglutination of the horse RBCs by heterophile antibodies in patient's serum. Heterophile means it reacts with proteins across species lines.[5] Heterophile also can mean that it is an antibody that reacts with antigens other than the antigen that stimulated it (an antibody that crossreacts). A 20% suspension of horse red cells is used in an isotonic 3-8% sodium citrate formulation. One drop of the patient’s serum to be tested is mixed on an opal glass slide with one drop of a particulate suspension of guinea-pig kidney stroma, and a suspension of beef red cell stroma; sera and suspensions are mixed with a wooden applicator 10 times. Ten micro liters of the horse red cell suspension are then added and mixed with each drop of adsorbed serum. The mixture is left undisturbed for one minute (not rocked or shaken). Examine for the presence or absence of red cell agglutination. If stronger with the sera adsorbed with guinea-pig kidney, the test is positive. If stronger with the sera adsorbed with beef red cell stroma, the test is negative. If agglutination is absent in both mixtures, the test is negative. A known 'positive' and 'negative' control serum is tested with each batch of test sera.

Indications

It is indicated as a confirmatory test when a physician suspects EBV, typically in the presence of clinical features such as fever, malaise, pharyngitis, tender lymphadenopathy (especially posterior cervical; often called "tender glands") and splenomegaly.[6]

Usefulness of the test

The specificity of the test is high, virtually 100%,[7] so a positive test is useful in confirming EBV. Rarely, however, a false positive heterophile antibody test may result from toxoplasmosis, rubella, lymphoma and leukemia.[7]

However, the sensitivity is only moderate, so a negative test does not exclude EBV. This lack of sensitivity is especially the case in young children, many of whom will not produce the heterophile antibody at any stage and thus have a false negative test result.

In the case of delayed or absent seroconversion, an immunofluorescence test could be used if the diagnosis is in doubt. It has the following characteristics: VCAs (Viral Capsid Antigen) of the IgM class, antibodies to EBV early antigen (anti-EA), absent antibodies to EBV nuclear antigen (anti-EBNA)

References

  1. Basson V, Sharp AA (May 1969). "Monospot: a differential slide test for infectious mononucleosis". J. Clin. Pathol. 22 (3): 324–5. doi:10.1136/jcp.22.3.324. PMC 474075. PMID 5814738.
  2. J. Clin. Path. (1969), 22, 321-323
  3. Elgh F, Linderholm M, Clinical and Diagnostic Virology 7 (1996) 17-21 http://dx.doi.org/10.1016/S0928-0197(96)00245-0
  4. Ebell, MH (1 October 2004). "Epstein-Barr virus infectious mononucleosis". American family physician. 70 (7): 1279–87. PMID 15508538.
  5. heterophil - Definitions from Dictionary.com
  6. Davidson's Principles & Practices of Medicine 20th ed
  7. 7.0 7.1 Infectious Mononucleosis Workup from Medscape. Author: Burke A Cunha, MD; Chief Editor: Michael Stuart Bronze, MD. Updated: Sep 21, 2011