| Heterophile antibody test | |
|---|---|
 A commercialimmunochromatographic test kit for the heterophile antibody test. Solid lines are visible at the "C" (control) and "T" (test) positions, indicating a positive result. | |
| Synonyms | Monospot test |
| Purpose | rapid test for infectious mononucleosis |
Themononuclear spot test ormonospot test, a form of theheterophile antibody test,[1] is a rapid test forinfectious mononucleosis due toEpstein–Barr virus (EBV). It is an improvement on the Paul–Bunnell test.[2] The test isspecific forheterophile antibodies produced by the humanimmune 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]
TheUnited States Center for Disease Control deems the monospot test not to be very useful.[5]
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") andsplenomegaly.[6]
In the case of delayed or absentseroconversion, 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)[citation needed]
One source states that thespecificity of the test is high, virtually 100%,[7] Another source states that a number of other conditions can causefalse positives.[5] Rarely, however, a false positive heterophile antibody test may result fromsystemic lupus erythematosus,toxoplasmosis,rubella,lymphoma andleukemia.[7]
However, thesensitivity 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 detectable amounts of the heterophile antibody and will thus have a false negative test result.[8]
It will generally not be positive during the 4–6 week incubation period before the onset of symptoms. The highest amount of heterophile antibodies occurs 2 to 5 weeks after the onset of symptoms.[9] If positive, it will remain so for at least six weeks.[10] An elevated heterophile antibody level may persist up to 1 year.[9]
The test is usually performed using commercially available test kits which detect the reaction of heterophile antibodies in a person's blood sample with horse or cow red blood cell antigens. These test kits work on the principles oflatex agglutination orimmunochromatography. Using this method, the test can be performed by individuals without specialized training, and the results may be available in as little as five minutes.[8][11]
Manual versions of the test rely on the agglutination of horse erythrocytes by heterophile antibodies in patient serum. Heterophile means it reacts with proteins across species lines.[12] Heterophile also can mean that it is an antibody that reacts with antigens other than the antigen that stimulated it (an antibody that crossreacts).[citation needed]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 ox red cell stroma; sera and suspensions are mixed with a wooden applicator 10 times.Ten microliters 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).It is then examined for the presence or absence ofred cell agglutination.If stronger with the sera adsorbed with guinea-pig kidney, the test is positive.If stronger with the sera adsorbed with ox 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.[citation needed]