Epstein-Barr virus is associated with various diseases in humans. Human reaction to this viral infection is through the humoral immunity system. Identification of this virus can be done through various tests. Monospot testing is one of the tests to diagnose the presence of EBV in various diseases associated with it. This discussion explains Monospot testing regarding its reliability in children and adults.
Epstein-Barr Virus (EBV) is commonly associated with infectious mononucleosis (IM) (Naughton et al., 2021). This disease is extremely common in the US and worldwide. Being a viral illness, most diagnostic tests for IM are serological. The human body produces heterophile antibodies toward EBV infection (Byrne et al., 2020). Monospot testing is a serological test that is classified under the agglutination type. This test is a latex agglutination test that uses equine erythrocytes as the substrate.
When the human serological sample containing antibodies against EBV is added to the substrate, the erythrocytes clump together due to agglutination with the antibodies and antigens on the red cell surface. The outcome is interpreted as a positive result. When the sample added does not contain these antibodies, agglutination will not occur.
The Monospot test replaced the Paul-Bunnell test that was used to diagnose infectious mononucleosis. Infectious mononucleosis presents with fever, malaise, sore throat, tonsilitis, fatigue, and lymphadenopathy. The triad of pharyngitis, lymphadenopathy, and fever is considered classical in infectious mononucleosis. However, atypical cases can also present to physicians and nurses, which can change the clinician’s decisions regarding diagnosis. Monospot testing is, therefore, a rapid test that can be used to confirm the presence of disease.
However, other disease entities can also present with symptoms similar to those of infectious mononucleosis. Bacterial tonsilitis and other viral upper respiratory tract infections (URTIs) can present with the above symptoms (Naughton et al., 2021). The duration of the symptoms and the high clinician’s index suspicion are required. Infectious mononucleosis can have serious complications such as splenomegaly that risks rupture and hemorrhage. Therefore, early identification of infectious mononucleosis by Monospot testing helps provide a timely and insightful objective understanding of the patient’s presentation.
Monospot testing is rapid and requires few materials to conduct and interpret. The kit and the blood sample from the patient are the essential requirements. The blood sample is obtained intravenously, either through a finger prick or phlebotomy. The kits are commercially acquired. Once the blood sample is withdrawn, a drop is placed into the kit and left for about 5 to 10 minutes. The presence of an additional indicator to the control indicator shows a positive test, while the presence of the control indicator alone shows a negative test result.
The Monospot test is a qualitative test whose findings are either interpreted as positive or negative. A positive test only indicates that antibodies against EBV are present and can be interpreted that the symptoms could result from infectious mononucleosis. Notably, antibodies against infections and illness sometimes stay in the patient’s system longer, and even after the patient recovers from the disease, the antibodies can still be identified. With time, the quantities of these antibodies wane off, but the tests cannot quantify their amount and thus cannot be used to identify the stage or monitor the disease. The absence of these antibodies in a clinically evident disease also presents a challenge.
The Monospot test, from the above description, is a test that can have false positives and negatives. It has high specificity but low sensitivity. Sensitivity is the ability of a test to identify true positives (Ball et al., 2022). According to Stuempfig & Seroy (2021), the Monospot test’s sensitivity ranges between 70% and 90%. Put into perspective; this implies that among 100 people with infectious mononucleosis confirmed by a gold standard test, Monospot will correctly identify about 70 to 90 people from the 100 people. Specificity, the ability to identify true negative cases (Dains et al., 2019), is, however, higher for the Monospot test.
According to a study by Wang et al. (2021), the specificity of this test ranged between 80.0% and 90.6%. However, this study acknowledged that these values were lower than previously reported values – 95% to 100% (Stuempfig & Seroy, 2021). Factors such as age and timing between sample collection and testing are critical co
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