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Introduction ⬇

Epstein–Barr virus (EBV) is a herpesvirus found throughout the world. The most common symptomatic manifestation of EBV infection is a disease known as infectious mononucleosis (IM). This disease induces formation of increased numbers of abnormal lymphocytes in the lymph nodes and stimulates increased heterophile antibody formation. IM occurs most often in young adults who have not been previously infected through contact with infectious oropharyngeal secretions. Symptoms include fever, pharyngitis, and lymphadenopathy. EBV is also thought to play a role in the etiology of Burkitt lymphoma, nasopharyngeal carcinoma, and chronic fatigue syndrome.

The most common test for EBV is the rapid slide test (Monospot) for heterophile antibody agglutination. The heterophile antibody agglutination test is not specific for EBV and therefore is not useful for evaluating chronic disease. If the heterophile test is negative in the presence of acute IM symptoms, specific EBV antibodies should be determined. These include antibodies to viral capsid antigen and antibodies to EBV nuclear antigen using IFA and 
ELISA tests.

Diagnosis of IM is based on the following criteria: clinical features compatible with IM, hematologic picture of relative and absolute lymphocytosis, and presence of heterophile antibodies.

Normal Findings ⬆ ⬇

Procedure ⬆ ⬇

  1. Collect a 7-mL blood serum sample in a red-topped tube. Observe standard precautions.

  2. Label the specimen with the patient’s name, date, and tests ordered and place in a biohazard bag for transport to the laboratory.

Clinical Implications ⬆ ⬇

  1. The presence of heterophile antibodies (Monospot), along with clinical signs and other hematologic findings, is diagnostic for IM.

  2. Heterophile antibodies remain elevated for 8–12 weeks after symptoms appear.

  3. Approximately 90% of adults have antibodies to the virus.

  4. The Monospot test is negative more frequently in children and almost uniformly in infants with primary EBV infection.

Interventions ⬆

Pretest Patient Care

  1. Assess patient’s clinical history, symptoms, and test knowledge. Explain test purpose and procedure. If preliminary tests are negative, follow-up tests may be necessary.

  2. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Review test results; report and record findings. Modify the nursing care plan as needed.

  2. Counsel the patient regarding abnormal findings; explain the need for possible follow-up testing and treatment, such as IV fluids. See Interpreting Results of Immunologic Tests.

  3. Tell the patient that, after primary exposure, a person is considered immune. Recurrence of IM is rare.

  4. Resolution of IM usually follows a predictable course: pharyngitis disappears within 14 days after onset; fever subsides within 21 days; and fatigue, lymphadenopathy, and liver and spleen enlargement regress by 21–28 days.

  5. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.