Mononucleosis Testing

Synonym/Acronym

monospot, Epstein-Barr test, heterophil antibody test, IM serology.

Rationale

To assess for Epstein-Barr virus (EBV) and assist with diagnosis of infectious mononucleosis.

Patient Preparation

There are no food, fluid, activity, or medication restrictions unless by medical direction.

Normal Findings

(Method: Infectious mononucleosis antibodies (rapid IM) test by agglutination; serological tests for EBV early antigen D (IgG antibody), EBV nuclear antigen (IgG antibody), EBV viral capsid antigen (IgG antibody), EBV viral capsid antigen (IgM antibody) by immunoassay).

Rapid IM		Negative (indicating nondetectable levels of the infectious mononucleosis heterophile antibody)
EBV antibody to early antigen D (IgG antibody)		10.9 Units/mL or less (EBV antibody to early antigen D, IgG antibody not detected)
EBV antibody to nuclear antigen (IgG antibody)		21.9 Units/mL or less (EBV antibody to nuclear antigen IgG not detected)
EBV antibody to viral capsid antigen (IgG antibody)		21.9 Units/mL or less (EBV antibody to viral capsid antigen IgG not detected)
EBV antibody to viral capsid antigen (IgM antibody)		43.9 Units/mL or less (EBV antibody to viral capsid antigen IgM not detected)

Critical Findings and Potential Interventions ⬆ ⬇

Overview ⬆ ⬇

(Study type: Blood collected in a gold-, red-, or red/gray-top tube; related body system: Immune system.)

Infectious mononucleosis is caused by the human herpesvirus 4, more commonly known as the Epstein-Barr virus. The incubation period is 10 to 50 days, and the symptoms last 1 to 4 wk after the infection has fully developed. The hallmark of EBV infection is the presence of heterophilic (cross-reacting) antibodies, also called Paul-Bunnell-Davidsohn antibodies, which are immunoglobulin M (IgM) antibodies that agglutinate sheep or horse red blood cells. The disease induces formation of abnormal lymphocytes in the lymph nodes; stimulates increased formation of heterophil antibodies; and is characterized by fever, cervical lymphadenopathy, tonsillopharyngitis, and hepatosplenomegaly.

EBV is also thought to play a role in Burkitt lymphoma, nasopharyngeal cancer, and chronic fatigue syndrome. If the results of the heterophil antibody screening test are negative and infectious mononucleosis is highly suspected, EBV-specific serology should be requested (EBV early antigen D antibody IgG, EBV nuclear antigen antibody IgG, EBV viral capsid antigen antibody IgG, EBV viral capsid antigen antibody IgM). Molecular testing methods (e.g., polymerase chain reaction) are available to identify the presence of EBV viral DNA and to monitor viral load in patients being treated for other EBV-related diseases.

Indications ⬆ ⬇

Assist in confirming infectious mononucleosis.

Interfering Factors ⬆ ⬇

False-positive results may occur in the presence of other conditions or circumstances such as narcotic addiction, serum sickness, lymphomas, hepatitis, leukemia, cancer of the pancreas, and phenytoin therapy.
A false-negative result may occur if treatment was begun before antibodies developed or if the test was done less than 6 days after exposure to the virus.

Potential Medical Diagnosis: Clinical Significance of Results ⬆ ⬇

Positive Findings in

EBV mononucleosis

Negative Findings in

N/A

Nursing Implications ⬆

Before the Study: Planning and Implementation

Teaching the Patient What to Expect

Explain that a blood sample is needed for the test. Inform the patient that approximately 10% of all results are false negative or false positive.
Discuss how this test can assist with diagnosing a mononucleosis infection.

After the Study: Implementation & Evaluation Potential Nursing Actions

Treatment Considerations

Advise the patient to refrain from direct contact with others because the disease is transmitted through saliva.

Fatigue

Fatigue related to infection can be a concern. Symptoms of fatigue include decreased concentration, increased physical health concerns, inability to restore energy with sleep, reports being tired, and inability to maintain normal routine.
Interventions/actions related to fatigue include the following: Monitor and trend mononucleosis screening results. Trend the degree of fatigue over time. Pace activities to preserve energy stores. Identify what aggravates and decreases fatigue. Consider related emotional factors such as depression, current medications in relation to fatigue, and physiological factors such as anemia.

Infection

Infection management is essential. Symptoms of infection include fatigue, malaise, sore throat, fever, enlarged lymph nodes in the neck and armpits, swollen tonsils, headache, rash, and swollen spleen. Review signs and symptoms of infection: chills, enlarged lymph nodes, facial edema, fatigue, fever, maculopapular rash, sore throat.
Interventions/actions related to infection include the following: Administer ordered antibiotics to treat strep throat and steroids to treat swollen throat or tonsils. Gargle with warm saltwater to decrease sore throat pain and use over-the-counter ibuprofen or acetaminophen. Encourage rest and ingestion of plenty of fluids (water and fruit juice). Discuss the importance of avoiding at-risk activities that may cause trauma and spleen rupture.

Clinical Judgement

Consider how to successfully address the social implications of disease transmission.

Follow-Up Evaluation and Desired Outcomes

Acknowledges the importance of fluids and rest for recovery, avoiding vigorous activities, heavy lifting, roughhousing, and contact sports for at least 1 mo or as recommended by the health-care provider.