Difficulties with the serologic diagnosis of infectious mononucleosis : A review of the RCPA quality assurance programs

SummaryThe Royal College of Pathologists of Australasia's Quality Assurance Programs (QAP) on serologic assays for Infectious Mononucleosis (IM) have identified a number of important problems in laboratory diagnosis of this condition. A wide range of assays for the diagnosis of acute Epstein-Barr virus (EBV) infection are available, although heterophile antibody tests are still the most frequently performed procedures for the diagnosis of IM. In 1993, eighty-six (54%) of the 159 participating laboratories performed only a heterophile test; of these, 71% did not provide an interpretation of their results and none mentioned the need for confirmatory EBV-specific antibody testing. This revealed a lack of appreciation that heterophile tests should only be used for screening, due to their inferior sensitivity of less than 50% in children and 80–90% in adults and specificity of 95% compared to EBV-specific assays. For these reasons the use of heterophile tests is discouraged. Although EBV-specific serology has ...