title: Validity of a point-of-care based on heterophile antibody detection for the diagnosis of infectious mononucleosis in primary care.
abstract: OBJECTIVE
  To evaluate the validity of a point-of-care test to diagnose infectious mononucleosis (IM) compared with Epstein-Barr virus (EBV) specific serology.
  
  
  METHODS
  Patients over 14 years with sore throat and four Centor criteria--tonsillar exudate, fever, lymph glands tenderness and absence of cough--and negative pharyngeal testing for group A β-haemolytic streptococcal antigen were consecutively recruited. All patients underwent pharyngotonsillar swab for microbiological culture, the rapid OSOM MonoTest for the diagnosis of IM in whole blood, the Paul-Bunnell test and complete blood analysis with serology for EBV and cytomegalovirus the day after the visit and at 15 days. Sensitivity and specificity were determined.
  
  
  RESULTS
  We included 145 patients with a mean age of 24 ± 6.8 years. Of these, serology was determined in 129 subjects, with IM being diagnosed in 14 (10.9%). Both the MonoTest and the Paul-Bunnell test were positive in 13 patients with IM (92.9%) with no patient without disease being positive for either test--sensitivity of 92.9% (95% CI: 64.2-99.6%) and specificity of 100% (95% CI: 96-100%). The culture showed streptococcus A infection in 1 case (0.7%) and streptococcus C in 62 cases (42.8%). A total of 78 patients presented past infection by EBV (60.5%).
  
  
  CONCLUSIONS
  Only one out of 10 patients with sore throat, four Centor criteria and negative rapid test for streptococcal infection presents IM. Despite the MonoTest presenting optimum sensitivity and specificity, it was found to have the same validity as the Paul-Bunnell test, with serological study continuing to be necessary for precise diagnosis of IM.
authors.affiliation: Primary Healthcare Centre Jaume I, University Rovira i Virgili, Tarragona, Spain. carles.llor@urv.cat
authors.forename: Carl
authors.initials: C
authors.lastname: Llor
authors.forename: Marta
authors.initials: M
authors.lastname: Hernández
authors.forename: Silvia
authors.initials: S
authors.lastname: Hernández
authors.forename: Teresa
authors.initials: T
authors.lastname: Martínez
authors.forename: Frederic Francesc
authors.initials: FF
authors.lastname: Gómez
mesh_terms: D000293:Adolescent; D000328:Adult; D000910:Antibodies, Heterophile / Q000032:analysis*; D005260:Female; D004854:Herpesvirus 4, Human / Q000276:immunology*; D006801:Humans; D007159:Immunologic Tests / Q000379:methods; D007244:Infectious Mononucleosis / Q000175:diagnosis* / Q000276:immunology / Q000821:virology; D008137:Longitudinal Studies; D008297:Male; D010612:Pharyngitis / Q000175:diagnosis / Q000821:virology; D019095:Point-of-Care Systems; D011320:Primary Health Care / Q000379:methods; D012680:Sensitivity and Specificity; D012698:Serologic Tests / Q000379:methods; D055815:Young Adult
chemical_list: D000910:Antibodies, Heterophile