Diagnosis of Mono

November 22, 2009

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Diagnosis of Mono

by Lynn Cates, M.D., F.A.A.P.
reviewed by Laura Jana, M.D., F.A.A.P.

It's reasonable to suspect mononucleosis, commonly known as mono, when a person--particularly a teenager--has the classic mono symptoms of fever, sore throat, and swollen lymph nodes, or if she comes down with a fever after known exposure to Epstein-Barr virus (EBV) infection. However, the diagnosis cannot be established without laboratory testing. The following tests may be helpful in determining if your child has mono:

Complete blood count (CBC). One readily available blood test that can suggest, but not establish, the diagnosis of mono is a routine CBC. In individuals with mono, the white blood count usually is high, and special white blood cells called atypical lymphocytes can be seen under the microscope. This test can also detect anemia (low red blood cells), which can accompany some cases of mono.

Blood antibody tests. Antibodies are proteins formed by the body's immune system to help fight infection. Measuring certain blood antibodies is necessary to confirm the diagnosis of mono.

Mono Spot. The antibody test that is most readily available is the mono spot (also known as the heterophile antibody) test. The results of this test usually are available within a couple of days and, if positive, will establish the diagnosis. This test is very helpful for diagnosing mono in older children and adults, because it will be positive in about 90 percent of cases. Unfortunately, it usually doesn't turn positive in children under four years of age, necessitating testing for EBV-specific antibodies.

EBV antibodies. A set of antibody tests are available for detecting the Epstein-Barr virus specifically. This is the best way to test for mono in young children; it also is helpful for the few older individuals with mono whose mono spot tests are negative. However, EBV antibody testing is not as readily available as the mono spot test, so it takes longer to get the results. Another disadvantage is that it is more expensive.

If the mono spot and the EBV antibodies are negative, the mono-like symptoms are most likely due to something besides EBV, such as cytomegalovirus (CMV), adenovirus, or toxoplasmosis.

Viral cultures. Although EBV virus can be grown in research laboratories, viral cultures are not available--or needed--on a routine basis.

Liver function tests. If your child has an enlarged liver or jaundice, her healthcare provider may want to evaluate her liver function when he checks for mono, since EBV can cause hepatitis (inflammation or infection of the liver).

Throat culture for strep. Because the symptoms of mono can be very similar to those of strep--and on occasion a child can have both mono and strep--a throat culture for strep may be indicated.


RELATED INFORMATION

			Strep Infections: An Overview
			Suspecting Mono in Your Teenager
			Suspecting Mono in Your Younger Child
			Mononucleosis

Created June 17, 2001
Reviewed June 21, 2001

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