Choosing Wisely Recommendations
Don’t perform heterophile antibody (monospot) testing to diagnose acute Epstein-Barr virus infection in children younger than five years.
Rationale and Comments
Approximately 40% of children younger than five years do not develop heterophile antibodies following primary Epstein-Barr virus (EBV) infection. If the heterophile is the only test ordered, the diagnosis may be missed. The U.S. Centers for Disease Control and Prevention has advised against heterophile testing in this age group because of a lack of specificity and the potential for false negative results. Testing in this age group should be a panel of EBV-specific serologic antibody immunoassays for viral capsid antigen immunoglobulin M and immunoglobulin G and Epstein-Barr nuclear antigen.
Sponsoring Organizations
- American Society for Microbiology
- American Society for Clinical Laboratory Science
- American Society for Clinical Pathology
Sources
Disciplines
- Infectious disease
- Pediatric
References
- Horwitz CA, Henle W, Henle G, et al. Clinical and laboratory evaluation of infants and children with Epstein-Barr virus-induced infectious mononucleosis: report of 32 patients (aged 10-48 months). Blood. 1981;57(5):933-938.
- Centers for Disease Control and Prevention. Epstein-Barr virus and infectious mononucleosis. Accessed August 8, 2014. http://www.cdc.gov/epstein-barr/laboratory-testing.html
- Committee on Infectious Diseases, American Academy of Pediatrics; Kimberlin DW, Barnett ED, eds. Red Book: 2021-2024 Report of the Committee on Infectious Diseases. 32nd ed. American Academy of Pediatrics; 2021;318-322.
