Which other tests may be indicated in the workup of Epstein-Barr virus (EBV) infectious mononucleosis (mono)?

Updated: Sep 20, 2018
  • Author: Burke A Cunha, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Other tests are as follows:

  • Patients with suspected infectious mononucleosis should not have their throats cultured for group A streptococci because the carriage rate is approximately 30% in these patients. The mere recovery of group A streptococci from the oropharynx does not signify the cause of the patient's pharyngitis; it does not differentiate colonization from infection. In such patients, a Gram stain of the oropharynx is used to differentiate patients who have pharyngitis with positive cultures for group A streptococci from those colonized with group A streptococci.

  • Patients with EBV infectious mononucleosis or other causes of viral pharyngitis and group A streptococcal colonization have little or no white cell response on the Gram stain of the pharynx. Patients with group A streptococcal pharyngitis also have a positive finding on throat culture, but, in contrast to the patients with colonization, they show an intense polymorphonuclear cellular response with cellular debris and fibrous fragments indicating acute infection. The rapid streptococcal test cannot be used to differentiate colonization from infection any more than throat cultures.

  • Patients with presumed CNS involvement with EBV infectious mononucleosis should undergo serological tests for other causes of viral encephalitis appropriate to the patient's exposure history.


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