Diagnosis

The diagnosis is suggested by the clinical features. The most frequently used serologic test is the EBV-specific heterophile antibody test (the "monospot test," "mononucleosis spot test," or Paul-Bunnell test), which gives a positive result (2). Other abnormal laboratory findings include elevated white blood cell (WBC) count ranging from 1.0 x 109/L to 1.5 x 109/L; of these WBCs, 50% or more are "atypical" lymphocytes with oval, kidney-shaped nuclei and vacuolated cytoplasm. Thrombocytopenia is common, and levels of hepatic enzymes may be elevated.

Cytomegalovirus (CMV) can produce symptoms that mimic those of infectious mononucleosis, but give a negative result when subjected to the heterophile antibody test. The diagnosis must be made by isolating the CMV virus. CMV-type mononucleosis usually has both slower onset and slower resolution. Most infected patients recover without sequelae.

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