Armstrong C W, Hackler R L, Miller G B
Pediatr Infect Dis. 1986 May-Jun;5(3):325-7. doi: 10.1097/00006454-198605000-00010.
Two outbreaks of suspected infectious mononucleosis (IM) were investigated. In the first outbreak IM was diagnosed in nine children attending a day care center. They had been tested in physicians' offices for heterophile antibody using rapid differential slide tests; all tests had been reported positive. On retesting, none of the suspected cases had detectable serum heterophile antibody. The initial test results had been falsely positive as a result of poor laboratory technique. In the second outbreak IM had been diagnosed in 285 college students. Suspected cases had been found to have serum IgG antibody to the viral capsid antigen of Epstein-Barr virus, but most had not been tested for the presence of heterophile antibody. Retesting of 64 students within 1 month of initial testing yielded only one with heterophile antibody. With the exception of young children (less than 4 years of age), differential slide tests for heterophile antibody are sensitive and specific for recent Epstein-Barr virus infection if properly performed. Viral capsid antigen to Epstein-Barr virus (IgG) titers are of limited usefulness in diagnosing acute IM. The misdiagnosis of IM can be prevented by the appropriate selection, performance and interpretation of diagnostic laboratory tests.
对两起疑似传染性单核细胞增多症（IM）的疫情进行了调查。在第一起疫情中，一家日托中心的9名儿童被诊断为IM。他们在医生办公室使用快速鉴别玻片试验检测嗜异性抗体；所有检测报告均为阳性。再次检测时，所有疑似病例均未检测到血清嗜异性抗体。由于实验室技术不佳，最初的检测结果出现了假阳性。在第二起疫情中，285名大学生被诊断为IM。疑似病例被发现血清中存在针对EB病毒病毒衣壳抗原的IgG抗体，但大多数人未检测嗜异性抗体的存在。在初次检测后1个月内对64名学生进行再次检测，只有1人有嗜异性抗体。除幼儿（4岁以下）外，如果操作得当，嗜异性抗体的鉴别玻片试验对近期EB病毒感染敏感且特异。EB病毒病毒衣壳抗原（IgG）滴度在诊断急性IM方面作用有限。通过正确选择、进行和解释诊断实验室检测，可以预防IM的误诊。
