Summary

The monospot test is used to diagnose glandular fever (infectious mononucleosis) by detecting the antibodies your body makes to the Epstein-Barr virus (EBV) which causes the infection. It is used as an initial screen because only 70 to 80 percent of cases of glandular fever produce antibodies. 

If the test is negative (most commonly in young children) and the symptoms persist, your doctor may arrange for more specific tests for EBV infection or test for other possible infections.

Why get tested?

Glandular fever or infectious mononucleosis is relatively common with symptoms that include fever, sore throat, swollen glands, and fatigue. In young adults it can usually be diagnosed during the acute or initial phase of the infection using the monospot also known as the Infectious Mononucleosis screening test.

The test measures the heterophile antibodies that your body makes to the Epstein-Barr virus (EBV) and, much less commonly, other viral infections, autoimmune diseases and non-infectious conditions.

Your body takes time to make these antibodies and because of this the test will not be able to detect them until you have been infected for about two weeks or longer.

Sometimes, the monospot test does not detect the virus even though the person has it. About 15 to 20 percent of people with glandular fever test negative in the monospot test and they need to have further testing for antibodies to the EBV viral capsid antigen.

When the monospot test is negative, a combination of EBV antibody tests for IgM and IgG to the viral capsid antigen, IgM to the early antigen, and IgG antibody to the nuclear antigen may be requested. These additional tests can show whether you are susceptible to EBV, if you have had a recent or past infection, or have a reactivation of EBV infection.

The disease is most common in young adults and it spreads through close contact with the saliva of an infected person. It can be spread through kissing but also through contact with hands or objects contaminated with infected saliva. Infected people should take precautions such as avoiding kissing, sharing drink containers and practice good hygiene.  Many healthy people can carry and spread the virus intermittently for life, without any symptoms.  

Glandular fever is a self-limiting disease in that it resolves spontaneously without specific treatment after two to three weeks. In some cases, the infection may cause swelling of the spleen or liver and in these cases, people are recommended to avoid contact sports.  

Having the test

Sample

Blood

Any preparation?

None 

Your results

Reading your test report

Your results will be presented along with those of your other tests on the same form.  You will see separate columns or lines for each of these tests.

Glandular fever is characterised by the presence of unusual white blood cells (atypical lymphocytes) in an infected person. 

A positive monospot test result in someone who has typical symptoms of glandular fever will confirm the diagnosis. Accompanying tests such as a full blood count (FBC) will generally show an increased white blood cell count with a higher than usual number of lymphocytes which may appear reactive. The number of heterophile antibodies declines after the fourth week of illness, and the test will become negative as the infection resolves.

A negative test result means that a person may not have mononucleosis or that it is too early in the illness to detect the antibodies. The test may need to be repeated if symptoms persist. Infants and young children often do not make heterophile antibodies when infected with EBV, so more specific viral tests must be used to make the diagnosis.

Questions to ask your doctor

The choice of tests your doctor makes will be based on your medical history and symptoms.   It is important that you tell themeverything you think might help.

You play a central role in making sure your test results are accurate. Do everything you can to make sure the information you provide is correct and follow instructions closely.

Talk to your doctor about any medications you are taking. Find out if you need to fast or stop any particular foods or supplements. These may affect your results. Ask:

• Why does this test need to be done?
• Do I need to prepare (such as fast or avoid medications) for the sample collection?
• Will an abnormal result mean I need further tests?
• How could it change the course of my care?
• What will happen next, after the test?

Any more to know?

Rarely, EBV has been linked to more serious illnesses such as haemophagocytic lymphohistiocytosis (HLH) and lymphoproliferative disorders such as Burkitt's lymphoma, Hodgkin's disease, nasopharyngeal carcinoma, and AIDS-related lymphoma.  

More information

Pathology and diagnostic imaging reports can be added to your My Health Record. You and your healthcare provider can now access your results whenever and wherever needed.
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