Table 1.

Characteristics of Included Studies

Author, YearDesignNumberInclusion CriteriaAgeSex/CountryYear(s) Patients Recruited
Balfour, 200516Prospective cohort25College students aged ≥18 years who had a clinical diagnosis of IM and presented within 10 days after the onset of symptoms were included. Students were excluded if they had acute infection consistent with IM or if they were immunocompromised.Mean, 21 years72% femaleEBV profile was tested by EIA (80%)United States2002 to 2004
Biggs, 20139Retrospective cohort726Retrospective patients presenting with sore throat, fever, and lymphadenopathy and undergoing Monospot test at university health service were included in the study. Patients without full blood count results were excluded from the study.Positive group: Mean, 21 years; Negative group: Mean, 30 yearsNAMonospot test (Heterophile antibody test) (6.9%)United Kingdom2011 to 2012
Grotto, 20036Prospective cohort590Young adults who were clinically suspected with IM and reported diagnosis of clinical IM for physical and lab examinations at military lab were included. Patients with intermediate EBV or CMV IgM were excluded from the study.NA40% femaleMono-Latex (heterophile antibody test) and detection of IgM by ELISA kit (64.4%)Israel1988 to 1991
Hossain, 198922Prospective cohort38Patients aged 5 to 32 years presenting with symptoms suggestive of IM were studied. The minimal criteria included temperature greater than 37°C, greater than 50% lymphocytes and monocytes, and at least 10% atypical lymphocytes.NANAIM Quick test to detect heterophile antibodies and EBV profile was tested by indirect/IFA (76.3%)Saudi ArabiaNA
Llor, 201223Prospective cohort144Consecutive adults aged over 14 years with sore throat and 4 Centor criteria—tonsillar exudate, fever, lymph glands tenderness, and absence of cough—and negative pharyngeal testing for group Aβ were recruited.Mean, 24 years53% femaleOSOM MonoTest (Genzyme) as immunochromatographic technology to detect EBV profile, then PBD test (10.9%)Spain2006 to 2009
Lennon, 201027Retrospective cohort10001000 patients with tonsillitis both in an outpatient and inpatient setting were analyzed to compare the L/WBC ratio in 500 positive and 500 negative Monospot test results.NA68% femaleMonospot test (Heterophile antibody test) (50%)IrelandNA
Sumaya, 198517Case series113Pediatric patients aged 16 years and younger who had clinical manifestations consistent with IM (fever, tonsillopharyngitis, cervical adenopathy, hepatomegaly, splenomegaly) were included in the study. Patients with WBC≥50% or ≥5000 lymphocytes and at least 10% atypical lymphocytes were also included.Median, 4 yearsNAEBV profiles were tested by indirect/IFA, and rapid slide tests to detect heterophile antibodies (100%)United States1976 to 1982
Ventura, 200418Retrospective cohort147Consecutive patients with clinical features that were suspected with IM and had heterophile antibody tests ordered were included in the study.Mean, 20 years58% femaleMono-Latex slide (heterophile antibody test) (46.3%)United StatesNA
Rea, 20013Case series150Patients aged 16 years or older with EBV infection had a positive heterophile antibody test and reported the onset of symptoms within 2 weeks of the test ordered were included in the study. Those suffering chronic, disabling medical condition or having been treated with steroids were excluded.Mean, 22 years48% femaleAll patients had positive heterophile antibody test; IFA was used to detect VCA-IgM and VCA-IgG (100%)United StatesNA
Brigden, 19998Prospective cohort181Sera were obtained from patients with clinical diagnoses of mononucleosis who subsequently tested positive for heterophile antibody using Monosticon test and from 181 patients with clinical suspected IM who tested negative for heterophile antibody test.Mean, 21 years59% femaleMonosticon Dri-Dot test (heterophile antibody test) (50%)CanadaNA
Ginsburg, 197719Prospective cohort43Children aged 1 to 13 years were selected based on the symptoms and signs compatible with IM. All of them had positive Monospot reactions and showed atypical lymphocytes, and their serum was collected during the acute phase at pediatric outpatient clinic.Mean, 7.7 years37% femaleEBV profile was tested by indirect/IFA (69.8%)United States1974 to 1975
Fleisher, 198320Prospective cohort500Sera from consecutive patients seeking treatment at university health service with illness suggestive of IM were included for EBV-specific serological test. WBC and differential counts were performed uniformly during weekdays and sporadically at other times.NANAEBV profiles were tested by indirect/IFA (28.3%)United States1980 to 1981
Krabbe, 198124Prospective cohort43Consecutive hospitalized children aged between 6 months and 7 years were selected if displaying one of the following: nonbacterial pharyngitis or tonsillitis, lymphadenopathy, hepatosplenomegaly, rash or unknown etiology, a blood count with more than 10% atypical lymphocytes, or thrombocytopenia.Below 7 yearsNAVCA-IgM and IgG were tested by indirect immunofluorescence test (18.6%)Denmark1981
Chretien, 197721Case series150Patients aged between 17 and 29 years diagnosed with IM from university health service were included in the study. The diagnoses were based on usual clinical criteria for the presence of atypical lymphocytes on peripheral blood smears and positive heterophile antibody tests.NA36.7% femaleMonospot test (heterophile antibody test) (100%)United StatesNA
Aronson, 19825Prospective cohort709Consecutive ambulatory adult patients aged between 16 and 73 years presenting sore throat or strep throat from 4 primary care settings were included in the study. The extensive clinical data and heterophile antibody tests were obtained.Mean, 32 years60% femaleMonospot test (heterophile antibody test) (2.1%)United States1976 to 1977
Gartzonika, 201226Case series118Sera from patients aged between 1 and 47 years with a clinical suspicion of IM or acute EBV infection were included in the study.Median, 21 years51% femaleEBV profile tested using ELISA test and Cellognost-Mononucleosis test to detect heterophile antibodies (100%)GreeceNA
Ho-Yen, 198125Prospective cohort61Sera from patients with suspected IM and having positive PBD test results were included in the study.Mean, 17 years50% femalePBD test (61%)United KingdomNA
  • CMV, cytomegalovirus; EBV, Epstein-Barr virus; EIA, enzyme-linked immunosorbent assay; ELISA, enzyme-linked immunosorbent assay; IFA, indirect immunofluorescence test/anti-complement immunofluorescence assay; IM, infectious mononucleosis; L/WCC, lymphocyte/white blood cell ratio; NA, not applicable; PBD, Paul-Bunnel Davidsohn (heterophile antibody) test; WBC, white blood cell.