III. Diagnosis: Acute Mononucleosis Syndrome

  1. Step 1: Monospot Test Positive
    1. Diagnose Epstein-Barr Virus
  2. Step 2: Complete Blood Count with differential
    1. Evaluate for >10% Atypical lymphocytes
    2. Lymphocytosis >50% and Atypical lymphocytes >10% may be sufficient alone to diagnose Mononucleosis without further testing
      1. Test Sensitivity: 75%
      2. Test Specificity: 92%
  3. Step 3a: Obtain HIV Test if <10% Atypical lymphocyte
    1. See Acute Retroviral Syndrome for testing
  4. Step 3b: Obtain EBV IgM if >10% Atypical lymphocytes
    1. EBV IgM Positive: Diagnose Epstein-Barr Virus
    2. EBV IgM Negative: Go to Step 4
  5. Step 4: Obtain CMV IgM
    1. CMV IgM Positive: Diagnose CMV-Induced Mononucleosis
    2. CMV IgM Negative: Evaluate for differential diagnosis
      1. Toxoplasmosis
      2. Acute Viral Hepatitis
      3. Human Herpesvirus 6
  6. References
    1. Tsaparas (2000) Arch Pathol Lab Med 124:1324-30 [PubMed]

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