What is heterophile negative mononucleosis? A negative test means there were no heterophile antibodies detected. Most of the time this means you do not have infectious mononucleosis
Infectious Mononucleosis
A disease usually caused by the Epstein-Barr virus (EBV).
Is EBV heterophile negative?
The tip of the spleen is palpable. A heterophile antibody test for Epstein-Barr virus-induced infectious mononucleosis is negative.
What does Heterophile antibody detected mean?
A positive test indicates the presence of heterophile antibodies. This result, alongside a patient's symptoms, are used to make a diagnosis of infectious mononucleosis. A negative test may indicate that a patient does not have infectious mononucleosis.
What are heterophile antibodies in infectious mononucleosis?
Heterophile antibodies are IgM antibodies with affinity for sheep and horse red blood cells. They appear during the first week of infectious mononucleosis symptoms, 3–4 weeks after infection and return to undetectable levels 3 to 6 months after infection.
What is heterophile antibody?
Heterophile antibodies are antibodies produced against poorly defined antigens, and these are generally weak antibodies with multi-specific activities. This is in contrast to strong human anti-animal antibodies produced against well-defined antigens as a result of treatment with animal immunoglobulins ( Kaplan and Levinson, 1999). Heterophile antibodies can bridge capture and conjugate antibodies in sandwich assays but cannot compete well with the high-affinity antigens in competitive binding assays. It has been suggested that antibodies should be called heterophile when: “there is no history of medicinal treatment with animal immunoglobulins or other well-defined immunogens and the interfering antibodies can be shown to be multi-specific (react with immunoglobulins from two or more species) or exhibit natural rheumatoid factor activity” (Kaplan and Levinson, 1999 ).
What percentage of EBV is heterophile?
Heterophile Antibodies. Heterophile antibodies, originally described by Paul and Bunnell, are present in 90% to 95% of EBV infections at some point during the illness. However, in infants and children under the age of 4 years with primary EBV infection, heterophile antibody responses are often not detected.
Why do people have heterophilic antibodies?
Heterophilic antibodies may arise in a patient in response to exposure to certain animals or animal products, due to infection by bacterial or viral agents , or nonspecifically. Although many of the immunoglobulin clones in normal human serum may display anti-animal antibody properties, only those antibodies with sufficient titer and affinity toward the reagent antibody used in the assay may cause clinically significant interference. Prevalence of heterophilic antibody varied widely in various published reports. In one study the prevalence of heterophilic antibody was 0.2%–3.7%. 36 Heterophilic antibodies are found more in sick and hospitalized patients, with reported prevalence of 0.2%–15%, but some reports claimed prevalence of up to 40% in the general population. An individual can form heterophilic antibody at any time when exposed to a foreign antigen, for example, during vaccination, antibody-targeted therapies (cancer, autoimmune disorder, etc.), and antibody-targeted imaging reagents. Exposure to animals may also lead to formation of heterophilic antibody. Moreover, blood transfusion, autoimmune disease, etc. may also result in the formation of heterophilic antibodies. Although up to 40% of samples may contain heterophilic antibodies, analytically important interferences due to the presence of heterophilic antibody in serum most likely occur in 0.5%–3% specimens. 37
How to determine heterophilic antibody interference?
Another way to investigate heterophilic antibody interference is serial dilution of a specimen. If serial dilution produces a non-linear result, it indicates interference in the assay.
Why do heterophilic antibodies arise?
Heterophilic antibodies may arise in a patient in response to exposure to certain animals or animal products or due to infection by bacterial or viral agents, or non-specifically.
What are the two interferences in immunoassays?
Two well-known interferences in immunoassay methods are heterophile antibodies and hook effect . Heterophile antibodies present in the specimen bind to antibodies in the assay creating pseudo-complex formation in the absence of analyte, i.e., false positivity. Alternatively, heterophile antibodies may block interaction causing falsely negative results. These are nearly impossible to detect, but are assay specific [87].
Which antibodies interact poorly and nonspecifically with the assay?
Heterophilic antibodies that interact poorly and nonspecifically with the assay antibodies.
Are heterophile antibodies IgG or IgM?
Heterophile antibodies are IgM antibodies, which agglutinate erythrocytes from different species including bovine, camel, horse, goat, and sheep.
Are heterophile antibodies IgM?
Heterophile antibodies are IgM antibodies with affinity for sheep and horse red blood cells. They appear during the first week of infectious mononucleosis symptoms, 3–4 weeks after infection and return to undetectable levels 3 to 6 months after infection.
Is heterophile antibody?
Heterophile antibodies are antibodies produced against poorly defined antigens. These are generally weak antibodies with multispecific activities. Human anti-animal antibodies that develop as a result of treatments with animal immunoglobulins are antibodies with strong avidities, produced against well-defined antigens.
What is heterophile antibody in EBV?
The heterophile antibody is an immunoglobulin M (IgM) antibody produced by infected B lymphocytes . It is not directed against Epstein-Barr virus (EBV) or EBV-infected cells, but it is a result of the infection and the subsequent transformation of the B cell to a plasmacytoid state.
What is Heterophilic antibody interference?
Heterophile antibodies are endogenous antibodies in human serum/plasma that may interfere with immunoassays resulting in false elevation, or rarely false depression of measured values .
What do heterophile antibodies indicate?
A positive test means heterophile antibodies are present. These are most often a sign of mononucleosis. Your provider will also consider other blood test results and your symptoms.
What is heterophile agglutination test?
The test is usually performed using commercially available test kits which detect the reaction of heterophile antibodies in a person’s blood sample with horse or cow red blood cell antigens. These test kits work on the principles of latex agglutination or immunochromatography.
When do heterophile antibodies show up in a patient with mononucleosis?from clevelandheartlab.com
Clinical Significance: Heterophile antibodies, in patients with infectious mononucleosis, may be present as early as the fourth day of illness, and by the twenty-first day of illness, 90% of patients will exhibit a positive test. The Epstein-Barr virus causes infectious mononucleosis.
What is the significance of a heterophile mono screen?from testdirectory.questdiagnostics.com
Heterophile, Mono Screen (REFL) - Heterophile antibodies, in patients with infectious mononucleosis, may be present as early as the fourth day of illness, and by the twenty-first day of illness, 90% of patients will exhibit a positive test. The Epstein-Barr virus causes infectious mononucleosis.
What is heterophile antibody?
Heterophile antibodies are of particular importance in clinical medicine for their use in detecting Epstein-Barr Virus (the causative agent of infectious mononucleosis). EBV infection induces the production of several antibody classes, of which heterophile antibodies are one (others include anti-i, rheumatoid factor and ANA). Heterophile antibodies are IgM antibodies with affinity for sheep and horse red blood cells. They appear during the first week of infectious mononucleosis symptoms, 3–4 weeks after infection and return to undetectable levels 3 to 6 months after infection.
What is heterophilia in medicine?
Jump to navigation Jump to search. For the paraphilia, see Heterophilia. Heterophile antibodies are antibodies induced by external antigens ( heterophile antigens ). Some cross-react with self-antigens. For example, in rheumatic fever, antibodies against group A streptococcal cell walls can also react with (and thus damage) human heart tissues.
How to block heterophile antibody interference?
Blocking heterophile antibody interference can be achieved by removal of immunoglobulins from a sample (such as with PEG), by modifying antibodies which may be present in a sample or by using buffers to reduce interference .
When do heterophile antibodies appear?
They appear during the first week of infectious mononucleosis symptoms, 3–4 weeks after infection and return to undetectable levels 3 to 6 months after infection.
Does heterophile antibody interference change linearly?
Heterophile antibody interference usually doesn't change linearly with serial dilution, but a true result most often will. This is one strategy for heterophile antibody detection. However, there are cases where heterophilic antibodies will give a linear response to dilutions, as well as immunoassays that do not change linearly upon dilution, meaning that the method is not fool-proof.
Can heterophile antibodies give false positives?
Heterophile antibodies may thus give false positives (by bridging the capture and signal antibody) or false negatives (by blocking one or the other). Both detecting and deterring this interference is difficult in clinical medicine. One option is to repeat the test using a different type of assay.
Can heterophile antibodies cause interference?
Heterophile antibodies can cause significant interference in any immunoassay. The presence of a heterophile antibody is characterized by broad reactivity with antibodies of other animal species (which are often the source of the assay antibodies). Such antibodies are commonly referred to as human anti-animal antibodies (HAAA). Human anti-mouse antibodies (HAMA) belong to this category. They can create both false positive and false negative results.
How long does it take for a patient to be heterophile negative?
Patients who remain heterophile negative after 6 weeks with a mononucleosis illness should be considered as having heterophile-negative infectious mononucleosis.
What is the basis of the monospot test?
Agglutination of horse RBCs on exposure to heterophile antibodies is the basis of the Monospot test. Heterophile antibodies. Since heterophile antibodies typically return quicker than EBV specific antibodies, it is the test of choice in most clinical settings to determine if an individual has infectious mononucleosis.
What is the Epstein-Barr virus?
Epstein-Barr virus (EBV) infection induces specific antibodies to EBV and various unrelated non-EBV heterophile antibodies. These heterophile antibodies react to antigens from animal RBCs. Sheep RBCs agglutinate in the presence of heterophile antibodies and are the basis for the Paul-Bunnell test.
Why can't you culture throat for streptococci?
Patients with suspected infectious mononucleosis should not have their throats cultured for group A streptococci because the carriage rate is approximately 30% in these patients. The rapid streptococcal test cannot be used to differentiate colonization from infection either. In such patients, a Gram stain of the oropharynx is used to differentiate patients who have pharyngitis with positive cultures for group A streptococci from those colonized with group A streptococci. Patients with EBV infectious mononucleosis or other causes of viral pharyngitis and group A streptococcal colonization have little or no white cell response on the Gram stain of the pharynx. Patients with group A streptococcal pharyngitis, in contrast to the patients with colonization, show an intense polymorphonuclear cellular response with cellular debris and fibrous fragments indicating acute infection.
Can EBV be tested for mononucleosis?
These may be considered in patients with suspected infectious mononucleosis who have a negative heterophile test. Specific EBV testing should be obtained in those with prolonged illness or patients who do not fit the classic al diagnostic criteria. IgM and IgG antibodies directed against viral capsid antigen has high sensitivity and specificity. [ 32]
Can a monospot test be negative?
Studies have shown that the Monospot test can lead to false negative and false positive results. One must consider that the heterophile antibody test results may be negative early in the course of EBV infectious mononucleosis. Positivity increases during the first 6 weeks of the illness.
Can you biopsy a lymph node for EBV?
Rarely, if ever, is a bone marrow biopsy or lymph node biopsy needed in patients with EBV infectious mononucleosis. In the diagnosis of EBV infectious mononucleosis, the assessment of lymph node enlargement can be made confidently based on specific EBV antibody testing, and surgery is almost never necessary.
