Comparative evaluation of eight commercial tests for the diagnosis of infectious mononucleosis by Epstein-Barr virus-specific or -non specific serology

Eight commercially-available tests were compared for the diagnosis of Epstein-Barr virus (EBV)-associated infectious mononucleosis (IM). They consisted in four slide agglutination assays (one of them using horse erythrocytes and three of them latex beads coated with purified bovine erythrocyte antigen), in a classical Paul-Bunnell-Davidsohn (PBD) tube-test using sheep erythrocytes, and in three assays intended to detect EBV-specific IgM antibodies either by indirect immunofluourescence (one test) or by ELISA (two tests). Sixty serum specimens from patients with symptoms compatible with IM were selected on the following criteria: presence of EBV-specific IgM by at least 2 of the 3 specific assays and absence or very low titres (≤5) of antibodies to EBV nuclear antigen (EBNA). Using this panel of positive samples, the sensitivity of the 8 assays ranged from 55 to 100%. The EBV-specific IgM tests exhibited the higher sensitivities, especially the one using a combination of peptides directed to different viral antigens. Whereas the PBD tuve test was shown to be time-consuming and insensitive, even in young adults, the slide agglutination tests were easy to perform and exhibited sensitivities ranging from 70 to 80%. The latter tests represent a good alternative to EBV-specific serology for the rapid diagnosis of IM; however, in case of negativity, an EBV specific testing must be done, especially in children under 5 years.