What tests, other than the heterophile antibody and Epstein-Barr serology, are useful for diagnosing infectious mononucleosis?

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EVIDENCE-BASED ANSWERIn adolescents and young adults presenting with sore throat, a white blood cell (WBC) count with more than 50% lymphocytes and at least 10% atypical lymphocytes is useful for ruling in infectious mononucleosis, with a positive likelihood ratio of 54, although a negative test is not useful for ruling out mono (SOR: A, meta-analysis of diagnostic cohort studies and laboratory-based studies). Helpful tests for ruling out infectious mononucleosis include a lymphocyte count of less than 4 × 109/L (SOR: B, systematic review with a single retrospective cohort trial) and a negative polymerase chain reaction (PCR) for Epstein-Barr virus (EBV) DNA (SOR: A, meta-analysis of diagnostic cohort studies), both with negative likelihood ratios of 0.2. Point-of-care heterophile antibody tests show potential for both ruling in and ruling out infectious mononucleosis (SOR: C, small diagnostic cohort study).

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