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Donation PROMISED--monospot reliable indicator of mono?
Feb 4, 2004

I promise you a donation for answering this question.

I am beside myself with fear and an unshakeable OCD episode. In late November, I came down with a nasty mono-like syndrome--very swollen glands (so swollen I was eventually given a steroid to reduce swelling), some fever (highest 99.8 or so over course of approx. 10 days), very swollen tonsils with exudate, and fatigue. My throat pain was unbearable, I could not swallow without serious pain. I visited an ER and was told it was probably strep and given an antibiotic. The ER also administered an anti-inflammatory which significantly helped the swelling and pain in throat.

Approximately 5-7 days after being on antibiotics and very acute throat pain still present, I visited an ER out of fear of the beginnings of a rash. I had developed the beginning of a maculopapular type rash on shoulders and chest. I also had a bright red "slap-face" effect on my face and my ears. The ER did a CBC and told me that I had classic mono symptoms based on the blood work and my physical exam. He advised to refrain from physical activity and expressed he did NOT believe I was having an HIV reaction (he is a doc located in a major metro area with high HIV incidence.

The rash got worse over the next few days, spreading literally from head to toe and taking on a more papular form, i.e., little red bumps appeared on arms and legs. I also had a more splotchy type rash on neck, chest and stomach. I do understand that those with mono who take amoxicillin (which I was given by one of the ERS and took for approx. 5 days)can present with a rash--that is rather common.

My GP saw me and wanted to do a monospot test to confirm the mono diagnosis. Of course, I was freaking out over HIV during this entire episode (not the first time). The monospot came back "positive" and my doc told me I had a recent mono infection. He said "it's all over." However, I recently came across the article, pasted below, and I'd like your thoughts as to its applicability to my situation.

You should also know that I was tested approximately four months ago--negative. However, my concern is over one unprotected encounter (vaginal intercourse) with a woman whom I did not know well approximately 12 weeks ago. While I did not know the lass well, she is a professional (legal field), well educated, and did seem well kept, if not downright snobbish. She also was intent on condom usage, but succumbed, as it were, due to her being under the influence of alcohol and in my car where no such device was available. We did go back to my place later that evening and engage in safe sex.

Please take a look at the article below. I am definitely going to get tested. However, based on my positive mono result, my doctor's insistence that what I had was NOT primary HIV infection, and the opinion of all of the ER docs that I had mono and NOT HIV, do you think I have experienced primary infection?

I have read from various sources that the monospot test (like just about any test) is not perfectly reliable, and in fact is only approximately 85 accurate. That sounds a bit low to me for a medical test.

Thank you, and the donation is forthcoming. You are a saint for the work you do, Robert.

Frantic in Florida

Am J Med. 2001 Aug 15; 111(3): 192-4. Related Articles, Links

Comment in: Am J Med. 2001 Aug 15;111(3):237-8.

Positive Epstein-Barr virus heterophile antibody tests in patients with primary human immunodeficiency virus infection.

Vidrih JA, Walensky RP, Sax PE, Freedberg KA.

Department of Medicine, Section of General Internal Medicine and Clinical AIDS Program, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.

PURPOSE: To describe three cases of primary human immunodeficiency virus (HIV) infection in patients who had laboratory studies consistent with infectious mononucleosis. SUBJECTS: We describe 3 patients who presented with a viral syndrome, had a positive heterophile antibody test, and were diagnosed with primary HIV infection. RESULTS: The results of Epstein-Barr virus serology studies in each of these patients were consistent with chronic, but not acute, Epstein-Barr virus infection. HIV antibody tests were negative, and HIV RNA was >500,000 copies/mL in each patient. CONCLUSIONS: Clinicians should recognize that a positive heterophile antibody test in the setting of an acute viral illness does not exclude the diagnosis of primary HIV infection, although reactivation of latent Epstein-Barr virus infection cannot be ruled out. Patients presenting with nonspecific viral syndromes should be assessed for HIV risk behaviors and tested for primary HIV infection when appropriate.

Publication Types: Case Reports

Response from Dr. Frascino

Hello Frantic in Florida,

Your symptoms, clinical course, and laboratory tests are very consistent with mononucleosis including the amoxicillin rash!

Please note the article you reference says the "Epstein-Barr virus serology studies in each of these patients were consistent with chronic, but not acute, Epstein-Barr infection." You state that your doctor told you your monospot was indicative of "a recent mono infection." Therefore your case was not at all like the ones reported in the article. Consequently, I totally agree with your doc and the ER docs, O.K.?

Are you getting treatment for your OCD? If not, it might be something to consider. Also, definitely get a box of condoms for your hot wheels, as well as your love shack! Your worries (and HIV) are easily preventable.

Thank you for your donation (www.concertedeffort.org). Your gift will touch many lives!

Stay well.

Dr. Bob



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