Challenging the use of the lymphocyte to white cell count ratio in the diagnosis of infectious mononucleosis by analysis

Challenging the use of the lymphocyte to white cell count ratio in the diagnosis of infectious mononucleosis by analysis of a large cohort of monospot test results

Lennon, P.,* O’ Neill, J.P.,* Fenton, J.E.€ & O’ Dwyer, T.*

*Department of Otolaryngology, Head and Neck Surgery, Mater Misericordiae University Hospital, Dublin, Ireland, and University of Limerick, Limerick, Ireland

Objective: We investigated the hypothesis that a lymphocyte ⁄ white cell count ratio should be used as a diagnostic indicator of infectious mononucleosis. Design: Retrospective study to compare lymphocyte counts and white blood cell counts, against the criterion standard, the mononucleosis spot test.

Setting: Department of Otolaryngology, Mater Misericordiae University Hospital, Dublin, Ireland. Participants: We reviewed 1000 patients who had Monospot assays, 500 positive and 500 negative.

Main outcome measures: The lymphocyte counts and white blood cell ratio was calculated and compared with the monospot result to calculate the sensitivity and speci?city at various ratios.

Results: The lymphocyte counts and white blood cell ratio was signi?cantly different in the positive and negative monospot groups (P < 0.05). The mean lymphocyte counts and white blood cell ratio in the positive group was 0.49 and the mean lymphocyte to white cell count ratio in the monospot negative group was 0.29.A ratio of 0.35 had a speci?city of 72% and a sensitivity of 84% for the detection of glandular fever.

A higher ratio will give a greater speci?city, but a lower sensitivity, and vice versa.

Conclusions: The mean lymphocyte to white cell count ratio is not suf?cient to diagnose or exclude infectious mononucleosis. Thus, this study does not con?rm the conclusions of earlier studies.

References

1 Pfeiffer E. (1889) Glandular Fever. Yearbook of Pediatrics and Physical Education. Vol. 29. Books of S. Karger, Vienna, 257–264

2Sprunt T.P. & Evans F.A. (1920) Mononucleosis leukocytosis in reaction to acute infections (infectious mononucleosis). Bull. Johns Hopkins Hosp. 31, 410

3Davidsohn I. (1937) Serologic diagnosis of infectious mononucleosis. JAMA 108, 289–295

4Henle G., Henle W. & Diehl V. (1968) Relation of Burkitt’s tumor-associated herpes-type virus to infectious mononucleosis. Proc. Natl. Acad. Sci. U S A 59, 94–101

5Ebell M.H. (2004) Epstein-Barr virus infectious mononucleosis. Am. Fam. Physician 70, 1279–1287

6Hoagland R.J. (1975) Infectious mononucleosis. Prim. Care 2, 295–307

7NHS Clinical Knowledge on Glandular fever. URL http:// www.cks.nhs.uk/glandular_fever/view_whole_topic. Accessed 22nd February 2010

8Wolf D.M., Friedrichs I. & Toma A.G. (2007) Lymphocyte-white blood cell count ratio: a quickly available screening tool to differentiate acute purulent tonsillitis from glandular fever. Arch. Otolaryngol. Head Neck Surg. 133, 61–64

9Clearview IM product information, http://www.cliawaived.com/ web/items/pdf/INV-92401_Clearview_Mono_Plus_II_Test_Insert

?467?le1.pdf, accessed 6th February 2010

10Aghenta A., Osowo A. & Thomas J. (2008) Symptomatic atrial ?brillation with infectious mononucleosis. Can. Fam. Physician 54, 695–696

11Bruu A.L., Hjetland R., Holter E. et al. (2000) Evaluation of 12 commercial tests for detection of Epstein-Barr virus-speci?c and heterophile antibodies. Clin. Diagn. Lab. Immunol. 7, 451–456

12Hoagland R.J. (1960) Diagnosis of infectious mononucleosis. Blood 16, 1045–1047

13Komaroff A.L., Pass T.M., Aronson M.D. et al. (1986) The prediction of streptococcal pharyngitis in adults. J. Gen. Intern. Med. 1, 1–7

14HES data for2002–2003. HospitalEpisodeStatisticsWebsite URL http://www.hesonline.nhs.uk/Ease/servlet/AttachmentRetriever? site_id=1937&?le_name=d:\efm?les\1937\Accessing\DataTables\

Diagnosis\3%20character\Diagnosis3_0203.pdf&short_name= Diagnosis3_0203.pdf&u_id=5664 (accessed on 11 February 2010)

15Johnsen T. (1981) Infectious mononucleosis and peritonsillar abscess. J. Laryngol. Otol. 95, 873–876

16Johnsen T., Katholm M. & Stangerup S.E. (1984) Otolaryngo-logical complications in infectious mononucleosis. J. Laryngol. Otol. 98, 999–1001

17Arkkila E., Sipila J., Laurikainen E. et al. (1998) Peritonsillar abscess associated with infectious mononucleosis. ORL J. Otorhinolaryngol. Relat. Spec. 60, 159–163

18McSherry J.A. (1982) Recurrent infectious mononucleosis. Can. Med. Assoc. J. 126, 899

19Paterson J.K. & Pinniger J.L. (1955) A case of recurrent infectious mononucleosis. Br. Med. J. 2, 476

20White P.D., Thomas J.M., Amess J. et al. (1998) Incidence, risk and prognosis of acute and chronic fatigue syndromes and psychiatric disorders after glandular fever. Br. J. Psychiatry 173, 475–481

21Spelman D.W. & Newton-John H.F. (1982) Metronidazole in the treatment of anginose infectious mononucleosis. Scand. J. Infect. Dis. 14, 99–101

22Davidson S., Kaplinsky C., Frand M. et al. (1982) Treatment of infectious mononucleosis with metronidazole in the pediatric age group. Scand. J. Infect. Dis. 14, 103–104

23Dalmau D., Travieso F., Sanchez C. et al. (1990) [Metronidazole and angina caused by infectious mononucleosis]. Enferm. Infecc. Microbiol. Clin. 8, 411–413

24Stevenson D.S., Webster G. & Stewart I.A. (1992) Acute tonsillectomy in the management of infectious mononucleosis.

J. Laryngol. Otol. 106, 989–991

25Chan S.C. & Dawes P.J. (2001) The management of severe infectious mononucleosis tonsillitis and upper airway obstruction.

J. Laryngol. Otol. 115, 973–977

26Daniels V.G., Wheater P.R. & Burkitt G.H. (1979) Functional Histology: A Text and Colour Atlas. Churchill Livingstone, Edinburgh