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Use of the lymphocyte count as a diagnostic screen in adults with suspected Epstein-Barr virus infectious mononucleosis

Use of the lymphocyte count as a diagnostic screen in adults with suspected Epstein-Barr virus infectious mononucleosis
Use of the lymphocyte count as a diagnostic screen in adults with suspected Epstein-Barr virus infectious mononucleosis
Objective: To evaluate the predictive diagnostic accuracy of the lymphocyte count in Epstein-Barr Virus (EBV)-related infectious mononucleosis (IM).

Study Design: Retrospective case note and blood results review within a University-affiliated teaching hospital.

Method: A retrospective review of 726 patients undergoing full blood count and Monospot testing was undertaken. Monospot testing outcomes were compared with the lymphocyte count examining for significant statistical correlations.

Results: With a lymphocyte count of ?4 x 109/L, 99% of patients had an associated negative Monospot result (sensitivity of 84% and specificity of 94%). A group sub-analysis of the over 18s population with a lymphocyte count ?4 x 109/L revealed that 100% were Monospot negative (sensitivity of 100% and specificity of 97%). A lymphocyte count of ?4 x 109/L correlated significantly with a negative Monospot result.

Conclusion: A lymphocyte count of ?4 x 109/L appears to be a highly reliable predictor of a negative Monospot result, particularly in the over 18s population. Paediatric patients, and adults with strongly suggestive symptoms and signs of IM, should still undergo Monospot testing. However in adults with more subtle symptoms and signs, representing the vast majority, Monospot testing should be restricted to those with a lymphocyte count >4 x 109?L.
0023-852X
Biggs, T.
f9b3cb2c-bd3d-43ef-87f3-c6ede41142f8
Hayes, S.M.
b966466b-e52e-43f8-9cc5-ab20b3534197
Bird, J.
14330393-cdb9-4395-9ba0-ee03cab3f16b
Harries, P
5973cdaa-fb80-498b-b9af-d0f5b59ab8e0
Salib, R.J.
d6fde1c1-5b5e-43f7-ae1c-42cce6a0c9fc
Biggs, T.
f9b3cb2c-bd3d-43ef-87f3-c6ede41142f8
Hayes, S.M.
b966466b-e52e-43f8-9cc5-ab20b3534197
Bird, J.
14330393-cdb9-4395-9ba0-ee03cab3f16b
Harries, P
5973cdaa-fb80-498b-b9af-d0f5b59ab8e0
Salib, R.J.
d6fde1c1-5b5e-43f7-ae1c-42cce6a0c9fc

Biggs, T., Hayes, S.M., Bird, J., Harries, P and Salib, R.J. (2013) Use of the lymphocyte count as a diagnostic screen in adults with suspected Epstein-Barr virus infectious mononucleosis. The Laryngoscope. (In Press)

Record type: Article

Abstract

Objective: To evaluate the predictive diagnostic accuracy of the lymphocyte count in Epstein-Barr Virus (EBV)-related infectious mononucleosis (IM).

Study Design: Retrospective case note and blood results review within a University-affiliated teaching hospital.

Method: A retrospective review of 726 patients undergoing full blood count and Monospot testing was undertaken. Monospot testing outcomes were compared with the lymphocyte count examining for significant statistical correlations.

Results: With a lymphocyte count of ?4 x 109/L, 99% of patients had an associated negative Monospot result (sensitivity of 84% and specificity of 94%). A group sub-analysis of the over 18s population with a lymphocyte count ?4 x 109/L revealed that 100% were Monospot negative (sensitivity of 100% and specificity of 97%). A lymphocyte count of ?4 x 109/L correlated significantly with a negative Monospot result.

Conclusion: A lymphocyte count of ?4 x 109/L appears to be a highly reliable predictor of a negative Monospot result, particularly in the over 18s population. Paediatric patients, and adults with strongly suggestive symptoms and signs of IM, should still undergo Monospot testing. However in adults with more subtle symptoms and signs, representing the vast majority, Monospot testing should be restricted to those with a lymphocyte count >4 x 109?L.

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Accepted/In Press date: 2013
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 346984
URI: https://eprints.soton.ac.uk/id/eprint/346984
ISSN: 0023-852X
PURE UUID: 89d57ce8-ccb6-49ae-a921-8a28c2350a9c
ORCID for R.J. Salib: ORCID iD orcid.org/0000-0002-6753-7844

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Date deposited: 17 Jan 2013 14:55
Last modified: 06 Jun 2018 12:47

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Contributors

Author: T. Biggs
Author: S.M. Hayes
Author: J. Bird
Author: P Harries
Author: R.J. Salib ORCID iD

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