medigraphic.com
Anales de Otorrinolaringología Mexicana

2013, Number 1

<< Back Next >>

Otorrinolaringología 2013; 58 (1)

Non-serologic approximation for an early diagnosis of infectious mononucleosis by mean of clinic, analytic and cytologic orientation

García CFJ, Bécares MC, Escorihuela GV, Pla GI, Monzó GR, Jiménez MA

Language: Spanish
References: 21
Page: 26-34
PDF size: 401.77 Kb.


ABSTRACT

Background Infectious mononucleosis is a systemic viral disease with ENT findings that frequently shows atypic lymphocytes in peripheral blood. Combination of these features could make easy an early diagnostic even previous to specific serologic exams, which results can be not available on days or weeks.
Objective To attribute to findings of physical exploration and basic analysis the capacity to diagnose infectious mononucleosis even before its definitive serological typification.
Patients and methods A seven years retrospective evaluation was developed on outpatients consulting for sore throat or tonsillitis at two hospitals, one of primary assistance, and other one of tertiary level. Considering antibodies titles for Epstein-Barr virus (EBV) and cytomegalovirus (CMV) as definitive, there were created associations among clinic criteria and biochemical, hematologic o cytologic findings. The aim was to obtain a rapid detection profile of the disease with high accuracy.
Results One hundred and thirteen cases with infectious mononucleosis were identified on 442 studied. The association of clinic findings (tonsillitis, lymphadenopathies, fever and systemic discomfort) with the detection of a lymphocyte average higher than 55%, atypic cells higher than 6%, platelets lower than 50,000/mm3, elevation of transaminases, heterophils antibodies or concomitant presence of increase in AST, ALT and atypic lymphocytes showed sensibility rates of 55, 79, 32, 78, 86 and 93%, respectively. The specificity rates were 85, 87, 51, 97, 85 and 96%, respectively. With a diagnostic efficiency of 96% for EBV specific serology, this rate was 95% for the combination of clinic findings and increase on transaminases and atypic lymphocytes, and 93% for clinic and transaminases elevation only. Association of clinic and heterophils antibodies was similar to detection of atypic lymphocytes, over 85%.
Conclusion Diagnostic reliability of association of ENT signs and symptoms with an increase of AST and ALT and the presence of atypic lymphocytes in peripheral blood did not show differences in EVB serology for infectious mononucleosis, concluding that it is a high validity proof for an early diagnose of the infection.


REFERENCES

  1. González-Saldaña N, Monroy-Colín VA, Piña-Ruiz G, Juárez-Olguín H. Clinical and laboratory characteristics of infectious mononucleosis by Epstein-Barr virus in Mexican children. BMC Res Notes 2012;5:361-368.

  2. Fica A. Síndrome de mononucleosis infecciosa en pacientes adolescentes y adultos. Rev Chilena Infectol 2003;20:235-242.

  3. Luzuriaga K, Sullivan JL. Infectious mononucleosis. N Engl J Med 2010;362:1993-2000.

  4. Ebell MH. Epstein-Barr virus infectious mononucleosis. Am Fam Physician 2004;70:1279-1287.

  5. Guglielmo MC, Dangelo S, Osorio MP. Mononucleosis infecciosa. Arch Argent Pediatr 2011;109:88-90.

  6. González de Buitrago JM. Contadores automáticos para hematología. En: González de Buitrago JM, editor. Tecnología y métodos de laboratorio. Barcelona: Salvat, 1990;89-103.

  7. Hoagland RJ. The clinical manifestations of infectious mononucleosis: a report of two hundred cases. Am J Med Sci 1960;240:55-63.

  8. Stiki-Green DL, Edwards RH, Covington MM, Raab- Traub N. Biology of Epstein-Barr virus during infectious mononucleosis. J Infect Dis 2004;189:483-492.

  9. Al Tabaa Y, Tuaillon E, Jeziorski E, Ouedraogo DE, et al. B-cell polyclonal activation and Epstein-Barr viral abortive lytic cycle are two key features in acute infectious mononucleosis. J Clin Virol 2011;52:33-37.

  10. Biggs TC. Use of the absolute lymphocyte count in the diagnosis of infectious mononucleosis. Clin Otolaryngol 2011;36:515-516.

  11. Hadinoto V, Shapiro M, Greenough TC, Sullivan JL, et al. On the dynamics of acute EBV infection and the pathogenesis of infectious mononucleosis. Blood 2008;111:1420-1427.

  12. Michelow P, Wright C, Pantanowitz L. A review of the cytomorphology of Epstein-Barr virus-associated malignancies. Acta Cytologica 2012;56:1-14.

  13. Thorley-Lawson DA, Gross A. Persistence of the Epstein-Barr virus and the origins of associated lymphomas. N Engl J Med 2004;350:1328-1337.

  14. Vouloumanou EK, Rafailidis PI, Falagas ME. Current diagnosis and management of infectious mononucleosis. Curr Opin Hematol 2012;19:14-20.

  15. Paul JR, Bunnell WW. Classics in infectious diseases. The presence of heterophile antibodies in infectious mononucleosis. Am J Med Sci 1932;Rev Infec Dis 1982;4:1062-1068.

  16. Llor C, Hernández M, Hernández S, Martínez T, Gómez FF. Validity of a point of care based on heterophile anti body detection for the diagnosis of infectious mononucleosis in primary care. Eur J Gen Pract 2012;18:15-21.

  17. Javier-Zepeda CA. Mononucleosis infecciosa y síndromes similares. Rev Med Hond 1999;67:248-257.

  18. Katz BZ, Stewart JM, Shiraishi Y, Mears CJ, Taylor R. Autonomic symptoms at baseline and following infectious mononucleosis in a prospective cohort of adolescents. Arch Pediatr Adolesc Med 2011;165:765- 766.

  19. Mahmud I, Abdel-Mannan OA, Wotton CJ, Goldacre MJ. Maternal and perinatal factors associated with hospitalised infectious mononucleosis in children, adolescents and young adults: record linkage study. BMC Infect Dis 2011;11:51.

  20. Lennon P, O’Neill JP, Fenton JE, O’Dwyer T. 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. Clin Otolaryngol 2010;35:397-401.

  21. Okano M, Gross TG. Acute or chronic life-threatening diseases associated with Epstein-Barr virus infection. Am J Med Sci 2012;343:483-439.




2020     |     www.medigraphic.com