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Diagnosis of atypical cases of infectious mononucleosis
Abstract:
The variable manifestations of infectious mononucleosis rarely cause clinicians to suspect primary Epstein-Barr virus or cytomegalovirus infection; consequently, costly diagnostic tests and unnecessary treatments are undertaken. Seventeen cases of clinically atypical and 11 cases of clinically typical infectious mononucleosis were diagnosed through screening for atypical and apoptotic lymphocytes in the peripheral blood samples by means of an automated hematologic analyzer. Atypical and typical cases did not differ significantly with respect to peripheral white blood cell counts; percentages of lymphocytes, atypical lymphocytes, CD4(+) lymphocytes, human leukocyte antigen--DR positivity in CD3 lymphocytes, or apoptotic cells in blood smear after incubation; or levels of aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase. Only the percentage of CD8(+) lymphocytes was significantly higher in patients with typical infectious mononucleosis than it was in patients with atypical infectious mononucleosis. Because certain atypical cases of infectious mononucleosis display laboratory abnormalities that are characteristic of typical infectious mononucleosis, enhanced awareness can help in the diagnosis.
Insights
Diagnosing infectious mononucleosis can be challenging due to varied symptoms. Screening for atypical lymphocytes in blood samples aids in identifying both typical and atypical Epstein-Barr virus cases.
Area of Science:
- Hematology
- Infectious Diseases
- Immunology
Background:
- Infectious mononucleosis, often caused by Epstein-Barr virus (EBV), presents with variable clinical manifestations.
- Clinicians may not suspect primary EBV or cytomegalovirus (CMV) infection due to atypical presentations, leading to delayed diagnosis and inappropriate testing.
- Atypical presentations of infectious mononucleosis can mimic other conditions, complicating clinical suspicion and diagnosis.
Purpose of the Study:
- To investigate the utility of screening peripheral blood for atypical and apoptotic lymphocytes in diagnosing infectious mononucleosis.
- To compare laboratory findings between clinically typical and atypical infectious mononucleosis cases.
- To enhance diagnostic strategies for infectious mononucleosis, particularly in cases with non-standard presentations.
Main Methods:
- Peripheral blood samples from patients with clinically typical and atypical infectious mononucleosis were analyzed.
- Automated hematologic analyzers were used to screen for atypical and apoptotic lymphocytes.
- Key laboratory parameters including white blood cell counts, lymphocyte subsets (CD4+, CD8+), HLA-DR expression, and apoptotic cell percentages were assessed.
- Liver function tests (AST, ALT, LDH) were also evaluated.
Main Results:
- No significant differences were observed between typical and atypical cases in white blood cell counts, lymphocyte percentages, CD4+ counts, HLA-DR positivity, apoptotic cells, or liver enzymes.
- A significantly higher percentage of CD8+ lymphocytes was found in patients with typical infectious mononucleosis compared to those with atypical presentations.
- Some atypical cases exhibited laboratory abnormalities characteristic of typical infectious mononucleosis.
Conclusions:
- Screening for atypical lymphocytes in peripheral blood can aid in the diagnosis of infectious mononucleosis, including atypical presentations.
- The percentage of CD8+ lymphocytes may serve as a distinguishing marker between typical and atypical infectious mononucleosis.
- Increased clinical awareness of variable presentations and targeted laboratory screening can improve the diagnosis of Epstein-Barr virus infections.