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Common blood test can help distinguish between mononucleosis and tonsillitis

Measuring a patient's ratio of white blood cell types may help physicians accurately distinguish between the similar conditions infectious mononucleosis and bacterial tonsillitis, potentially guiding treatment decisions, according to an article in the January issue of Archives of Otolaryngology–Head & Neck Surgery, one of the JAMA/Archives journals.

Acute tonsillitis (inflammation of the tonsils) and infectious mononucleosis (caused by the Epstein-Barr virus) are both common ear, nose and throat conditions with similar symptoms, according to background information in the article. These symptoms include sore throat, fever, painful swallowing, white plaque on the tonsils and redness of the throat and tonsils. "The importance in differentiating patients with tonsillitis from those with glandular fever [mononucleosis] is the prevention of spontaneous rupture of the spleen and acute intra-abdominal hemorrhage," potential complications of mononucleosis, the authors write. Currently, distinguishing between them requires an expensive mononucleosis spot test.

Dennis M. Wolf, B.Sc., D.O.-H.N.S., M.R.C.S., and colleagues at St. George's Hospital, London, retrospectively analyzed laboratory tests from 120 patients with infectious mononucleosis and 100 patients with bacterial tonsillitis treated at their facility. All patients were given the spot test for mononucleosis and additional blood tests were performed to determine the number of lymphocytes (a particular type of white blood cell involved in the body's immune response) and overall white blood cell count.

Total white blood cell count was significantly increased in the tonsillitis group compared with the mononucleosis group (16,560 cells per microliter vs. 11,400 cells per microliter), but the lymphocyte count was higher in the mononucleosis group (6,490 cells per microliter vs. 1,590 cells per microliter). The ratio of lymphocyte/white blood cell count ratio averaged .54 in the mononucl
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Source:JAMA and Archives Journals


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