Lymphocyte or White Blood Cell Count Ratio
A common blood test that measures a patient's ratio of white blood cell types can help doctors distinguish between tonsillitis and mononucleosis and provide appropriate treatment, British researchers say.
Tonsillitis and mononucleosis are common conditions with similar symptoms, including sore throat, fever, painful swallowing, redness of the throat and tonsils, and white plaque on the tonsils, according to background information in the study.
"The importance of differentiating patients with tonsillitis from those with glandular fever (mononucleosis) is the prevention of spontaneous rupture of the spleen and acute intra-abdominal hemorrhage," both of which are potential complications of mononucleosis, the researchers wrote.
Infectious mononucleosis (also known in North America as mono, the kissing disease, or Pfeiffer's disease, and more commonly known as glandular fever in other English-speaking countries) is a disease seen most commonly in adolescents and young adults.Infectious mononucleosis (often called simply "mono") is a common viral infection that causes fever, sore throat, and enlarged lymph nodes. By adulthood, 90-95% of men and women have been infected. Mono usually occurs in people aged 15-25 years. Mono is highly contagious. Not surprisingly, 1-3% of college students contract mono each year. Infection spreads through exposure to body fluids containing the virus. It is most often transmitted via saliva (hence the name "kissing disease"). However, mono can also be spread through blood and genital secretions.
Currently, an expensive mononucleosis spot test is required to differentiate between the two conditions.Mononucleosis spot test detects the presence of heterophile antibodies . Heterophile antibodies are antibodies that non-specifically react against different proteins and are useful in the diagnosis of infectious mononucleosis.This test may take up to 24 hours to perform.
In this study, the researchers analyzed laboratory test results from 100 patients with bacterial tonsillitis and 120 patients with infectious mononucleosis. They looked at the number of lymphocytes (a type of white blood cell involved in immune response) and overall white blood cell count, and found the lymphocyte/white blood cell count ratio averaged 0.54 in the mononucleosis patients and 0.10 in tonsillitis patients.
The study authors concluded that people with a ratio of higher than 0.35 would be correctly diagnosed with mononucleosis 90 percent of the time and people with a ratio of 0.35 or lower would be correctly diagnosed as not having mononucleosis 100 percent of the time.
"In conclusion, we recommend that the lymphocyte-white blood cell count ratio should be used as an indicator to decide whether mononucleosis spot / monospot / heterophile antibody tests are required," the study authors wrote. "Results from our retrospective pilot study suggest that the lymphocyte-white blood cell count ratio could be quickly available alternative test for the detection of glandular fever (mononucleosis)."