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A Quickly Available Screening Tool to Differentiate Acute Purulent Tonsillitis From Glandular Fever

Dennis M. Wolf, BSc, DO-HNS, MRCS; Ilka Friedrichs, FRCS; Abbad G. Toma, FRCS(ORL)

Arch Otolaryngol Head Neck Surg. 2007;133(1):61-64.

Objective  To find a quickly available screening tool for the differentiation of patients with glandular fever from those with acute purulent tonsillitis. The null hypothesis was that there was no difference between the lymphocyte–white blood cell count (L/WCC) ratio between the 2 patient groups.

Design  Retrospective pilot study based on laboratory tests for lymphocyte counts, white blood cell counts, and the mononucleosis spot test.

Setting  Ear, Nose, and Throat Department, St George's Hospital, London, England.

Patients  One hundred twenty patients with glandular fever and 100 patients with bacterial tonsillitis.

Main Outcome Measures  Results from the mononucleosis spot test in conjunction with the clinical picture and the L/WCC ratio were analyzed. Significant differences were evaluated using the Mann-Whitney test and Fisher exact test.

Results  The L/WCC ratio was significantly different in the 2 groups (P<.001). The mean L/WCC ratio in the glandular fever group was 0.54 and the mean L/WCC ratio in the bacterial tonsillitis group was 0.10. A ratio higher than 0.35 had a specificity of 100% and a sensitivity of 90% for the detection of glandular fever.

Conclusions  We recommend that the L/WCC ratio should be used as an indicator to decide whether mononucleosis spot tests should be requested. A ratio higher than 0.35 had a high specificity in our study group.

Author Affiliations: Department of Otolaryngology, St George's Hospital, London, England.

RELATED LETTER

Differentiating Tonsillitis From Glandular Fever: Is the Lymphocyte–White Blood Cell Count Ratio Any Help?
Emma Louise Smale, Stephen Mcdonald, and Vikram Dhar
Arch Otolaryngol Head Neck Surg. 2007;133(9):952.
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THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Differentiating Tonsillitis From Glandular Fever: Is the Lymphocyte White Blood Cell Count Ratio Any Help?
Smale et al.
Arch Otolaryngol Head Neck Surg 2007;133:952-952.
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