PMID- 10975931
OWN - NLM
STAT- MEDLINE
DCOM- 20001003
LR  - 20210527
IS  - 0003-9985 (Print)
IS  - 0003-9985 (Linking)
VI  - 124
IP  - 9
DP  - 2000 Sep
TI  - Proportion positive for Epstein-Barr virus, cytomegalovirus, human herpesvirus 6, 
      Toxoplasma, and human immunodeficiency virus types 1 and 2 in 
      heterophile-negative patients with an absolute lymphocytosis or an 
      instrument-generated atypical lymphocyte flag.
PG  - 1324-30
AB  - OBJECTIVES: To determine the proportion of patients with evidence of an acute 
      infection due to Epstein-Barr virus (EBV), cytomegalovirus (CMV), human 
      herpesvirus 6 (HHV-6), Toxoplasma, or human immunodeficiency virus types 1 and 2 
      (HIV-1 and HIV-2) in heterophile-negative patients with an absolute lymphocytosis 
      or an instrument-generated atypical lymphocyte flag, and to develop a 
      cost-effective testing algorithm for managing such heterophile-negative patients. 
      DESIGN: We conducted a prospective investigation of 70 selected outpatients who 
      tested negative for heterophile antibody in association with an absolute 
      lymphocytosis or instrument-generated atypical lymphocyte flag. The control 
      population consisted of 50 patients who were heterophile negative and had a 
      normal absolute lymphocyte count and no instrument-generated atypical lymphocyte 
      flag. SETTING: A large outpatient laboratory system. INTERVENTION: Viral serology 
      for HHV-6 was performed by immunofluorescence, and all other serologies were 
      performed by enzyme-linked immunoassay. All testing was for immunoglobulin (Ig) M 
      antibodies, except in the case of HIV. RESULTS: The proportion of study patients 
      positive for EBV was 40% (28/70); for CMV, 39% (27/70); for HHV-6, 25% (16/65); 
      for Toxoplasma, 3% (2/70); and for HIV, 0% (0/70). All 50 control patients were 
      negative for EBV IgM antibodies. When patients with more than 1 positive viral 
      test were excluded from analysis, positivity was 20% (9/45) for EBV, 22% (10/45) 
      for CMV, 9% (4/45) for HHV-6, and 2% (1/45) for Toxoplasma. Utilizing 
      hypothesis-generating logistic regression models, Downey type II atypical 
      lymphocytes were significantly associated with EBV positivity (P =.006), while 
      Downey type III lymphocytes were significantly associated with HHV-6 positivity 
      (P =.016), and there was a trend for the association of Downey type I lymphocytes 
      with CMV positivity (P =.097). CONCLUSIONS: A positive viral serology was 
      identified in 70% of study patients. Multiple positive serologies complicate 
      establishing a definitive diagnosis. Potential cost savings may be associated 
      with the use of an appropriate testing algorithm.
FAU - Tsaparas, Y F
AU  - Tsaparas YF
AD  - University of Calgary Medical School, Calgary, Alberta, Canada.
FAU - Brigden, M L
AU  - Brigden ML
FAU - Mathias, R
AU  - Mathias R
FAU - Thomas, E
AU  - Thomas E
FAU - Raboud, J
AU  - Raboud J
FAU - Doyle, P W
AU  - Doyle PW
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Arch Pathol Lab Med
JT  - Archives of pathology & laboratory medicine
JID - 7607091
RN  - 0 (Antibodies, Heterophile)
RN  - 0 (Antibodies, Viral)
RN  - 0 (Immunoglobulin M)
SB  - IM
CIN - Arch Pathol Lab Med. 2001 Jul;125(7):858-9. PMID: 11419967
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Algorithms
MH  - Animals
MH  - Antibodies, Heterophile/*blood
MH  - Antibodies, Viral/*blood
MH  - Child
MH  - Child, Preschool
MH  - Cost Control
MH  - Cytomegalovirus/immunology
MH  - Female
MH  - HIV-1/immunology
MH  - HIV-2/immunology
MH  - Herpesvirus 4, Human/immunology
MH  - Herpesvirus 6, Human/immunology
MH  - Humans
MH  - Immunoglobulin M/blood
MH  - Infant
MH  - Linear Models
MH  - Lymphocytes/pathology
MH  - Lymphocytosis/*virology
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Toxoplasma/immunology
MH  - Virus Diseases/*diagnosis
EDAT- 2000/09/07 11:00
MHDA- 2000/10/07 11:01
CRDT- 2000/09/07 11:00
PHST- 2000/09/07 11:00 [pubmed]
PHST- 2000/10/07 11:01 [medline]
PHST- 2000/09/07 11:00 [entrez]
AID - 10.5858/2000-124-1324-PPFEBV [doi]
PST - ppublish
SO  - Arch Pathol Lab Med. 2000 Sep;124(9):1324-30. doi: 10.5858/2000-124-1324-PPFEBV.