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
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...
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| Veröffentlicht in: | Archives of pathology & laboratory medicine (1976) 2000-09, Vol.124 (9), p.1324-1330 |
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| creator | Tsaparas, Y F Brigden, M L Mathias, R Thomas, E Raboud, J Doyle, P W |
| description | 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.
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.
A large outpatient laboratory system.
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.
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).
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. |
| doi_str_mv | 10.5858/2000-124-1324-PPFEBV |
| format | Article |
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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.
A large outpatient laboratory system.
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.
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).
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.</description><identifier>ISSN: 0003-9985</identifier><identifier>ISSN: 1543-2165</identifier><identifier>EISSN: 1543-2165</identifier><identifier>DOI: 10.5858/2000-124-1324-PPFEBV</identifier><identifier>PMID: 10975931</identifier><language>eng</language><publisher>United States: College of American Pathologists</publisher><subject>Adolescent ; Adult ; Aged ; AIDS/HIV ; Algorithms ; Animals ; Antibodies, Heterophile - blood ; Antibodies, Viral - blood ; Child ; Child, Preschool ; Cost Control ; Cytomegalovirus - immunology ; Diagnosis ; Female ; Herpesvirus 4, Human - immunology ; Herpesvirus 6, Human - immunology ; HIV-1 - immunology ; HIV-2 - immunology ; Humans ; Immunoglobulin M - blood ; Infant ; Linear Models ; Lymphocytes - pathology ; Lymphocytosis - virology ; Male ; Middle Aged ; Mononucleosis ; Prospective Studies ; Toxoplasma - immunology ; Virus Diseases - diagnosis</subject><ispartof>Archives of pathology & laboratory medicine (1976), 2000-09, Vol.124 (9), p.1324-1330</ispartof><rights>COPYRIGHT 2000 College of American Pathologists</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c435t-f0d4144ad3e1504e771a3faa5d346afa4babefcce60f5eb81cdfffa3bc5cdd013</citedby><cites>FETCH-LOGICAL-c435t-f0d4144ad3e1504e771a3faa5d346afa4babefcce60f5eb81cdfffa3bc5cdd013</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10975931$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tsaparas, Y F</creatorcontrib><creatorcontrib>Brigden, M L</creatorcontrib><creatorcontrib>Mathias, R</creatorcontrib><creatorcontrib>Thomas, E</creatorcontrib><creatorcontrib>Raboud, J</creatorcontrib><creatorcontrib>Doyle, P W</creatorcontrib><title>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</title><title>Archives of pathology & laboratory medicine (1976)</title><addtitle>Arch Pathol Lab Med</addtitle><description>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.
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.
A large outpatient laboratory system.
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.
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).
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.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>AIDS/HIV</subject><subject>Algorithms</subject><subject>Animals</subject><subject>Antibodies, Heterophile - blood</subject><subject>Antibodies, Viral - blood</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cost Control</subject><subject>Cytomegalovirus - immunology</subject><subject>Diagnosis</subject><subject>Female</subject><subject>Herpesvirus 4, Human - immunology</subject><subject>Herpesvirus 6, Human - immunology</subject><subject>HIV-1 - immunology</subject><subject>HIV-2 - immunology</subject><subject>Humans</subject><subject>Immunoglobulin M - blood</subject><subject>Infant</subject><subject>Linear Models</subject><subject>Lymphocytes - pathology</subject><subject>Lymphocytosis - virology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mononucleosis</subject><subject>Prospective Studies</subject><subject>Toxoplasma - immunology</subject><subject>Virus Diseases - diagnosis</subject><issn>0003-9985</issn><issn>1543-2165</issn><issn>1543-2165</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNptkl2L1DAUhqso7rj6D0SC4F5NtWmazvRyd5lVYcG5WL0tp-nJNJImNUlX599vOh1whCGQkMPzni_eJHlHs098zdef8yzLUpoXKWXx2m7vNjc_nycLyguW5rTkL5JFJFhaVWt-kbz2_lf8VnlOXyUXNKtWvGJ08SzZOjtYF5Q1ZLBeBfWIRFpHNoMPqEx6A86RR-VGvyRiH2yPO9D2GOjGHgzp0A3oDyFSLsmD_WsHDb6HJQHTHiHV96OxLUolFBqxn3OSsI9SQg9gTtSULGBsqVMaUxNrHRoa4oMmePJHhS6yBBpv9RiQ6H0_dHZqzCtPYt9TKeODG_soSHdo0EHAlkCspATof4o4p4bdm-SlBO3x7fG9TH7cbR5uv6b33798u72-T0XBeEhl1ha0KKBlSHlW4GpFgUkA3rKiBAlFAw1KIbDMJMdmTUUrpQTWCC7aNqPsMrma8w7O_h7Rh7pXXqDWYNCOvl7leZGxKo_ghxmMe8ZaGWmDAzHB9XXJS1aVB2h5Bpqn1dbELcfwKZ6eweNpsVfiHP_xhO8QdOgOC4828f9xxcwJZ713KOvBqR7cvqZZPbm0nlxaR5fWk0vr2aVR9v64i7HpsT0RzbZkTy7X6yQ</recordid><startdate>20000901</startdate><enddate>20000901</enddate><creator>Tsaparas, Y F</creator><creator>Brigden, M L</creator><creator>Mathias, R</creator><creator>Thomas, E</creator><creator>Raboud, J</creator><creator>Doyle, P W</creator><general>College of American Pathologists</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20000901</creationdate><title>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</title><author>Tsaparas, Y F ; Brigden, M L ; Mathias, R ; Thomas, E ; Raboud, J ; Doyle, P W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c435t-f0d4144ad3e1504e771a3faa5d346afa4babefcce60f5eb81cdfffa3bc5cdd013</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>AIDS/HIV</topic><topic>Algorithms</topic><topic>Animals</topic><topic>Antibodies, Heterophile - blood</topic><topic>Antibodies, Viral - blood</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cost Control</topic><topic>Cytomegalovirus - immunology</topic><topic>Diagnosis</topic><topic>Female</topic><topic>Herpesvirus 4, Human - immunology</topic><topic>Herpesvirus 6, Human - immunology</topic><topic>HIV-1 - immunology</topic><topic>HIV-2 - immunology</topic><topic>Humans</topic><topic>Immunoglobulin M - blood</topic><topic>Infant</topic><topic>Linear Models</topic><topic>Lymphocytes - pathology</topic><topic>Lymphocytosis - virology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mononucleosis</topic><topic>Prospective Studies</topic><topic>Toxoplasma - immunology</topic><topic>Virus Diseases - diagnosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tsaparas, Y F</creatorcontrib><creatorcontrib>Brigden, M L</creatorcontrib><creatorcontrib>Mathias, R</creatorcontrib><creatorcontrib>Thomas, E</creatorcontrib><creatorcontrib>Raboud, J</creatorcontrib><creatorcontrib>Doyle, P W</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Archives of pathology & laboratory medicine (1976)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tsaparas, Y F</au><au>Brigden, M L</au><au>Mathias, R</au><au>Thomas, E</au><au>Raboud, J</au><au>Doyle, P W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>Archives of pathology & laboratory medicine (1976)</jtitle><addtitle>Arch Pathol Lab Med</addtitle><date>2000-09-01</date><risdate>2000</risdate><volume>124</volume><issue>9</issue><spage>1324</spage><epage>1330</epage><pages>1324-1330</pages><issn>0003-9985</issn><issn>1543-2165</issn><eissn>1543-2165</eissn><abstract>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.
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.
A large outpatient laboratory system.
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.
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).
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.</abstract><cop>United States</cop><pub>College of American Pathologists</pub><pmid>10975931</pmid><doi>10.5858/2000-124-1324-PPFEBV</doi><tpages>7</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0003-9985 |
| ispartof | Archives of pathology & laboratory medicine (1976), 2000-09, Vol.124 (9), p.1324-1330 |
| issn | 0003-9985 1543-2165 1543-2165 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_72240392 |
| source | MEDLINE; Free E-Journal (出版社公開部分のみ）; Allen Press Miscellaneous |
| subjects | Adolescent Adult Aged AIDS/HIV Algorithms Animals Antibodies, Heterophile - blood Antibodies, Viral - blood Child Child, Preschool Cost Control Cytomegalovirus - immunology Diagnosis Female Herpesvirus 4, Human - immunology Herpesvirus 6, Human - immunology HIV-1 - immunology HIV-2 - immunology Humans Immunoglobulin M - blood Infant Linear Models Lymphocytes - pathology Lymphocytosis - virology Male Middle Aged Mononucleosis Prospective Studies Toxoplasma - immunology Virus Diseases - diagnosis |
| title | 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 |
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