The laboratory in the diagnosis of infectious mononucleosis, with additional notes on epidemiology, etiology and pathogenesis

Evaluation of ten commercial heterophile antibody tests for infectious mononucleosis

Ten rapid slide agglutination tests for infectious mononucleosis were evaluated. The quality of the technical information included with the kits was found to differ considerably, as did the composition of the tests and the principles of test specificity. Furthermore, large variation was found in the shelf life and price of the different kits. Thirty-nine serum samples were selected according to titre in the Paul-Bunnell-Davidsohn differential absorption test, largely from the low titre area, since this is where most diagnostic problems can be expected. The sera were tested blindly using the ten rapid slide agglutination tests. Considerable differences were found in specificity and sensitivity. When compared with the results obtained from PBD, the tests could be divided into two groups. The first group consisted of three kits, all of which gave false negative, but no false positive results. The remaining seven tests gave false negative and false positive results, but were more sensitive than the tests in the first group. The large variation in the results obtained when using the different kits under controlled conditions indicates that such tests may give even less satisfactory results in practice.

Hodgkin's disease in patients with previous infectious mononucleosis

Patients with a positive reaction to the Paul-Bunnell test in the period 1961-72 were identified at nine different laboratories in Norway and matched against cases of malignant lymphoma registered at the Cancer Registry of Norway in the period 1961-75. Among 5,840 patients having a positive Paul-Bunnell test a total of six developed malignant lymphoma, three of these more than 1 year after the positive Paul-Bunnell test. The expected number of malignant lymphoma was 2.04. Of the six lymphoma cases, five were classified as Hodgkin's disease (HD). The present investigation agrees well with the findings of other epidemiological studies. There seems to be a small excess in incidence of HD among patients with previous infectious mononucleosis (IM), but both diagnostic problems and possible confounding factors must be taken into account before a possible causal association is considered.

Seronegative glandular fever

Seven sporadic cases of ;seronegative glandular fever' have been examined in detail; five of the patients were adults aged more than 30, two were children. None showed evidence of ;incomplete' or heat-labile sheep cell agglutinins, but in three very weak, though otherwise typical, glandular fever agglutinins were detected. Three of the other four showed evidence of certain infections, but these infections probably accounted for no more than a part of each illness. It is suggested that some, and possibly most, sporadic cases of seronegative glandular fever are of the same disease as seropositive cases, the patients' ages influencing the serological response. Certain conditions of known aetiology may, however, be clinically and haematologically indistinguishable from seronegative glandular fever.

Hodgkin's disease. II

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