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Proportion Positive for Epstein-Barr Virus, Cytomegalovirus, Human Herpesvirus 6, Toxoplasma, and Human Immunodeficiency Virus Types 1 and 2 in Heterophile-Negative Patients With a...

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Journal Title: Archives of Pathology & Laboratory Medicine
Authors and Corporations: Tsaparas, Yotis F., Brigden, Malcolm L., Mathias, Richard, Thomas, Eva, Raboud, Janet, Doyle, Patrick W.
In: Archives of Pathology & Laboratory Medicine, 124, 2000, 9, p. 1324-1330
Type of Resource: E-Article
Language: English
published:
Archives of Pathology and Laboratory Medicine
Subjects:
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rft.atitle Proportion Positive for Epstein-Barr Virus, Cytomegalovirus, Human Herpesvirus 6, <i>Toxoplasma,</i> 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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abstract <jats:title>Abstract</jats:title> <jats:p>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.</jats:p> <jats:p>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.</jats:p> <jats:p>Setting.—A large outpatient laboratory system.</jats:p> <jats:p>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.</jats:p> <jats:p>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).</jats:p> <jats:p>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.</jats:p>
authors Array ( [rft.aulast] => Tsaparas [rft.aufirst] => Yotis F. )
Array ( [rft.aulast] => Brigden [rft.aufirst] => Malcolm L. )
Array ( [rft.aulast] => Mathias [rft.aufirst] => Richard )
Array ( [rft.aulast] => Thomas [rft.aufirst] => Eva )
Array ( [rft.aulast] => Raboud [rft.aufirst] => Janet )
Array ( [rft.aulast] => Doyle [rft.aufirst] => Patrick W. )
doi 10.5858/2000-124-1324-ppfebv
languages eng
url http://dx.doi.org/10.5858/2000-124-1324-ppfebv
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General Medicine
Pathology and Forensic Medicine
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author Tsaparas, Yotis F., Brigden, Malcolm L., Mathias, Richard, Thomas, Eva, Raboud, Janet, Doyle, Patrick W.
author_facet Tsaparas, Yotis F., Brigden, Malcolm L., Mathias, Richard, Thomas, Eva, Raboud, Janet, Doyle, Patrick W., Tsaparas, Yotis F., Brigden, Malcolm L., Mathias, Richard, Thomas, Eva, Raboud, Janet, Doyle, Patrick W.
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container_start_page 1324
container_title Archives of Pathology & Laboratory Medicine
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description <jats:title>Abstract</jats:title> <jats:p>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.</jats:p> <jats:p>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.</jats:p> <jats:p>Setting.—A large outpatient laboratory system.</jats:p> <jats:p>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.</jats:p> <jats:p>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).</jats:p> <jats:p>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.</jats:p>
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spelling Tsaparas, Yotis F. Brigden, Malcolm L. Mathias, Richard Thomas, Eva Raboud, Janet Doyle, Patrick W. 1543-2165 0003-9985 Archives of Pathology and Laboratory Medicine Medical Laboratory Technology General Medicine Pathology and Forensic Medicine http://dx.doi.org/10.5858/2000-124-1324-ppfebv <jats:title>Abstract</jats:title> <jats:p>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.</jats:p> <jats:p>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.</jats:p> <jats:p>Setting.—A large outpatient laboratory system.</jats:p> <jats:p>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.</jats:p> <jats:p>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).</jats:p> <jats:p>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.</jats:p> Proportion Positive for Epstein-Barr Virus, Cytomegalovirus, Human Herpesvirus 6, <i>Toxoplasma,</i> and Human Immunodeficiency Virus Types 1 and 2 in Heterophile-Negative Patients With an Absolute Lymphocytosis or an Instrument-Generated Atypical Lymphocyte Flag Archives of Pathology & Laboratory Medicine
spellingShingle Tsaparas, Yotis F., Brigden, Malcolm L., Mathias, Richard, Thomas, Eva, Raboud, Janet, Doyle, Patrick W., Archives of Pathology & Laboratory Medicine, 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, Medical Laboratory Technology, General Medicine, Pathology and Forensic Medicine
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_full 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_fullStr 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_full_unstemmed 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_short 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_sort proportion positive for epstein-barr virus, cytomegalovirus, human herpesvirus 6, <i>toxoplasma,</i> and human immunodeficiency virus types 1 and 2 in heterophile-negative patients with an absolute lymphocytosis or an instrument-generated atypical lymphocyte flag
topic Medical Laboratory Technology, General Medicine, Pathology and Forensic Medicine
url http://dx.doi.org/10.5858/2000-124-1324-ppfebv