ORCID

0000-0001-7274-2650

Department

Biological Sciences

Year of Study

3

Full-time or Part-time Study

Part-time Study

Level

Postgraduate

Presentation Type

Poster

Supervisor

Dr Brigid Lucey

Supervisor

Michael Healy

Supervisor

Dr Frances Enright

Abstract

Background:

The eponymously named Epstein-Barr Virus (EBV) or human herpesvirus 4 (HHV-4) is the sole causative agent of the acute illness in humans described either as infectious mononucleosis (IM), or glandular fever. IM, when not clinically silent, can present in patients with at least two of the classic triad of symptoms of fever, pharyngitis, and lymphadenopathy. Challenges for the clinician arise when atypical cases present. Early, accurate and informed laboratory test results are vital for diagnosis, appropriate treatment, and patient management. A key challenge for the practitioner, particularly in cases where the illness can present atypically, is distinguishing bacterial tonsillitis infections from early acute IM. The ability to draw on timely, clear, and insightful laboratory results to distinguish viral from bacterial infection is vital. Correct and prompt diagnosis of IM can help prevent the unnecessary administration of antibiotics and mitigate the need for other expensive exploratory tests.

Methods:

In total, 420 patients had their peripheral bloods tested for heterophil antibodies over a two year period, 2018 and 2019 in the haematology department of the Mercy University Hospital (MUH), Cork. The qualitative detection of heterophile antibodies was determined using the Clearview® MONO test. Patients also had a full blood count (FBC) performed; any patients’ bloods that flagged abnormal results had a blood film prepared, stained, and examined by microscopy.

Data was collated using Excel 2007 software.

Results:

The majority of the Monospot test requests were ordered by clinicians following clinical assessment, 357 (85%); the remaining 63 (15%), were requested by laboratory staff following review of the peripheral blood results.

A total of 223 patients were female (53%) and 197 patients were male (47%). All age groups were included in the study and the patient age profile ranged from 5 months to 88 years.

The data shows that there were a much smaller number of Monospot requests made by laboratory staff as compared to clinicians but yet with a much greater accuracy, 32% as opposed to 7%. An understanding of the pathogenesis of the disease, and how biomarkers for the disease present in the laboratory would help account for this.

Conclusion:

A contemporary retrospective and prospective analysis of laboratory data could potentially guide a process to establish an international standard or algorithm for testing this disease. Such a study would go some way to verifying or discounting some of the present findings relating to this disease and potentially lead to a more standardized approach in the testing and diagnosis of this disease in the future.

Keywords:

Epstein-Barr virus, Infectious Mononucleosis, Cytology, Atypical lymphocytes, Antibodies, Haematology

Start Date

14-6-2022 10:45 AM

End Date

14-6-2022 2:00 PM

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Jun 14th, 10:45 AM Jun 14th, 2:00 PM

How Irish medical scientists can assist in the improved diagnosis of the disease Infectious Mononucleosis

Background:

The eponymously named Epstein-Barr Virus (EBV) or human herpesvirus 4 (HHV-4) is the sole causative agent of the acute illness in humans described either as infectious mononucleosis (IM), or glandular fever. IM, when not clinically silent, can present in patients with at least two of the classic triad of symptoms of fever, pharyngitis, and lymphadenopathy. Challenges for the clinician arise when atypical cases present. Early, accurate and informed laboratory test results are vital for diagnosis, appropriate treatment, and patient management. A key challenge for the practitioner, particularly in cases where the illness can present atypically, is distinguishing bacterial tonsillitis infections from early acute IM. The ability to draw on timely, clear, and insightful laboratory results to distinguish viral from bacterial infection is vital. Correct and prompt diagnosis of IM can help prevent the unnecessary administration of antibiotics and mitigate the need for other expensive exploratory tests.

Methods:

In total, 420 patients had their peripheral bloods tested for heterophil antibodies over a two year period, 2018 and 2019 in the haematology department of the Mercy University Hospital (MUH), Cork. The qualitative detection of heterophile antibodies was determined using the Clearview® MONO test. Patients also had a full blood count (FBC) performed; any patients’ bloods that flagged abnormal results had a blood film prepared, stained, and examined by microscopy.

Data was collated using Excel 2007 software.

Results:

The majority of the Monospot test requests were ordered by clinicians following clinical assessment, 357 (85%); the remaining 63 (15%), were requested by laboratory staff following review of the peripheral blood results.

A total of 223 patients were female (53%) and 197 patients were male (47%). All age groups were included in the study and the patient age profile ranged from 5 months to 88 years.

The data shows that there were a much smaller number of Monospot requests made by laboratory staff as compared to clinicians but yet with a much greater accuracy, 32% as opposed to 7%. An understanding of the pathogenesis of the disease, and how biomarkers for the disease present in the laboratory would help account for this.

Conclusion:

A contemporary retrospective and prospective analysis of laboratory data could potentially guide a process to establish an international standard or algorithm for testing this disease. Such a study would go some way to verifying or discounting some of the present findings relating to this disease and potentially lead to a more standardized approach in the testing and diagnosis of this disease in the future.