Diagnosis of Atypical Cases of Infectious

The variable manifestations of infectious mononucleosis rarely cause clinicians to suspect primary Epstein-Barr virus or cytomegalovirus infection; consequently, costly diagnostic tests and unnecessary treatments are undertaken. Seventeen cases of clinically atypical and 11 cases of clinically typical infectious mononucleosis were diagnosed through screening for atypical and apoptotic lymphocytes in the peripheral blood samples by means of an automated hematologic analyzer. Atypical and typical cases did not differ significantly with respect to peripheral white blood cell counts; percentages of lymphocytes, atypical lymphocytes, CD4+ lymphocytes, human leukocyte antigen–DR positivity in CD3 lymphocytes, or apoptotic cells in blood smear after incubation; or levels of aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase. Only the per-centage of CD8+ lymphocytes was significantly higher in patients with typical infectious mononucleosis than it was in patients with atypical infectious mononucleosis. Because certain atypical cases of infectious mono-nucleosis display laboratory abnormalities that are characteristic of typical infectious mononucleosis, enhanced awareness can help in the diagnosis. Infectious mononucleosis is an acute, self-limited, be-nign illness that occurs in children and young adults after primary infection with Epstein-Barr virus (EBV), cytomegalovirus (CMV), and other infectious agents [1]. The incidence of EBV-associated infectious mono-nucleosis in the United States has been estimated to be 1.6–99 cases per 100,000 persons, whereas the preva-lence of EBV infection reaches 190 % of the entire pop-ulation by the third decade of life [2]. Therefore, a number of primary EBV infections are clinically silent or atypical. The classic triad of symptoms of acute in-fectious mononucleosis—fever, pharyngitis, and lym