Nasopharyngeal endoscopy adds to reliability of clinical diagnosis of infectious mononucleosis

Frequently, the clinical picture in the oropharynx alone does not lend itse lf to a reliable differentiation between acute pharyngotonsillitis in infec tious mononucleosis and a streptococcal inflammation. Such a differentiatio n, however, is essential for the indication of antibiotic therapy. Therefor e, it was the aim of the present study to investigate whether or not endosc opic verification of larger-than-normal lymphatic tissue with fibrinous mem branes in the nasopharynx would enhance the reliability of diagnosis. Fifty hospitalized patients exhibiting the clinical picture of acute pharyn gotonsillitis were examined for the following parameters: nasopharyngeal en doscopy, determination of glutamine-oxaloacetic transaminase (GOT), glutami ne-pyruvic transaminase (GPT), C-reactive protein (CRP), erythrocyte sedime ntation rate (ESR), leucocytes and haemogram, antibodies to viral capsid an tigen (VCA)-IgM, Epstein-Barr virus nuclear antigen (EBNA), and cytomegalov irus (CMV). In 24 patients with acute tonsillitis/peritonsillar abscess, and in 26 pati ents with infectious mononucleosis, the total leucocyte count in the blood and the blood/erythrocyte sedimentation rate were comparable. Atypical lymp hocytes or absolute lymphocytosis were not seen in acute tonsillitis, but w ere found in 88.5 per cent of patients with infectious mononucleosis. Eleva ted transaminase levels were noted in 77 (GOT) and 88.5 per cent (GPT) of p atients with infectious mononucleosis, and in acute tonsillitis in 4.2 (GOT ) and 12.5 per cent (GPT) of patients. The CRP was higher than normal in 91 .7 per cent of patients with acute tonsillitis, and in 57.7 of patients wit h infectious mononucleosis. In none of the patients with acute tonsillitis was lymphatic tissue with fibrinous membranes seen in the nasopharyngeal ca vity. In contrast, nasopharyngeal endoscopy in infectious mononucleosis was positive in 24 out of 26 patients. Hence, the sensitivity was 92.3 per cen t, the specificity 100 per cent, and the prediction value for a positive te st turned out to be 1. Endoscopy of the nasopharngeal cavity employed as a simple and supplementar y procedure adds to the reliability of diagnosis of infectious mononucleosi s.