Acute Tonsillitis: Do We Always Need a Monospot?

Abstract

Objective: Patients presenting with tonsillitis are tested for glandular fever. Studies suggest a high lymphocyte–white cell ratio is a useful screening test for glandular fever. The purpose of our study was to ascertain the usefulness of testing patients for glandular fever if they have normal lymphocyte counts and blood films. Method: Retrospective review of blood results and discharge summaries of all patients presenting to a university teaching hospital with a diagnosis of acute tonsillitis or peritonsillar abscess over a 3-year period from 2008 to 2011. Data were collected for age, sex, blood results, and EBV testing and analyzed in Excel. Results: Seven hundred forty-three patients were identified with a diagnosis of tonsillitis or peritonsillar abscess. Four hundred seventy-two (63.5%) were tested for glandular fever, and of those tested, 32 (6.78%) patients tested positive. Thirty (93.8%) of the confirmed glandular fever patients had deranged lymphocytes. Conclusion: Patients with acute tonsillitis presenting without a lymphocyte derangement on blood film are unlikely to test positive for glandular fever. However, given the clinical implications of a positive glandular fever test, it is advisable to perform a monospot test in all patients presenting with tonsillitis.