722 where the carrier-rate for HBsAg is lower than in Greece, Asia, or Africa, but higher than in Britain or the U.S.A. area

of Internal Medicine and Hæmatology Ciudad Sanitaria de la Seguridad Social, Universidad Autonoma,

Departments

Barcelona, Spain

V. VARGAS J. D. PEDREIRA J. VILASECA J. RUIZ R. ESTEBAN

J. M. HERNANDEZ J. GUARDIA R. BACARDI

produced by these cells.6 One would expect a few atypical lymphocytes to be still present in the peripheral blood, since it is not uncommon for circulating atypical lymphocytes to persist for several months in LM.7 This finding would not support Smith’s suggestion of a recent t.M. illness. Therefore, it would seem most likely that the patient had an adenovirus-7 infection which was responsible for production of the heterophile antibodies. We thank Ms Sondra Gandler Getz for editorial assistance. Division

of Hematopathology, Department of Laboratory Medicine, National Naval Medical Center, Bethesda, Maryland 20014, U.S.A.

H. R. SCHUMACHER R. M. AUSTIN S. A. STASS

FALSE-POSITIVE SEROLOGY IN INFECTIOUS MONONUCLEOSIS

(Feb. 10, p. 299) on fatal adenovirus infection with misleading positive serology for infectious mononucleosis (l.M.) raises several points. Ox erythrocytes usually -remove the sheep cell agglutinins completely with absorption. The titre of 1/320 reported by Smith can probably be explained by the very high titre of sheep agglutinins. If a decline in the titre of sheep-cell agglutinins after absorption with ox erythrocytes is at least four times lower than the Paul-Bunnell test, the test is positive for l.M.’ This was true in Smith’s patient. However, in such a case, a second absorption with ox erythrocytes will usually remove sheep agglutinins completely from the l.M. serum. A second absorption with the guineapig kidney does not lower sheep agglutinin titres. Was a second absorption done with ox erythrocytes? SiR,—The report by

Dr Smith

of identification of the virus as an adenovirusIn view of the negative adenovirus was the viral isolate confirmed as adenovirus-7 by serology, titration or neutralisation? hoemagglutination-inhibition Smith states that "The strongly positive monospot indicated a diagnosis of I.M., and this was apparently confirmed by a strongly positive Paul-Bunnell test, although atypical lymphocytes were not seen." This might suggest to the reader that the diagnosis of l.M. was established; however, Smith did not mean this since the phrase "atypical lymphocytes were not seen" was added. The diagnosis of l.M. is dependent upon the triad of clinical features and serological and hasmatological findings. The peripheral blood picture is characterised by the presence of 50% or more lymphocytes and monocytes, and 10% or more atypical lymphocytes.2 False-positive monospot tests have been reported in acute leukaemia, Hodgkin’s disease, poorly differentiated lymphoma, histiocytic medullary reticulosis, and malarial False-positives have also occurred with the PaulBunnell and the differential Paul-Bunnell-Davidsohn tests.4 The detection of IgG antibody to the Epstein-Barr virus in this case should be further clarified. In a study on 1457 young adults entering English universities and colleges 57% had antibodies to Epstein-Barr virus,5 so Smith’s patient probably had better than a 50% chance of having antibodies to the EpsteinBarr virus at the time the adenovirus infection developed. In support of the suggestion that the patient had a recent episode of acute l.M. is the report by Evans2 who noted a case of adenovirus infection without Epstein-Barr virus and heterophile antibodies. Nevertheless, Evans’ patient did have the haematological findings of l.M. We find it difficult to accept the fact that Smith’s patient had 67% lymphocytes without atypical lymphocytes, especially since heterophile antibodies may be The

means

type 7 is

1. 2

3. 4 5

not

entirely clear.

Davidsohn, I., Lee, C.

Infectious Mononucleosis (edited by R. L. Carter and H.G Penman), p. 181. Oxford, 1969. Evans, A. S. Am. J. med. Sci. 1979, 276, 325. Miale, J. B. in Laboratory Medicine Hematology (edited by J. B. Miale); p. 780. St. Louis, 1977. Davidsohn, I., Lee, C. L. in Infectious Mononucleosis (edited by R. L Carter and H. G Penman); p. 192. Oxford, 1969. University Health Physicians and P H.L.S Laboratories. Br. med. J. 1971,

IV, 643.

L.

in

***This letter has been shown follows.-ED.L.

to

Dr

Smith, whose reply

SIR,-A second absorption with ox erythrocytes was not done; the adenovirus was typed by specific neutralising serum. The important points in my paper are the death caused by a usually benign infection and the laboratory findings before death which were misleading. Mine was a reasoned attempt to explain the findings, and Captain Schumacher’s is another very reasonable hypothesis. Unfortunately, neither can be proved. But just as I would hesitate to say that the illness was probably related to a previous episode of infectious mononucleosis so I would be careful not to state that this was a false-positive Paul-Bunnell test caused by adenovirus type 7.

Department of Medicine (Cardiology), Freeman Hospital, Newcastle upon Tyne NE7 7DN

R. H. SMITH

POSTOPERATIVE ILEUS

SiR,-A prolonged post-office strike explains

our

belated

your editorial.’ You wonder whether the progresof colonic activity from caecum to sigmoid is respon-

comment on

sive

return

sible for the tendency for colonic anastomosis leak. The experiments of Woods et al .2 on the myoelectrical activity of the gastrointestinal tract of monkeys after operations producing retroperitoneal trauma may, as you imply, throw light on the main factor responsible for anastomotic leak in large-bowel operations. Of the methods applied to prevent anastomotic leaking, which has a frequency ranging from 16% to 31%, cutaneous transcxcal insertion of a Foley catheter and evacuation through it of any fluid load and/or air which may pass from small intestine into csecum, seems to be the most successful. Over the past three years we have applied this method in nineteen cases of colonic resection. No anastomotic leaks have been recorded in this series. Moreover, the morbidity of a temporary colostomy and of its closure is avoided. The results of this simple measure in colonic surgery are encouraging, and may be attributed to an improved understanding of the pathophysiology of postoperative intestinal motility. Statistical analysis will be done when comparative data

are

available.

Aretaieion Hospital, Athens University, Athens 136, Greece

JOHN PAPADIMITRIOU

6. MacKinney, A. A. Blood, 1968, 32, 217. 7. Finch, S C. in Infectious Mononucleosis (edited by R. L. Carter and H. G Penman); p. 50. Oxford, 1969. 1. Lancet, 1978, ii, 1186. 2. Woods, J. H., Erikson, L. W., Condon, R. E., Schulte, W. J., Sillin, L F 3 4.

5.

Surgery, 1978, 84, 527. Goligher, J C , Graham, N. G., DeDombal, F. T. Br. J. Surg. 1970, 57, 109. Herler, F. P., Splanetz, C. A. Am. J. Surg. 1967, 113, 1965. Whitaker, B. L., Dixon, R. A., Greatorex, G. Proc. R. Soc Med. 1970, 63, 751.

False-positive serology in infectious monoucleosis.

722 where the carrier-rate for HBsAg is lower than in Greece, Asia, or Africa, but higher than in Britain or the U.S.A. area of Internal Medicine and...
147KB Sizes 0 Downloads 0 Views