THE HISTOCHEMICAL NITROBLUE TETRAZOLIUM REDUCTION TEST IN THE DIFFERENTIAL DIAGNOSIS OF ACUTE INFECTIONS

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Abstract
Nitroblue tetrazolium (NBT) reduction by phagocytic leukocytes was investigated histochemically in 296 subjects with and without infections. Among 130 patients with noninfectious diseases, osteogenesis imperfecta patients and their relatives, and hemophiliacs frequently displayed high NBT-reduction values in their neutrophils. Four percent of the other noninfected patients yielded NBT-reduction values higher than normal in their neutrophils and were considered to have "false-positive" NBT-reduction tests. Most patients with acute bacterial infections (83%) showed an increased percentage of NBT-positive neutrophils. In patients who did not respond to a bacterial infection by increasing their percentage of NBT-positive neutrophils, there was suggestive evidence of a state of neutrophil dysfunction. Eighty-four percent of patients with viral or tuberculous infections demonstrated normal percentages of NBT-positive neutrophils. Acute bacterial infections were most often associated with a high percent of NBT-positive neutrophils, while low values predominated in viral infections regardless of the patient's total leukocyte counts. The NBT histochemical test would appear to be a useful adjunct to microbiologic techniques in establishing the diagnosis in patients with suspected infection.

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