Heterophil Antibody in Adults with Sore Throat

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Abstract
The prevalence and the clinical and laboratory findings of infectious mononucleosis were studied in ambulatory adult patients with the presenting symptom of sore throat. Extensive clinical data, heterophil antibody test and differential leukocyte count were obtained prospectively for 709 patients, 16-73 yr old, observed in 4 primary care settings. Heterophil tests were positive in 15 of 709 patients (2%); 4 of the 15 had > 10% atypical lymphocytes. No heterophil-negative patient had > 10% atypical lymphocytes. Heterophil-positive patients had mild disease; none was older than 40 yr. Of 70 symptoms and signs evaluated, 4 were found significantly more often (P < 0.005 for each) in the heterophil-positive patients: palatine petechiae, posterior auricular adenopathy, marked axillary adenopathy and inguinal adenopathy. If any of these 4 physical findings was present, the likelihood of the patient having heterophil antibody was considerably increased; if absent, the probability of infectious mononucleosis was so low that not ordering a heterophil test or differential leukocyte count would have been efficient and safe.

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