Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-19T10:09:08.742Z Has data issue: false hasContentIssue false

A longer stay for the kissing disease: epidemiology of bacterial tonsillitis and infectious mononucleosis over a 20-year period

Published online by Cambridge University Press:  07 January 2013

P Lennon*
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, University Hospital Limerick, Ireland
J Saunders
Affiliation:
Statistical Consulting Unit, Graduate Entry Medical School, University of Limerick, Ireland
J E Fenton
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, University Hospital Limerick, Ireland
*
Address for correspondence: Mr Paul Lennon, ENT Registrar, Department of Otolaryngology, Head and Neck Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland E-mail: paullennon81@gmail.com

Abstract

Introduction:

Anecdotally, infectious mononucleosis is considered a more severe infection than bacterial tonsillitis, requiring a longer hospital stay. However, there is little in the literature comparing the epidemiology of the two conditions. This study aimed to compare the epidemiology of bacterial tonsillitis and infectious mononucleosis, in particular any differences in the length of in-patient stay.

Methodology:

The hospital in-patient enquiry system was used to analyse patients admitted with bacterial tonsillitis and infectious mononucleosis between 1990 and 2009 inclusive.

Results:

There was a total of 3435 cases over the 20 years: 3064 with bacterial tonsillitis and 371 with infectious mononucleosis. The mean length of stay was 3.22 days for bacterial tonsillitis and 4.37 days for infectious mononucleosis. The median length of stay for each condition was compared using the Mann–Whitney U non-parametric test, and a significant difference detected (p < 0.001).

Conclusion:

Patients with infectious mononucleosis have a significantly longer stay in hospital than those with bacterial tonsillitis.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented at the Sylvester O’Halloran Surgical Scientific Meeting, 4 March 2011, Limerick, Ireland

References

1Masucci, MG, Ernberg, I. Epstein-Barr virus: adaptation to a life within the immune system. Trends Microbiol 1994;2:125–30CrossRefGoogle ScholarPubMed
2Schuster, V, Kreth, HW. Epstein-Barr virus infection and associated diseases in children. I. Pathogenesis, epidemiology and clinical aspects. Eur J Pediatr 1992;151:718–25CrossRefGoogle ScholarPubMed
3Tattevin, P, Le Tulzo, Y, Minjolle, S, Person, A, Chapplain, JM, Arvieux, C et al. Increasing incidence of severe Epstein-Barr virus-related infectious mononucleosis: surveillance study. J Clin Microbiol 2006;44:1873–4CrossRefGoogle ScholarPubMed
4Crowcroft, NS, Vyse, A, Brown, DW, Strachan, DP. Epidemiology of Epstein-Barr virus infection in pre-adolescent children: application of a new salivary method in Edinburgh, Scotland. J Epidemiol Community Health 1998;52:101–4CrossRefGoogle ScholarPubMed
5Morris, MC, Edmunds, WJ. The changing epidemiology of infectious mononucleosis? J Infect 2002;45:107–9CrossRefGoogle ScholarPubMed
6Hoagland, RJ. Infectious mononucleosis. Prim Care 1975;2:295307CrossRefGoogle ScholarPubMed
7Lennon, P, O'Neill, JP, Fenton, JE, O'Dwyer, TP. Challenging the use of the lymphocyte to white cell count ratio in the diagnosis of infectious mononucleosis by analysis of a large cohort of Monospot test results. Clin Otolaryngol 2010;35:397401CrossRefGoogle ScholarPubMed
9Ramagopalan, SV, Hoang, U, Seagroatt, V, Handel, A, Ebers, GC, Giovannoni, G et al. Geography of hospital admissions for multiple sclerosis in England and comparison with the geography of hospital admissions for infectious mononucleosis: a descriptive study. J Neurol Neurosurg Psychiatry 2011;82:682–7CrossRefGoogle ScholarPubMed
10The Economic and Social Research Institute: Understanding Ireland's Economic Success. In: http://www.esri.ie/UserFiles/publications/20071114092120/WP111.pdf [18 July 2011]Google Scholar
12Evans, AS, Kaslow, RA. Viral Infections in Humans: Epidemiology and Control, 4th edn.New York: Plenum Medical Book, 1997CrossRefGoogle Scholar
13Evans, AS. Infectious mononucleosis. Observations from a public health laboratory. Yale J Biol Med 1961;34:261–76Google ScholarPubMed
14Munoz, N, Davidson, RJ, Witthoff, B, Ericsson, JE, De-The, G. Infectious mononucleosis and Hodgkin's disease. Int J Cancer 1978;22:1013CrossRefGoogle ScholarPubMed
15Odegaard, K. Kissing as a mode of transmission of infectious mononucleosis. Lancet 1967;i:1052–3CrossRefGoogle Scholar
16Carvalho, RP, Evans, AS, Frost, P, Dalldorf, G, Camargo, ME, Jamra, M. EBV infections in Brazil. I. Occurrence in normal persons, in lymphomas and in leukemias. Int J Cancer 1973;11:191201CrossRefGoogle Scholar
17Axelrod, P, Finestone, AJ. Infectious mononucleosis in older adults. Am Fam Physician 1990;42:1599–606Google ScholarPubMed
18Schmader, KE, van der Horst, CM, Klotman, ME. Epstein-Barr virus and the elderly host. Rev Infect Dis 1989;11:6473CrossRefGoogle ScholarPubMed
19Clinical Knowledge Summaries. In: http://www.cks.nhs.uk/patient_information_leaflet/tonsillitis [24 July 2011]Google Scholar
20Bhattacharyya, N, Kepnes, LJ. Economic benefit of tonsillectomy in adults with chronic tonsillitis. Ann Otol Rhinol Laryngol 2002;111:983–8CrossRefGoogle ScholarPubMed
21Gallegos, B, Rios, A, Espidel, A, Reynal, JL. A double-blind, multicenter comparative study of two regimens of clindamycin hydrochloride in the treatment of patients with acute streptococcal tonsillitis/pharyngitis. Clin Ther 1995;17:613–21CrossRefGoogle ScholarPubMed
22Wolf, DM, Friedrichs, I, Toma, AG. Lymphocyte-white blood cell count ratio: a quickly available screening tool to differentiate acute purulent tonsillitis from glandular fever. Arch Otolaryngol Head Neck Surg 2007;133:61–4CrossRefGoogle ScholarPubMed
23Mahmud, I, Abdel-Mannan, OA, Wotton, CJ, Goldacre, MJ. Maternal and perinatal factors associated with hospitalised infectious mononucleosis in children, adolescents and young adults: record linkage study. BMC Infect Dis 2011;11:51CrossRefGoogle Scholar
24Thompson, SK, Doerr, TD, Hengerer, AS. Infectious mononucleosis and corticosteroids: management practices and outcomes. Arch Otolaryngol Head Neck Surg 2005;131:900–4CrossRefGoogle ScholarPubMed
25Almasi, I, Ternak, G, Bali, I. Clinical aspects of the diagnosis and treatment of infectious mononucleosis in primary care and in departments of infectious diseases [in Hungarian]. Orv Hetil 2001;142:899903Google ScholarPubMed
27Wennberg, JE, Gittelsohn, A, Shapiro, N. Health care delivery in Maine, III: evaluating the level of hospital performance. J Maine Med Assoc 1975;66:298306Google ScholarPubMed
28Halevy, J, Ash, S. Infectious mononucleosis in hospitalized patients over forty years of age. Am J Med Sci 1988;295:122–4CrossRefGoogle ScholarPubMed
29Torre, D, Tambini, R. Acyclovir for treatment of infectious mononucleosis: a meta-analysis. Scand J Infect Dis 1999;31:543–7Google ScholarPubMed
30Stenfors, LE, Bye, HM, Raisanen, S. Noticeable differences in bacterial defence on tonsillar surfaces between bacteria-induced and virus-induced acute tonsillitis. Int J Pediatr Otorhinolaryngol 2003;67:1075–82CrossRefGoogle ScholarPubMed
31Stenfors, LE, Bye, HM, Raisanen, S. Bacterial coating with immunoglobulins on the palatine tonsils during infectious mononucleosis: immunocytochemical study with gold markers. J Laryngol Otol 2001;115:101–5CrossRefGoogle ScholarPubMed
32Brook, I. The association of anaerobic bacteria with infectious mononucleosis. Anaerobe 2005;11:308–11CrossRefGoogle ScholarPubMed
33Hedstrom, SA, Mardh, PA, Ripa, T. Treatment of anginose infectious mononucleosis with metronidazole. Scand J Infect Dis 1978;10:79CrossRefGoogle ScholarPubMed
34Dalmau, D, Travieso, F, Sanchez, C, Garau, J. Metronidazole and angina caused by infectious mononucleosis [in Spanish]. Enferm Infecc Microbiol Clin 1990;8:411–13Google ScholarPubMed
35Hedstrom, SA. Treatment of anginose infectious mononucleosis with metronidazole. A controlled clinical and laboratory study. Scand J Infect Dis 1980;12:265–9CrossRefGoogle ScholarPubMed
36Spelman, DW, Newton-John, HF. Metronidazole in the treatment of anginose infectious mononucleosis. Scand J Infect Dis 1982;14:99101CrossRefGoogle ScholarPubMed
37Davidson, S, Kaplinsky, C, Frand, M, Rotem, J. Treatment of infectious mononucleosis with metronidazole in the pediatric age group. Scand J Infect Dis 1982;14:103–4CrossRefGoogle ScholarPubMed
38Rapoport, J, Teres, D, Zhao, Y, Lemeshow, S. Length of stay data as a guide to hospital economic performance for ICU patients. Med Care 2003;41:386–97CrossRefGoogle ScholarPubMed
39Stock, GN, McDermott, C. Operational and contextual drivers of hospital costs. J Health Organ Manag 2011;25:142–58CrossRefGoogle ScholarPubMed
40Analysis in Brief: November 30, 2005: Inpatient Hospitalizations and Average Length of Stay Trends in Canada, 2003–2004 and 2004–2005. In: https://secure.cihi.ca/free_products/hmdb_analysis_in_brief_e.pdf [26 July 2011]Google Scholar