Biological False-Positive Reactions in Mononucleosis

Abstract

The foregoing comments were referred to Dr. Stone, and he has submitted the following reply: My statement concerns the manner and occasion, or the propriety, of the use of the term "cholesterol" by the doctor in his discussions with his patient. I feel strongly that the patient should be informed, but from the many inquiries we have had about cholesterol my impression is that many patients are more perplexed than enlightened on cholesterol by the doctor's discussions. Why this is I do not know. I can only surmise that the importance of the role of cholesterol is emphasized, but insufficient information is provided to enable the patient to understand its relationship to his condition or to follow the instructions intelligently.Cholesterol to the patient is an intangible substance, and thus it may be difficult for some to grasp its significance. In many instances it would be better probably to focus the attention of the patient on some other feature of his condition with which he is more familiar and which can be explained more logically and objectively. For many years patients with diabetes, myxedema, and car¬ diovascular-renal disorders have been treated as effectively as possible with the existing therapeutics without mention or emphasis of the role of cho¬ lesterol. Therapy for these and other conditions in which cholesterol is of interest may still be given just as well without concerning the patient unduly with this substance.Vague or indefinite instructions about cholesterol or unreasonable dietary restrictions may aggravate the depression of the person who has suffered a heart attack. If he thinks he should not eat any food which contains cholesterol, he may be very much disturbed when he learns that most of his favorite foods, those of animal sources, contain some of it. Dietary restrictions, of course, are im¬ portant, but they should be reasonable, explicit, and adjusted to the needs of the individual patient. , USA, is to be commended on his personal accumulation of 300 consecutive cases in view of the critical diagnostic criteria laid down.His conclusion that the incidence of biological false-positive (BEP) reactions in serologic tests for syphilis in this entity is only 0.66% requires explanation. This is especially true since he indicates that the frequently quoted high incidence (approximately 20%) may have arisen from "uncritical repe-tition of statements by earlier writers."The incidence of BFP reactions 1 in any disease entity depends on a variety of factors including (1) the number of serologic tests performed, (2) the frequency with which the test is done during the course of an illness, (3) the stage of the illness, and (4) the type of test performed.The last factor is undoubtedly the one which accounts for the low incidence in Colonel Hoagland's study. In his series he performed only one screen procedure, namely, the cardiolipin microflocculation test. This test employs a purified lipoidal antigen in contrast to such tests as the Mazzini and Kline which employ a crude lipoidal tissue extract....