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This month’s Editors’ Choice is a systematic review of the role of liver assessment in patients with glandular fever. Admission of patients with sore throat constitutes a significant burden of acute work for paediatric and adult ENT services as well as primary care. Within these patients, identification of those with infectious mononucleosis is important, as it allows the patient to understand the nature of their illness, duration of recovery, potential for recurrence of symptoms and management of these. We are all aware of the systemic nature of this viral condition, and assessment of liver function is a part of routine patient workup. The degree of investigation varies from blood testing through to ultrasonography for deranged bloods (as well as clinically apparent hepatomegaly and/or splenomegaly). The systematic review shows no significant correlation or predictive value in routine monitoring or scanning in patients with subclinical blood derangements. Clearly there needs to be individual patient assessment on a case-by-case basis, but with the current amount of work in the NHS, anything which helps to alleviate pressure on a system that is already stretched for capacity should be encouraged. To coin a well-known phrase “every little helps!” Thanks, as always, to all our reviewers for all their hard work and contributions. Happy New Year to all!

Nazia Munir and Hannah Cooper


In this paper Tan et al review the literature aiming to assess the appropriate modalities of investigation and level of vigilance regarding liver function derangement in patients with infective mononucleosis. They followed PRISMA consensus, reviewing PubMed, EMBASE and Cochrane libraries for both paediatric and adult populations. There were a total of 32 studies eligible for this systematic review, leading to a total of 2779 patients having their liver function test (LFT) values reported. Amongst these investigations, aspartate transaminase, alanine transaminase and alkaline phosphatase were abnormal in more than half the patients, while affected bilirubin and gamma-glutamyltransferase were demonstrated in a significantly lower percentage of the population. The median time for normalisation of these values was eight weeks. A little more than one third had clinical evidence of hepatomegaly and a little less than half, splenomegaly. Splenomegaly was confirmed via ultrasonography in all the patients, but hepatomegaly was found only in half of them. Overall, no patients developed decompensated liver disease. This systematic review summarises the data available in the literature regarding the work we are undertaking for the infective mononucleosis patients. At this stage, there is no significant correlation or predictive value in doing routine LFT monitoring or undertaking ultrasonography for subclinical derangement of LFTs in immunocompetent patients. Glandular fever is an extremely common presentation in both primary care and the emergency departments of hospitals. By reducing the amount of unnecessary investigations, we can potentially alleviate some of the pressure on the system caused by the multiple follow-up and investigations, as well as improve patients’ experience.

The utility of liver function tests and abdominal ultrasound in infectious mononucleosis—A systematic review.
Tan ET, Wilkinson D, Edafe O.


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Dimitrios Spinos

NHS West Midlands, UK.

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