Diagnostic Accuracy for Individual Elements of the Clinical Symptom, Sign, and Hematologic Parameter Sort by Positive Likelihood Ratios (LR+) Within Each Category. Where the LR+, Negative Likelihood Ratio (LR-) or Diagnostic Odds Ratio Differed Significantly from 1.0, the Value is Shown in Bold Face
| Studies (Patients)-Case Series | Studies (Patients)-Cohort Studies | Sensitivity (95% CI) | Specificity (95% CI) | LR+(95% CI) | LR-(95% CI) | Diagnostic Odds Ratio (95% CI) | AUC | |
|---|---|---|---|---|---|---|---|---|
| Symptoms | ||||||||
| Nausea or vomiting | 2 (262)3,21 | 3 (326)6,16,23 | 0.30(0.22-0.39) | 0.72(0.34-0.93) | 1.88(0.54-6.04) | 0.99(0.63-1.24) | 2.43(0.25-9.30) | 0.40 |
| Headache | 2 (262)3,21 | 4 (1036)5,6,16,23 | 0.59(0.40-0.76) | 0.37(0.23-0.54) | 1.19(1.01-1.45) | 0.72(0.50-0.98) | 1.72(1.03-2.77) | 0.59 |
| Sore throat | 2 (262)3,21 | 5 (474)6,16,24,25 | 0.81(0.68-0.90) | 0.25(0.17-0.35) | 1.121.01-1.25) | 0.67(0.41- 1.01) | 1.78(1.00-2.98) | 0.52 |
| Malaise or fatigue | 3 (472)3,21,26 | 5 (1137)5,6,16,23–25 | 0.72(0.59-0.82) | 0.24(0.11-0.43) | 1.02(0.91-1.20) | 0.99(0.67-1.48) | 1.09(0.62-1.74) | 0.57 |
| Loss of appetite | 0 | 2 (883)5,6 | 0.47-0.74 | 0.24-0.64 | 0.86-1.86 | 0.64-1.54 | 0.57-2.64 | |
| Cough | 1 (140)3 | 1 (709)5 | 0.22-0.40 | 0.36(0.32-0.40) | 0.63(0.31-1.01) | 1.66(0.99-2.28) | 0.43(0.14-1.02) | |
| Abdominal pain | 0 | 2 (197)6,16 | 0.33-0.38 | 0.00-0.56 | 0.58-1.17 | 0.90-1.50 | 0.40-1.31 | |
| Myalgia or arthralgia | 2 (262)3,21 | 2 (303)6,24 | 0.23(0.09-0.49) | 0.39-0.59 | 0.45-1.35 | 0.47-1.39 | 0.34-2.76 | |
| Signs | ||||||||
| Lymphadenopathy | ||||||||
| Posterior cervical | 2 (253)3,17 | 1 (709)5 | 0.67(0.51-0.80) | 0.87(0.84-0.89) | 3.16(1.45-5.20) | 0.68(0.41-0.93) | 5.18(1.55-12.6) | |
| Axillary or inguinal | 1 (113)17 | 1 (632)5 | 0.23(0.09-0.47) | 0.82-0.91 | 3.05(1.85-4.70) | 0.67(0.36-0.91) | 4.97(2.05-10.5) | |
| Anterior cervical | 2 (253)3,17 | 1 (709)5 | 0.74(0.59-0.85) | 0.43(0.39-0.47) | 1.27(0.80-1.58) | 0.65(0.25-1.28) | 2.47(0.63-6.17) | |
| Any | 4 (445)3,17,21,26 | 6 (1014)5,6,19,22,24,25 | 0.93(0.86-0.97) | 0.21(0.07-0.49) | 1.26(1.05-1.65) | 0.37(0.20-0.67) | 3.77(1.61-7.55) | 0.81 |
| Hepatomegaly | 1 (140)3 | 5 (971)5,6,19,22,24 | 0.32(0.07-0.75) | 0.84(0.18-0.99) | 2.42(0.95-6.36) | 0.78(0.48-1.10) | 3.25(0.84-8.34) | 0.63 |
| Splenomegaly | 2 (262)3,21 | 5 (972)5,6,19,22,24 | 0.45(0.20-0.73) | 0.74(0.30-0.95) | 2.39(1.11-5.51) | 0.66(0.50-0.84) | 3.63(1.38-7.77) | 0.65 |
| Palatal petechiae | 1 (122)21 | 2 (838)5,23 | 0.14(0.06-0.28) | 0.94-1.00 | 1.32-11.40 | 0.57-0.94 | 1.48-155 | |
| Exudate | ||||||||
| Tonsillar | 1 (122)21 | 2 (747)5,22 | 0.47(0.30-0.64) | 0.78-0.84 | 1.39-4.13 | 0.23-0.93 | 1.49-17.0 | |
| Pharyngeal | 0 | 2 (752)5,19 | 0.13-0.50 | 0.54-0.93 | 0.72-4.35 | 0.62-1.29 | 0.57-5.39 | |
| Fever | ||||||||
| Measured fever >37.5°C | 3 (332)3,21,26 | 4 (938)5,6,14,17 | 0.64(0.37-0.84) | 0.46(0.17-0.79) | 1.20(0.91-1.84) | 0.88(0.63-1.33) | 1.45(0.67-2.68) | 0.56 |
| Subjective fever | 0 | 2 (122)14,23 | 0.67(0.48-0.82) | 0.40(0.24-0.60) | 1.14(0.85-1.60) | 0.85(0.49-1.32) | 1.50(0.64-3.15) | |
| Jaundice | 0 | 1 (177)6 | 0.17(0.10-0.25) | 0.79(0.68-0.88) | 0.85(0.45-1.51) | 1.06(0.91-1.23) | 0.83(0.37-1.65) | |
| Diarrhea | 0 | 1 (175)6 | 0.15(0.09-0.23) | 0.79(0.67-0.89) | 0.79(0.39-1.41) | 1.07(0.94-1.26) | 0.76(0.31-1.50) | |
| Rash | 4 (445)3,17,21,26 | 4 (323)6,16,19,24 | 0.12(0.06-0.21) | 0.75(0.59-0.86) | 0.48(0.18-1.12) | 1.24(0.98-1.66) | 0.41(0.11-1.15) | 0.22 |
| Rhinorrhea | 0 | 2 (838)5,24 | 0.14-0.47 | 0.37-0.83 | 0.40-1.53 | 0.85-2.20 | 0.25-1.78 | |
| Pharyngitis | 2 (210)3,26 | 0 | 0.94(0.68-0.99) | - | - | - | - | |
| Hematologic parameters | ||||||||
| >50% lymphocytes and >10% atypical lymphocytes | 0 | 3 (1361)5,8,20 | 0.45(0.29-0.62) | 0.99(0.92-1.00) | 50.4(8.43-162) | 0.58(0.38- 0.76) | 81.2(19.10-216) | 0.82 |
| Atypical lymphocytosis (%) | ||||||||
| >40% | 0 | 1 (362)8 | 0.25(0.19-0.32) | 1.00(0.98-1.00) | 50.3(38.6-64.1) | 0.75(0.68-0.82) | 355(7.43-622) | |
| >20% | 0 | 1 (362)8 | 0.56(0.49-0.64) | 0.98(0.94-0.99) | 28.1(9.68-61.4) | 0.45(0.38-0.52) | 63.9(10.5-148) | |
| >10% | 0 | 5 (888)6,8,18,20,24 | 0.55(0.38-0.70) | 0.94(0.91-0.96) | 8.97(3.39-19.5) | 0.48(0.31-0.65) | 19.30(6.48-44.4) | 0.83 |
| Lymphocytosis (>4 × 109/L lymphocytes) | 0 | 3 (1235)8,9,18 | 0.59(0.27-0.84) | 0.94(0.93-0.96) | 10.2(4.79-16.0) | 0.44(0.16-0.75) | 30.6(6.53-99.4) | 0.64 |
| Lymphocytosis (%) | ||||||||
| >45% | 0 | 1 (1000)28 | 0.65(0.61-0.69) | 0.93(0.90-0.95) | 9.46(6.76-13.1) | 0.38(0.34-0.42) | 25.2(16.5-36.8) | |
| >50% | 0 | 4 (1740)6,8,20,27 | 0.56(0.46-0.65) | 0.93(0.84-0.97) | 8.52(2.86-19.9) | 0.49(0.36-0.63) | 18.7(4.8-51.1) | 0.76 |
| >40% | 0 | 1 (1000)27 | 0.74(0.70-0.78) | 0.86(0.83-0.89) | 5.31(4.24-6.68) | 0.30(0.26-0.35) | 17.7(12.8-24.3) | |
| >35% | 0 | 1 (1000)27 | 0.84(0.80-0.87) | 0.72(0.68-0.76) | 3.02(2.63-3.50) | 0.22(0.18-0.27) | 13.8(10.1-18.8) | |
| >30% | 0 | 1 (1000)27 | 0.88(0.85-0.91) | 0.5(0.46-0.55) | 1.78(1.62-1.97) | 0.23(0.18-0.30) | 7.94(5.63-10.8) | |
| Monocytosis (>1 × 109/L monocytes) | 0 | 2 (1088)8,9 | 0.14-0.72 | 0.89-0.95 | 1.46-7.89 | 0.11-0.98 | 1.49-55.3 | |
| Atypical lymphocytosis (>1 × 109/L atypical lymphocytes) | 0 | 1 (38)22 | 0.93(0.76-0.98) | 0.11(0.01-0.48) | 1.11(0.82-1.78) | 1.20(0.07-5.69) | 4.16(0.15-25.2) | |
| Leukocytosis | ||||||||
| >10 × 109/L | 0 | 4 (1281)6,8,9,19 | 0.43(0.37-0.49) | 0.83(0.76-0.88) | 2.55(1.58-3.99) | 0.68(0.56-0.82) | 3.85(1.93-7.01) | 0.63 |
| >5 × 109/L | 0 | 2 (193)6,19 | 0.93-0.94 | 0.15-0.21 | 1.05-1.36 | 0.15-0.70 | 1.51-8.73 | |
| Neutrophilia (>7.5 × 109/L neutrophils) | 0 | 1 (726)9 | 0.02(0.00-0.13) | 0.88(0.85-0.90) | 0.25(0.02-1.03) | 1.11(0.99-1.16) | 0.23(0.02-1.04) |
AUC, receiver operating characteristics curve; CI, confidence interval.