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Cryptococcal Antigen Titer Normal Range

Lab Test - Cryptococcal Antigen

Lab Test - Cryptococcal Antigen

The test is a Lateral Flow Assay which is an immunochromatographic test system for the detection of Cryptococcal antigen. This test replaces India Ink preparation for cerebrospinal fluid specimens. CSF: daily, 24 hours, performed STAT; blood: Daily, 0800-1430 STAT, 2 hours after receipt of the specimen in the laboratory; routine, same day if received by 1330. Insufficient quantity of specimen, inappropriate specimen container, hemolyzed blood specimen, bloody cerebrospinal fluid specimen. Specimen should be transported as soon as possible. When transportation is delayed, leave at room temperature. False negative results may occur due to a low concentration of the polysaccharide antigen or due to a prozone effect at high antigen concentrations. False positive results may occur due to invasive infections with the yeast Trichosporon beigelii, Capnocytophaga species, or Rothia (Stomatococcus) mucilaginosus. A titer will be reported for all positive results. A higher titer usually corresponds with worse disease. Pretreatment of blood specimens with pronase reduces false-positives and increases the sensitivity of the method. A fungal culture should also be performed for patients who are suspected of having cryptococcosis. Antigen detection may precede the detection of viable organisms in cerebrospinal fluid Gram stains and fungal culture. The India Ink preparation has been replaced by the cryptococcal antigen procedure due to the increased sensitivity. A cryptococcal antigen will routinely be performed on all cerebrospinal fluid specimens submitted for a fungal culture providing an adequate volume of specimen is submitted. Continue reading >>

Cryptococcus Latex Agglutination Test | Cryptococcal Testmiravista Diagnostics

Cryptococcus Latex Agglutination Test | Cryptococcal Testmiravista Diagnostics

The Cryptococcal Antigen Latex Agglutination System is a qualitative and semi-quantitative test system for the detection of capsular polysaccharide antigens of Cryptococcus neoformans. Latex agglutination test has both diagnostic and prognostic value since progressive disease is usually accompanied by increasing antigen titers. Declining titers are usually associated with clinical improvement, with or without therapy. Inadequate therapy is indicated by stationary or rising titers on subsequent, sequential specimens. Cryptococcal antigen in the body fluids of the untreated patient indicates active infection. However, in some treated patients, titers remain positive at low levels for extended periods during which the organism can no longer be demonstrated. Serum specimens are pre-treated with pronase and heat inactivated prior to testing. CSF specimens are heat inactivated prior to testing. The result is not intended to be used as the sole means for clinical diagnosis or patient management decisions. CSF titers of 1:4 or less are presumptive evidence of central nervous system infection by C. neoformans; additional follow-up and culture are strongly recommended. CSF titers of 1:8 or greater from patients with meningitis strongly suggest infection by C. neoformans. However, diagnosis should be confirmed by identification of the organism from culture or by microscopic examination of the specimen. A negative test does not preclude diagnosis of cryptococcosis, particularly if only a single specimen has been tested and the patient shows symptoms consistent with cryptococcosis. A false positive reaction due to the antigen of Trichosporon beigelii which cross reacts with the C. neoformans capsular polysaccharide has been reported. High protein levels can cause interference. Seru Continue reading >>

Cryptococcal Antigen Is A Csf Test For Cryptococcus Neoformans

Cryptococcal Antigen Is A Csf Test For Cryptococcus Neoformans

Cryptococcus neoformans is acquired by inhalation and causes pneumonia.It may disseminate from the lungs and invade the CNS causing meningitis.Other viscera, bone, and skin may also be involved. Cryptococcosis can occur as a primary disease or secondary to immunosuppression.Previously, cryptococcal meningitis was diagnosed by staining CSF with India Ink.A more sensitive cryptococcal antigen test has replaced the India ink test and can detect fungus in both serum and CSF. The cryptococcal antigen test has both diagnostic and prognostic value.Positive specimens are titrated and the highest titers are reported.CSF titers of 1:8 or higher are considered strong evidence of active infection. The antigen titer is proportional to the extent of infection, with increasing titers indicating progressive infection.Response to chemotherapy can be monitored with serial titers. Decreasing titers suggest a favorable response, while unchanging or increasing titers suggest unsuccessful treatment. Specimen requirement is one SST tube of blood or 1 mL of spinal fluid. Continue reading >>

Importance Of Follow-up Cerebrospinal Fluid Analysis In Cryptococcal Meningoencephalitis

Importance Of Follow-up Cerebrospinal Fluid Analysis In Cryptococcal Meningoencephalitis

Importance of Follow-Up Cerebrospinal Fluid Analysis in Cryptococcal Meningoencephalitis 1Department of Neurology, Hannover Medical School, Carl-Neuberg-Strae-1, 30625 Hanover, Germany 2Department of Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany 3Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, 30625 Hannover, Germany 4Department of Neurology, University of Lbeck, 23538 Lbeck, Germany 5Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, 30625 Hannover, Germany Received 2 July 2014; Accepted 15 September 2014; Published 13 October 2014 Copyright 2014 Thomas Skripuletz et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Cryptococcal meningoencephalitis represents a serious infection of the central nervous system, where reliable prognostic factors during the disease course are needed. Twenty-one patients diagnosed with cryptococcal meningoencephalitis in a German university hospital from 1999 to 2013 were analysed retrospectively. CSF parameters were analysed prior to therapy and during antifungal treatment and were compared between patients who survived or deceased. Fifteen patients clinically improved after antifungal therapy, while six patients died. No differences were observed between the outcome groups for the CSF parameters cell count, lactate, total protein, and CSF-serum albumin quotients (QAlb). Follow-up examinations of serum cryptococcal antigen titer and CSF cell count have shown that these parameters cannot be used to monitor the efficacy of antifungal therapy as well. In contrast, the cou Continue reading >>

Veterinary Cryptococcus Latex Agglutination Diagnostic Test

Veterinary Cryptococcus Latex Agglutination Diagnostic Test

-The Cryptococcus Antigen Latex Agglutination System is a qualitative and semi-quantitative test system for the detection of capsular polysaccharide antigens of Cryptococcus neoformans. Monitoring of the antigen titer may be useful during therapy, as clinical improvement is usually accompanied by a decrease in antigen titer. -Latex agglutination test has both diagnostic and prognostic value since progressive disease is usually accompanied by increasing antigen titers. Declining titers are usually associated with clinical improvement, with or without therapy. Inadequate therapy is indicated by stationary or rising titers on subsequent, sequential specimens. Cryptococcus antigen in the body fluids of the untreated patient indicates active infection. However, in some treated patients, titers remain positive at low levels for extended periods during which the organism can no longer be demonstrated. -Serum specimens are pre-treated with pronase and heat inactivated prior to testing. -CSF specimens are heat inactivated prior to testing. The result is not intended to be used as the sole means for clinical diagnosis or patient management decisions. Although the test sensitivity and specificity are high overall, false positives and false negatives may be observed. False negatives are more common with localized disease. Titers of up to 200 have been observed in cats without demonstrable overt cryptococcosis. High protein levels can cause interference. Serum: Collect serum specimens in serum separator or red top tube. Allow blood to clot for 30 minutes, then centrifuge. Pipette serum into a plastic screw cap vial. CSF: Collect in sterile container. Centrifuge to remove leukocytes and particulate matter. Continue reading >>

Clfa - Clinical: Cryptococcus Antigen Screen With Titer, Spinal Fluid

Clfa - Clinical: Cryptococcus Antigen Screen With Titer, Spinal Fluid

Cryptococcus Antigen Screen with Titer, Spinal Fluid If result is positive, Cryptococcus titer will be performed at an additional charge. Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test Cryptococcosis is an invasive fungal infection caused by Cryptococcus neoformans or C gattii. C neoformans has been isolated from several sites in nature, particularly weathered pigeon droppings. C gattii was previously only associated with tropical and subtropical regions, however, more recently this organism has also been found to be endemic in British Columbia and among the Pacific Northwest United States, and is associated with several different trees species. Infection is usually acquired via the pulmonary route. Patients are often unaware of any exposure history. Approximately half of the patients with symptomatic disease have a predisposing immunosuppressive condition such as AIDS, steroid therapy, lymphoma, or sarcoidosis. Symptoms may include fever, headache, dizziness, ataxia, somnolence, and cough. While the majority of C neoformans infections occur in immunocompromised patient populations, C gattii has a higher predilection for infection of healthy hosts.(1,2) In addition to the lungs, cryptococcal infections frequently involve the central nervous system (CNS), particularly in patients infected with HIV. Mortality among patients with CNS cryptococcosis may approach 25% despite antibiotic therapy. Untreated CNS cryptococcosis is invariably fatal. Disseminated disease may affect any organ system and usually occurs in immunosuppressed individuals. Note: According to the College of American Pathologists (CAP, IMM.41840), cerebrospinal fluid (CSF) samples submitted for initial diagnosis, which test positive by the lateral f Continue reading >>

Cryptococcus Antigen Titer, Lfa, Serum -essentia Health Laboratories

Cryptococcus Antigen Titer, Lfa, Serum -essentia Health Laboratories

Monitoring Cryptococcus antigen titers inserum Aiding in the diagnosis of cryptococcosis Cryptococcosis is an invasive fungal infection caused byCryptococcus neoformans or C gattii. Cneoformans has beenisolated from several sites in nature, particularly weatheredpigeon droppings. C gattii was previously onlyassociated with tropical and subtropical regions, however, morerecently this organism has also been found to be endemic in BritishColumbia and among the Pacific Northwest United States, and isassociated with several different trees species. Infection is usually acquired via the pulmonary route. Patientsare often unaware of any exposure history. Approximately half ofthe patients with symptomatic disease have a predisposingimmunosuppressive condition such as AIDS, steroid therapy,lymphoma, or sarcoidosis. Symptoms may include fever, headache,dizziness, ataxia, somnolence, and cough. While the majority ofC neoformansinfections occur in immunocompromised patient populations, Cgattii has a higherpredilection for infection of healthy hosts.(1,2) In addition to the lungs, cryptococcal infections frequentlyinvolve the central nervous system (CNS), particularly in patientsinfected with HIV. Mortality among patients with CNS cryptococcosismay approach 25% despite antibiotic therapy. Untreated CNScryptococcosis is invariably fatal. Disseminated disease may affectany organ system and usually occurs in immunosuppressedindividuals. The presence of cryptococcal antigen in any body fluid (serum orcerebrospinal fluid: CSF) is indicative ofcryptococcosis. Disseminated infection is usually accompanied by a positiveserum test. Declining titers may indicate regression of infection. However,monitoring titers to cryptococcal antigen should not be used as atest of cure or to guide treatmen Continue reading >>

Slfa - Clinical: Cryptococcus Antigen Screen With Titer, Serum

Slfa - Clinical: Cryptococcus Antigen Screen With Titer, Serum

Cryptococcus Antigen Screen with Titer, Serum An aid in the diagnosis of cryptococcosis If result is positive, Cryptococcus titer will be performed at an additional charge. Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test Cryptococcosis is an invasive fungal infection caused by Cryptococcus neoformans or C gattii. C neoformans has been isolated from several sites in nature, particularly weathered pigeon droppings. C gatti was previously only associated with tropical and subtropical regions; however, more recently this organism has also been found to be endemic in British Columbia and among the Pacific Northwest United States, and is associated with several different trees species. Infection is usually acquired via the pulmonary route. Patients are often unaware of any exposure history. Approximately half of the patients with symptomatic disease have a predisposing immunosuppressive condition such as AIDS, steroid therapy, lymphoma, or sarcoidosis. Symptoms may include fever, headache, dizziness, ataxia, somnolence, and cough. While the majority of C neoformans infections occur in immunocompromised patient populations, C gattii is has a higher predilection for infection of healthy hosts.(1,2) In addition to the lungs, cryptococcal infections frequently involve the central nervous system (CNS), particularly in patients infected with HIV. Mortality among patients with CNS cryptococcosis may approach 25% despite antibiotic therapy. Untreated CNS cryptococcosis is invariably fatal. Disseminated disease may affect any organ system and usually occurs in immunosuppressed individuals. Continue reading >>

Ucsf Departments Of Pathology And Laboratory Medicine | Sfgh Lab Manual | Laboratory Test Database | Cryptococcal Antigen

Ucsf Departments Of Pathology And Laboratory Medicine | Sfgh Lab Manual | Laboratory Test Database | Cryptococcal Antigen

CRAC (CSF): Qualitative test done 24 hours/7 days The cryptococcal antigen detection test utilizes latex particles coated with anticryptococcal immunoglobulin. The sensitized latex particles react with the cryptococcal polysaccharide antigen causing a visible agglutination. Titers are performed on all positive specimens. Cryptococcal antigen in the CSF or serum of untreated patients indicates active disease. Declining titers indicate a positive response to chemotherapy in the treated patient. Failure of titers to decline indicates inadequate therapy. Occasionally, however, low titers may persist for an indefinite period in the presence of nonviable fungus. A negative test result does not exclude a diagnosis of cryptococcosis, particularly if only a single specimen has been tested and the patient shows symptoms consistent with cryptococcosis. One false positive reaction due to an antigen of Trichosporon beigelii which crossreacts with the Cryptococcus neoformans capsular polysaccharide has been reported. The reaction occurred in a serum specimen from a patient with disseminated Trichosporon infection. REQUISITION: Blood/Serum - Main Laboratory (for blood) or Microbiology (for CSF). 1. Chuck SL, and Sande MA. 1989. Infections with Cryptococcus neoformans in the acquired immunodeficiency syndrome. N. Engl. J. Med., 321:794-799. 2. Hamilton JR, Noble A, Denning DW, Stevens DA. 1991. Performance of cryptococcus antigen latex agglutination kits on serum and cerebrospinal fluid specimens of AIDS patients before and after pronase treatment. J. Clin. Microbiol., 29:333-339. 3. Frank U, Nishimura SL, Li NC, Sugai K, Yajko DM, Hadley WK, Ng VL. 1993. Evaluation of an enzyme immunoassay for detection of cryptococcal capsular polysaccharide antigen in serum and cerebrospinal fluid. Continue reading >>

Cryptococcosis Workup: Laboratory Studies, Imaging Studies, Procedures

Cryptococcosis Workup: Laboratory Studies, Imaging Studies, Procedures

Author: John W King, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD more... Cutaneous lesions should be biopsied and evaluated with fungal stains and cultures. Blood and CSF should be cultured for fungi and submitted for cryptococcal antigen testing. Even with widespread disease, the routine laboratory tests (eg, leukocyte count, hematocrit, sedimentation rate) may yield normal results. Evaluation of spinal fluid is essential in diagnosing CNS disease. Opening pressures should be measured at each spinal tap; elevated pressures (250 mm H2 O) portend a poor prognosis. Opening pressures in excess of 250 mm H2 O require drainage of CSF to reduce the pressure to 200 mm H2 O or lower. Prior to removal of CSF, CT scanning or MRI should be performed to exclude masses that could result in herniation. CSF glucose concentrations are usually depressed, while CSF protein concentrations are usually elevated. Leukocyte counts in the CSF are 20/L or higher, with a lymphocyte predominance. The CSF can be normal at times, as in patients with AIDS who are unable to mount an adequate inflammatory response or in persons with early infection. However, these patients often have positive results on India ink preparation and CSF cryptococcal antigen testing. Serologic testing of blood and CSF should be done whenever cryptococcal CNS infection is considered. Antigen tests are frequently out of reach in impoverished countries due to cost. As a result, cryptococcosis often goes undiagnosed in these areas. In 2009, a lateral flow assay (LFA) for diagnosing cryptococcosis was developed. A study of HIV-infected patients in Thailand compared LFA results with culture and enzyme immunoassay (EIA). Results showed a high level of agreement between LFA and EIA testing, which suggests LFA may Continue reading >>

1992 - Bronchoalveolar Cryptococcal Antigen Was Accurate For Diagnosing Cryptococcal Pneumonia In Immunocompromised Patients | 1992 Nov-dec : Volume 117, Number 3, Page 85 | Acp Journal Club Archives

1992 - Bronchoalveolar Cryptococcal Antigen Was Accurate For Diagnosing Cryptococcal Pneumonia In Immunocompromised Patients | 1992 Nov-dec : Volume 117, Number 3, Page 85 | Acp Journal Club Archives

Bronchoalveolar cryptococcal antigen was accurate for diagnosing cryptococcal pneumonia in immunocompromised patients ACP J Club. 1992 Nov-Dec;117:85. doi:10.7326/ACPJC-1992-117-3-085 Baughman RP, Rhodes JC, Dohn MN, Henderson H, Frame PT. Detection of cryptococcal antigen in bronchoalveolar lavage fluid: a prospective study of diagnostic utility. Am Rev Respir Dis. 1992 May;145:1226-9. To assess the accuracy of measuring cryptococcal antigen in the bronchoalveolar lavage (BAL) fluid in diagnosing Cryptococcus neoformans pneumonia in immunocompromised patients. Independent evaluation of the BAL fluid for cryptococcal antigen and of specimens from bronchoscopy and lung biopsy for C. neoformans. Pulmonary service department in a university medical center in the United States. 224 immunocompromised patients (188 patients with AIDS, 16 with solid organ transplant, 11 with malignancy on chemotherapy, and 9 without malignancy who were receiving high-dose corticosteroids or cytotoxic agents) having bronchoscopy and BAL for respiratory symptoms and fever. The lavage specimens from 4 patients were not tested because they were insufficient or lost. Description of test and diagnostic standard BAL was done in the area of the infiltrate or in the right middle lobe of patients with diffuse infiltrates or normal roentgenograms. An aliquot of the cell-free fluid was tested for cryptococcal antigen using a latex agglutination system (CALAS; Meridian Diagnostics, Norwich, Ohio). The amount of agglutination was read on a 5-point scale (0 to 4+). The highest dilution that caused at least 2+ agglutination was considered positive. The standard for diagnosis was the detection of a pulmonary infiltrate and identification of C. neoformans by either culture or cytologic examination of a pulmona Continue reading >>

Cryptococcal Ag, Blood

Cryptococcal Ag, Blood

Clinical Microbiology (Weekends, Evenings, Nights) 2 hours (STAT); 1-3 days(Routine) For STAT requests, please call 984-974-1815 (Dayshift Mon-Sat), 984-974-1805 (after hours) The Immy CrAg Lateral Flow Assay is a dipstick sandwich immunochromatographic test system for the qualitative or semi-quantitative detection of the capsular polysaccharide antigens of Cryptococcus species complex in serum and cerebral spinal fluid (CSF). The lateral flow device is placed into a tube containing sample and diluent. Specimen wicking is used to capture gold-conjugated, anti-CrAg monoclonal antibodies and gold-conjugated control antibodies deposited on the test membrane. If CrAg is present in the specimen, then it binds to the gold-conjugated, anti-CrAg antibodies. The gold-labeled antibody-antigen complex forms a sandwich at the test line causing a visible line to form. Results are reported as negative or positive. Positive results are accompanied by the endpoint titer determined by serial dilution of the specimen. Reviewed by jcayless on December 02, 2019 Note: Reference ranges provided on this web site are for guidance only, and may not reflect the most recent changes. Refer to laboratory reports for current reference data. Continue reading >>

Low Cryptococcus Antigen Titers As Determined By Lateral Flow Assay Should Be Interpreted Cautiously In Patients Without Prior Diagnosis Of Cryptococcal Infection

Low Cryptococcus Antigen Titers As Determined By Lateral Flow Assay Should Be Interpreted Cautiously In Patients Without Prior Diagnosis Of Cryptococcal Infection

Low Cryptococcus Antigen Titers as Determined by Lateral Flow Assay Should Be Interpreted Cautiously in Patients without Prior Diagnosis of Cryptococcal Infection Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA Address correspondence to Elitza S. Theel, [email protected] . Citation Dubbels M, Granger D, Theel ES. 2017. Low Cryptococcus antigen titers as determined by lateral flow assay should be interpreted cautiously in patients without prior diagnosis of cryptococcal infection. J Clin Microbiol 55:24722479. . Received 2017 May 8; Revisions requested 2017 May 23; Accepted 2017 May 24. Copyright 2017 American Society for Microbiology. Detection of Cryptococcus antigen (CrAg) is invaluable for establishing cryptococcal disease. Multiple different methods for CrAg detection are available, including a lateral flow assay (LFA). Despite excellent performance of the CrAg LFA, we have observed multiple cases of low-titer (1:5) positive CrAg LFA results in patients for whom cryptococcosis was ultimately excluded. To investigate the accuracy of low-titer positive CrAg LFA results, we performed chart reviews for all patients with positive CrAg LFA results between June 2014 and December 2016. During this period, serum and/or cerebrospinal fluid (CSF) samples from 3,969 patients were tested with the CrAg LFA, and 55 patients (1.5%) tested positive. Thirty-eight of those patients lacked a history of cryptococcal disease and were the focus of this study. Fungal culture or histopathology confirmed Cryptococcus infection for 20 patients (52.6%), and CrAg LFA titers in serum and CSF samples ranged from 1:5 to 1:2,560. For the 18 patients (47.4%) without culture or histopathological confirmation, the CrAg LFA Continue reading >>

Practice Guidelines For The Management Of Cryptococcal Disease

Practice Guidelines For The Management Of Cryptococcal Disease

An 8-person subcommittee of the National Institute of Allergy and Infectious Diseases (NIAID) Mycoses Study Group evaluated available data on the treatment of cryptococcal disease. Opinion regarding optimal treatment was based on personal experience and information in the literature. The relative strength of each recommendation was graded according to the type and degree of evidence available to support the recommendation, in keeping with previously published guidelines by the Infectious Diseases Society of America (IDSA). The panel conferred in person (on 2 occasions), by conference call, and through written reviews of each draft of the manuscript. The choice of treatment for disease caused by Cryptococcus neoformans depends on both the anatomic sites of involvement and the host's immune status. For immunocompetent hosts with isolated pulmonary disease, careful observation may be warranted; in the case of symptomatic infection, indicated treatment is fluconazole, 200400 mg/day for 36 months. For those individuals with non-CNS-isolated cryptococcemia, a positive serum cryptococcal antigen titer >1 : 8, or urinary tract or cutaneous disease, recommended treatment is oral azole therapy (fluconazole) for 36 months. In each case, careful assessment of the CNS is required to rule out occult meningitis. For those individuals who are unable to tolerate fluconazole, itraconazole (200400 mg/day for 612 months) is an acceptable alternative. For patients with more severe disease, treatment with amphotericin B (0.51 mg/kg/d) may be necessary for 610 weeks. For otherwise healthy hosts with CNS disease, standard therapy consists of amphotericin B, 0.71 mg/kg/d, plus flucytosine, 100 mg/kg/d, for 610 weeks. An alternative to this regimen is amphotericin B (0.71 mg/kg/d) plus 5-flucyt Continue reading >>

Cryptococcal Thyroiditis And Hyperthyroidism

Cryptococcal Thyroiditis And Hyperthyroidism

Please confirm that you would like to log out of Medscape.If you log out, you will be required to enter your username and password the next time you visit. Log out Cancel Cryptococcal Thyroiditis and Hyperthyroidism A 39-year-old man on long-term immunosuppressive therapy for kidney and pancreas transplants was evaluated in the outpatient clinic for low-grade fever (37.5C), dry cough, and rhinorrhea; he then exhibited painless thyroid gland enlargement. His past medical history was significant for type 1 diabetes mellitus for 27 years complicated by the development of peripheral somatic neuropathy, diabetic retinopathy and diabetic nephropathy leading to end-stage renal disease. Eight years previously the patient received a kidney transplant from a living-related donor, and subsequently a cadaver pancreatic transplant. His immunosuppressive regimen for the past several years consisted of tacrolimus 6 mg twice daily, mycophenolate mofetil 1000 mg twice daily, and prednisone 10 mg daily. On admission to the hospital the patient presented with fever (38.5C), headache, weakness, nausea and vomiting, tachycardia (97 beats per minute) and blood pressure of 160/90 mm Hg. His thyroid gland was asymmetrically enlarged (right lobe larger than left lobe), approximately 3 times normal size, of firm consistency and nontender to palpation. There were no discrete nodules nor areas of fluctuency in the thyroid gland; cervical lymphadenopathy was absent. Laboratory studies revealed: normal white blood cell count of 8100 cells per microliter with lymphopenia and relative monocytosis: neutrophils 67.8%, lymphocytes 11.2% and monocytes 19.9%; hemoglobin was 11.5 g/dL and platelets 309,000 cells per microliter. Erythrocyte sedimentation rate (Westergren method) was 14 mm/hr (normal range, Continue reading >>

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