Pfeiffersches glandular fever (infectious mononucleosis)

Description

The Epstein-Barr virus (EBV) causes glandular fever. Mucous membranes of the nose, mouth and throat as well as B-lymphocytes (a subspecies of white blood cells) are affected. Due to the frequent infection by saliva contact, this disease is popularly known as kissing disease.

The disease usually heals after 2-3 weeks without complications. In rare cases, Pfeiffer's glandular fever takes a severe course.

Infectious mononucleosis is particularly widespread among young adults; by the age of 30, 95% have already been infected with it. Those who have already been infected once have formed antibodies against the Epstein-Barr virus, which ensure almost lifelong immunity. Only people with a weakened immune system can become infected again.

A representative of the herpes viruses triggers infectious mononucleosis. To be more precise, it is the Epstein-Barr virus. Transmission takes place via droplet (coughing and sneezing), contact or smear infection (saliva contact, e.g. through kissing). This disease is also known colloquially as student sickness, student fever or kissing disease.

The incubation period (time between infection and symptom formation) is between 14 and, more rarely, 50 days.

Before the onset of the disease in adults announce flu-like symptoms that turn into fever.

• Fever
• Tonsillitis (inflamed tonsils) with white coating
• Severely swollen, painful lymph nodes in the neck and throat (rarely armpits)
• Persistent fatigue (lasting up to several months)
• aching limbs, headache
• Pain in the upper abdomen, nausea
• Enlargement of the spleen
• Enlargement of the liver
• jaundice (icterus)
• rash after treatment with aminopenicillins (antibiotic-associated drug rash)

In young children, mononucleosis can also be completely asymptomatic (without any symptoms).

Chronic mononucleosis is possible in exceptional cases. Depressive mood, fever or fatigue can last for months to years, as can swollen lymph nodes.

Due to the uncharacteristic symptoms, infectious mononucleosis is often not recognized immediately.

An examination of the blood values brings a clear diagnosis. Indicators in the blood are antibodies against the Epstein-Barr virus, increased leukocyte count and virocytes or Pfeiffer cells. The latter are activated T-lymphocytes (special defence cells). Elevated liver values also confirm a suspicion of Pfeiffer's glandular fever.

The tests sometimes have to be repeated, as the Epstein-Barr antibodies in particular are not detectable immediately after infection with the disease.

Treatment is symptom-oriented. There is no drug against the cause of mononucleosis. Recommended in any case:

• Physical rest (danger of rupture of the spleen)
• Sufficient fluid intake (especially in case of fever)
• Antipyretic medication if the temperature is very high.

In addition to glandular fever, patients often also become infected with streptococci (bacteria), which can trigger tonsillitis.

Due to a possible skin rash (drug exanthema), aminopenicillins (e.g. ampicillin, amoxicillin) must not be taken!

Complications are rare. However, encephalitis (inflammation of the brain), autoimmune haematolytic anaemia (anaemia caused by infection) and thrombocytopenia (anaemia of the blood platelets) cannot be ruled out. In these cases, cortisone is used and, if necessary, also virustatics (virus inhibitors).

After 2-3 weeks, mononucleosis heals in most patients without complications. Rarely, the healing process can take a longer time.

Only in a few cases does the disease take a more complex course:

• Respiratory distress, threatened obstruction of the upper respiratory tract;
• pneumonia, pleural effusion (accumulation of fluid between the pleura and the lung);
• Rupture of the spleen (life-threatening!);
• Meningitis (inflammation of the brain), encephalitis (inflammation of the brain);
• Myocarditis (inflammation of the heart muscle), Pericarditis (inflammation of the heart sac);
• Hemolytic anemia (anemia), thrombocytopenia (decreased platelet count);
• Interstitial nephritis (inflammation of the kidneys);

In immunocompromised patients, rarer sequelae are not excluded:

• B-cell lymphoma, Burkitt's lymphoma (tumors of the lymph nodes).
• Nasopharyngeal carcinoma (tumours in the nose and throat)
• Oral hairy leukoplakia (whitish, streaky changes at the edge of the tongue)

Immunosuppressive people (e.g. after organ transplant) can also be affected by the above complications (post-transplant syndrome).

Infection by the Epstein-Barr virus can only be prevented by avoiding (bodily and salivary) contact with infected persons. To date, there are no vaccines of any kind.

Even after the symptoms have subsided, the pathogen can still be detected in saliva for months. Blood donations should also be avoided for the first 6 months after the onset of the disease.