Glandular Pfeiffer fever

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Pfeiffer's glandular fever (mononucleosis) is a viral disease that almost everyone becomes infected with in the course of their lives.It is usually transmitted through the saliva and is therefore also known as the kissing disease. However, the disease often does not break out or goes unnoticed. When adults become ill, the symptoms are often particularly severe and manifest as sore throats, swollen lymph nodes, fever and fatigue. Find out more about the most important signs, routes of infection and therapies here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. B27

Pfeiffer's glandular fever: brief overview

Main symptoms: sore throat, swollen lymph nodes, fatigue, fever, enlarged spleen
Contagion: Through saliva when kissing or through body fluids (sexual intercourse, blood)
Diagnostics: blood test for the Epstein-Barr virus (EBV) and EBV antibodies, throat swab, palpation of the spleen and lymph nodes
Treatment: Symptomatic treatment of pain and fever, if the course is severe, cortisone
Possible complications: threateningly swollen throat, ruptured spleen, inflammation of the liver, meningitis, symptoms of paralysis, skin rash

Glandular Pfeiffer fever: symptoms

Pfeiffer's glandular fever (infectious mononucleosis, mononucleosis infectiosa, monocyte angina) is caused by the Epstein-Barr virus (EBV). The disease manifests itself mainly in the form of tonsillitis and throat inflammation with heavily swollen lymph nodes, fever and fatigue due to Pfeiffer's glandular fever.

In children, the infection often has few symptoms because their immune system does not yet react strongly to the pathogen. In adults, lighter courses can be mistaken for a flu-like infection. However, severe courses with complications are also possible.

"You only get infected once"

Three questions for

Priv. Doz. med. Thomas Braun,
Specialist in ear, nose and throat medicine
1
When do you test specifically for glandular fever?

Priv. Doz. med. Thomas Braun
For stubborn sore throats with swelling of the lymph nodes, especially in the typical young age of infection. The tonsils are often yellowish or greyish, so that one usually assumes a bacterial strep throat and may prescribe antibiotics a little too quickly. If, however, the patient does not feel better afterwards, more extensive smear and blood tests are carried out. Some patients also specifically ask for clarification.
2
Is Pfeiffer's glandular fever dangerous?

Priv. Doz. med. Thomas Braun
Yes and no. The acute infection is sometimes extremely painful, persistent and grueling, but not really dangerous - unless you exercise too early and risk tearing your liver or spleen, as these organs are sometimes swollen. Unfortunately, the Epstein-Barr viruses can cause cancer later in life - about two percent of all cancers worldwide are believed to be due to them. Unfortunately, there is still no vaccine that would protect.
3
How long does it take to recover?

Priv. Doz. med. Thomas Braun
Very different. In children in particular, the disease often has only very mild symptoms, while some adults suffer for months, in particular from exhaustion and increased susceptibility to infections. Usually, however, the worst is over after a few weeks. And there is little consolation that you only get infected with it once in a lifetime ...
Priv. Doz. med. Thomas Braun,
Specialist in ear, nose and throat medicine
Priv.-Doz. Dr. med. Thomas Braun is a specialist in ear, nose and throat medicine in Augsburg and even after two decades remembers his own Pfeiffer glandular fever with horror.

Glandular Pfeiffer fever: main symptoms

Sore throat: Typical of Pfeiffer's glandular fever are severe sore throats with intense reddening of the pharynx and pronounced difficulty swallowing. The tonsils and lymph nodes swell and some patients develop a high fever.

Pronounced fatigue: In the acute phase of the illness, patients feel extremely exhausted and powerless. They usually recover within one to two weeks.

In others, however, tiredness, listlessness and the general feeling of illness can persist for a long time - even without the typical symptoms of Pfeiffer's glandular fever having first appeared.

In athletes in particular, sudden inefficiency is often the first, and sometimes the only, sign of the disease. In some cases the pronounced fatigue lasts for several months.

Swollen spleen (splenomegaly): The spleen plays an important role in defending against disease and filters dead blood cells from the blood. She is particularly challenged during an infection with the Epstein-Barr virus. As the disease progresses, it can therefore swell and sometimes even tear.

Typical symptoms of glandular fever

Pfeiffer's glandular fever triggers the symptoms shown. Further systemic symptoms are fever, shaking forests, headache and fatigue.

Glandular Pfeiffer fever: complications

Pfeiffer's glandular fever is usually uncomplicated. However, serious, sometimes life-threatening complications can also occur.

Heavily swollen throat: It becomes dangerous when the immune system reacts so strongly to the virus that the mucous membrane of the throat swells very much. This can make swallowing impossible and even impede breathing.

Rupture of the spleen: A severely swollen spleen can tear from impacts or falls. Then the heavy internal bleeding creates a life-threatening situation. Patients should therefore strictly avoid the risk of shock injuries in this condition.

Inflammation of the liver (hepatitis): The virus can also affect the liver, causing inflammation of the liver. If this is difficult, the skin turns yellow due to the impaired liver function (jaundice) in the case of glandular fever.

Skin rash: About five to ten percent of the sick develop a blotchy, raised (lumpy) skin rash, the so-called maculopapular rash.

Symptoms of paralysis: If the virus reaches the nervous system, it can trigger inflammation there with symptoms of paralysis, which can also threaten breathing.

Inflammation of the brain: the virus can get into the brain. There it can cause meningitis or meningitis.

Glandular fever: infection and causes

Glandular fever is contagious. It is caused by the Epstein-Barr virus (EBV). The pathogen multiplies in the lymphocytes and in the mucous membrane cells in the throat. The virus cannot survive long outside the human body.

Epstein-Barr Virus

The Epstein-Barr virus causes Pfeiffer's glandular fever. It is transmitted through body fluids - mainly through saliva.

Ways of infection

EBV is transmitted through body fluids. Since the virus is mainly found in saliva, it is particularly easy to get infected through close physical contact and kissing. In English-speaking countries, Pfeiffer's glandular fever is therefore referred to as “kissing disease”, in German also as “kissing disease”.

A particularly common route of infection is among small children, for example in kindergarten, where toys often get into their mouths and are exchanged with one another. Particularly “kissing” population groups such as young adults are also more likely to be infected (“student fever”). 95 percent of people over 30 are infected with the glandular fever pathogen.

Other routes of infection, such as sexual intercourse, blood transfusions or organ donations, are also possible, but far less common.

Glandular Pfeiffer fever: incubation period

The incubation period, i.e. the period between infection and the onset of the disease, is long in Pfeiffer's glandular fever. There are usually four to six weeks between infection and the onset of the disease. During this time, however, the infected person can infect other people without knowing that they are sick themselves.

How long is glandular fever contagious?

Newly infected people pass the virus on particularly easily. In this phase, a particularly large number of pathogens are excreted in the saliva. This is the case for a long time after the symptoms have subsided. In order not to infect others, you should therefore be cautious with kissing in the first few months after the initial infection and avoid unprotected sexual intercourse.

Pfeiffer's glandular fever - how long is it contagious?

A person who is once infected with glandular fever remains a carrier of the virus for life. The immune system then keeps the pathogen in check so that the disease does not usually break out again.

From time to time, however, the virus is increasingly released into the saliva. All virus carriers can therefore infect others for life even after the symptoms have subsided.

Course of infection in Pfeiffer's glandular fever

The Epstein-Barr virus affects mucosal cells and white blood cells. The body makes antibodies against the virus, which often remains in the body for life.

Infection with glandular fever during pregnancy

There is some evidence that initial infection during pregnancy is associated with a higher rate of miscarriages or deformities. However, most women of childbearing potential became infected with Epstein-Barr virus long before pregnancy. As a result, few become infected for the first time during pregnancy.

If the mother has already had an EBV infection, she transfers her protection against the virus to the newborn. This lasts for the first six months of the baby's life. As a rule, the child can only get infected afterwards.

Pfeiffer's glandular fever: examinations and diagnosis

Diagnosing glandular fever is often difficult. The main symptoms such as sore throat, fever and swelling of the lymph nodes also occur with simple flu-like infections and colds. In many cases, Pfeiffer's glandular fever is therefore not recognized at all or only recognized late.

A targeted examination for Pfeiffer's glandular fever is usually only carried out when the fever does not go down or the patient complains of fatigue for weeks or a severe inflammation of the throat does not subside.

The main aim of the investigation is to find out whether viruses such as the Epstein-Barr virus or bacteria such as streptococci are causing the symptoms. Antibiotics only help with bacterial infections, but not with viral infections. They would even burden the patient unnecessarily.

Physical examination

Throat Exam: During the physical exam, the doctor will first examine the throat and tonsils. With glandular fever, they are reddened and often very swollen. The coatings also provide an indication of the type of infection: While they look more like specks in bacterial streptococcal tonsillitis, they appear white and flat in Pfeiffer's glandular fever.

Palpation of the lymph nodes: By palpating the neck under the angle of the jaw, the armpits and the groin region, the doctor can determine whether and which lymph nodes are swollen.

Palpation of the spleen: In Pfeiffer's glandular fever, the spleen often swells to such an extent that the doctor can clearly feel it from the outside.

Throat swab: A throat swab can be used in the laboratory to determine whether bacteria are the cause of the disease. If the smear contains the Epstein-Barr virus, this is not enough for a reliable diagnosis of glandular fever. The pathogen is not only found in an acute infection on the mucous membrane. It can also be detected if the virus has been in the body for a long time and has only been reactivated.

Diagnosis by blood test

Antibodies: For a reliable diagnosis of Pfeiffer's glandular fever, specific antibodies against the Epstein-Barr virus can be detected in the blood.

Deformed lymphocytes: A blood test can also determine whether these white blood cells are changed. Since they have to be regenerated en masse during infection, many of them are somewhat deformed at first. For this reason they are also called Pfeiffer cells or atypical lymphocytes.

Elevated liver values: If the liver is attacked by the virus, a blood test also shows an increased concentration of liver enzymes (transaminases).

Glandular Pfeiffer fever: treatment

Pfeiffer's glandular fever is a viral disease. Antibiotics therefore do not help, because they only work against bacterial infections.

Treatment therefore focuses on relieving symptoms such as pain, difficulty swallowing and fever. To do this, common agents such as ibuprofen, acetylsalicylic acid or paracetamol are used.

An important principle of treatment for glandular fever is physical rest. This can significantly reduce the risk of serious complications. The discharge, which includes a strict ban on sports, should be observed for a while after the acute symptoms of the disease have persisted.

If complications arise, further treatment may be necessary. If the mucous membrane of the throat swells threateningly or if symptoms such as fatigue and fever are very pronounced, treatment is also given with cortisone or other active ingredients that dampen the activity of the immune system.

A ruptured spleen must be operated on immediately, otherwise the patient is in danger of bleeding to death.

What is still important in the treatment of Pfeiffer's glandular fever can be found in the article Pfeiffer's glandular fever - treatment.

Pfeiffer's glandular fever: disease course and prognosis

Glandular Pfeiffer fever lasts up to three weeks. Usually it heals without lasting consequences. However, if complications are suspected or if the blood values deteriorate dramatically, patients are treated in hospital for monitoring.

In very rare cases, glandular fever becomes chronic. That is, the symptoms persist for months or even years. On the other hand, Pfeiffer's glandular fever rarely leads to permanent damage due to complications such as liver inflammation and meningitis.

It is assumed that an EBV infection increases the risk of some blood cancers (for example B-cell lymphoma, Burkitt's lymphoma, Hodgkin's disease).

Pfeiffer's glandular fever: what you can do yourself

Since the Epstein-Barr virus is very widespread in the population (the "infection rate" is 95 percent), you can hardly protect yourself from it. In the event of illness, however, there are a few things you can do to prevent a severe course of glandular fever.

Avoid alcohol

The infection also often puts a considerable strain on the liver. Therefore, you should strictly avoid alcohol in the illness phase so as not to put additional strain on the liver. In some cases, the liver values remain elevated for months, so that regular blood tests are necessary and you should avoid alcohol even after the symptoms have subsided in order to avoid permanent liver damage.

Adjust medication

Since many drugs are broken down in the liver, some active ingredients have to be replaced with less liver-damaging substances for the duration of the illness, in consultation with the doctor.

Exercise caution!

In the acute phase or in the event of severe infections, you should refrain from exercising altogether; later, in consultation with the doctor, light exercise training may be possible.

If the spleen swells significantly with glandular fever, there is a risk that the very blood-rich organ will tear during physical exertion or through external force. The result is severe internal bleeding that can be life-threatening. Therefore, contact and martial arts are to be strictly avoided in the acute phase of the illness.