Medical: Pfeiffer glandular fever, infectious mononucleosis, mononucleosis infectiosa, monocyte angina, Pfeiffer's disease. Engl .: kissing disease
Pfeiffer's glandular fever is an acute febrile infectious disease caused by the Epstein-Barr virus (EBV).
Adolescents and young adults are particularly affected. The incubation period is about seven to nine days for children and four to six weeks for adolescents and young adults. It usually takes two months to heal completely.
According to the pediatrician Dr. Emil Pfeiffer (1846–1921) was named.
The pathogen is the Epstein-Barr virus (EBV), a DNA virus from the herpes virus family.
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It only infects B-lymphocytes (immune cells that form antibodies) and epithelial cells of the throat and nose, since only these cells are the only ones to have a docking point (receptor) for EBV.
The multiplication and release of the virus takes place for the most part in the infected epithelium instead of. In the phase of reproduction, the virus produces early and late proteins ("early"- and "late“- proteins) against which the body forms antibodies that are important for diagnostics.
In the acute phase of Pfeiffer's glandular fever, only about one in 1,000 B-lymphocytes is infected; after recovery, one in a million. However, few of these produce EBV.
With the virus antigens on their surface, the infected B-lymphocytes cause an immunological defense reaction. There is a strong increase in other groups of white blood cells (T lymphocytes and macrophages) instead of.
The pathological changes in the mucous membranes and in the lymphatic tissue are consequences of this immunological defense reaction. In the case of congenital or acquired defects in the immune system, infected B-lymphocytes cannot be sufficiently suppressed, which is why an uncontrolled multiplication leads to malignant tumors of the lymph tissue (malignant lymphomas) can come.
$config[ads_text2] not foundRead more on the topic: Epstein-Barr Virus
Pfeiffer's glandular fever in childhood usually goes unnoticed and the typical symptoms only appear in 25-50% of infected adults.
Symptoms that can appear before the onset of the disease include headache, fatigue, and aching limbs.
After the long incubation period of several weeks, pharyngitis, swelling of the lymph nodes in the neck, headache and fever, which can rise to 40 ° C, appear in almost all sufferers.
It can also cause inflammatory swelling and reddening of the tonsils (Tonsils) come with white-yellowish deposits. Most of the time, the patient has difficulty swallowing, coughs and has to breathe through the mouth because his nasopharynx is blocked by swelling of the lymph tissue in the pharynx wall, for example.
Small, punctiform hemorrhages (petechiae) can be seen on the palate and the oral mucosa and gums can be inflamed.
In about 50% of the sick there is an enlargement of the spleen (Splenomegaly). A tear in the spleen (Ruptured spleen) on the other hand is extremely rare, but it must be treated surgically immediately.
In 25% of the sick there is an enlargement of the liver (Hepatomegaly) with a slight yellowing of the skin and conjunctiva (jaundice). A rash in Pfeiffer's glandular fever is also rare.
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The most common neurological symptom is inflammation of the meninges (meningitis), but also paralysis of individual nerves can occur. Sometimes inflammation of the conjunctiva can also occur, rarely inflammation of the optic nerve occurs.
$config[ads_text2] not foundPatients with chronic infection have a pronounced subjective feeling of illness, which manifests itself over months in fatigue, fever, headache, weight loss and swelling of the lymph nodes.
To the main article: You can recognize Pfeiffer's glandular fever by these symptoms
Although fever and the inflammation of the tonsils are the main symptoms of Pfeiffer's glandular fever, atypical disease processes can also occur without the development of fever.
In about 10% of the cases there is no fever. These processes can occur in small children in particular, and they are accompanied by no symptoms at all or with only very mild symptoms.
The fever that occurs as part of the disease often lasts for 10-14 days and is in the rather low range of 38-39 ° C. If there has not yet been a fever, it may be that it only recurs in the course of the illness. A temporary defever is also not uncommon.
In summary, if other findings and complaints fit into the overall picture, it can be a glandular fever, even if no fever occurs over the entire course of the disease. If the course is largely symptom-free and the disease is suspected, a blood test can provide certainty.
A severe inflammation of the tonsils is typical of Pfeiffer's glandular fever.
This is often accompanied by whitish deposits, which can also trigger bad breath. Due to the inflammation of the tonsils, the entire throat and throat area is usually also inflamed and reddened. This leads to a sore throat and difficulty swallowing.
Due to the severe tonsillitis, Pfeiffer's glandular fever is often confused with bacterial tonsillitis, which is why it is incorrectly treated with antibiotics, which can also trigger a rash.
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Find out more about the topic: Signs of tonsillitis
In Pfeiffer's glandular fever, a cough usually arises from the inflammation in the throat and tonsils.
As a result, the mucous membranes in the throat area dry out faster, causing an urge to cough. In addition, the cough is a natural defense mechanism of the body, which is supposed to remove the pathogen. Because of the sore throat, the cough is often very painful. In addition, swallowing disorders and hoarseness are often symptoms.
Diarrhea is not a typical symptom of glandular fever.
In contrast to many other infectious diseases, the gastrointestinal tract is spared from symptoms when infected with the Epstein-Barr virus. However, drugs such as fever reducers can affect the gastrointestinal tract and cause secondary symptoms such as nausea, vomiting, abdominal pain and diarrhea. However, swelling of the spleen and liver should first and foremost be excluded in the case of bulging pain and diarrhea.
Earache is also not one of the classic symptoms of Pfeiffer's glandular fever.
However, due to the connection between the ears, nose and throat, pain can also occur in the ears. This can have two causes: One possibility is that the inflammation spreads from the throat to the ears and also causes inflammation there with pain. The other variant is that the access between the throat and the ears is blocked by the sore throat and the swollen tonsils. As a result, there is no adequate pressure equalization in the ears, which can lead to ear pain.
Fatigue and exhaustion are symptoms that, along with fever and tonsillitis, are most characteristic of Pfeiffer's glandular fever.
While most symptoms subside after a few weeks, the tiredness can persist for several months. This pronounced tiredness is also called fatigue in technical terms. Pfeiffer's glandular fever can even lead to a chronic fatigue syndrome that lasts for several years. The exact cause of this stubborn fatigue has not been adequately researched scientifically and therefore cannot be treated causally.
More on this: Chronic fatigue
$config[ads_text1] not foundJust like the lymph nodes, the spleen can swell considerably in Pfeiffer's glandular fever.
The spleen is like a large lymph node in our body and is primarily responsible for fishing out old cells from the blood. In glandular fever, there are changes in many different blood cells that damage or destroy some of these cells. The spleen has to sort out all these cells from the blood and can therefore easily be overwhelmed. Excessive swelling of the spleen can lead to a rupture of the spleen. This is an absolute emergency due to the heavy bleeding.
Also read: These symptoms indicate a ruptured spleen
The rash that is triggered by Pfeiffer's glandular fever can range from small reddish spots to large swellings and wheals. According to the textbook, the skin rash, also called exanthema, has very large spots, the red spots seem to flow into one another. Most commonly, this rash occurs on the face, stomach, chest and back, and arms and legs.
It usually forms about a week after the infection starts. More serious changes in the house, such as itchy wheals or target-shaped itchy skin changes, occur less frequently. What all these types of rash have in common is that they are accompanied by severe itching. About 30% of the people affected also experience edema (i.e. water retention) on the face. This symptom, too, is usually found within the first week after infection.
In general, the rash caused by Pfeiffer's glandular fever can be aggravated by incorrect therapy. If the disease is mistaken for acute tonsillitis due to the severe swelling of the tonsils, amoxicillin is often prescribed as an antibiotic. However, in the case of infection with the Epstein-Barr virus, i.e. Pfeiffer's glandular fever, this intensifies the rash or only triggers it.
Read more on the topic: Rash in glandular fever
The frequency of complications is less than 1%. The following complications can occur:
The blood values are greatly mixed up by Pfeiffer's glandular fever. If the liver is involved, the transaminases (also called liver values) can be increased.
Antibodies against the virus are formed, which can also be found in the blood. A distinction can be made between acute antibodies, the immunoglobulins M, and those antibodies that indicate that an infection has taken place and the body is now immune to it (immunoglobulin G).
The blood cells also change during Pfeiffer's glandular fever. Anemia can occur, there are fewer platelets and the white blood cells also change.
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Read on this topic too: Blood values in Pfeiffer's glandular fever - These parameters are important
Risks and complications are rare, but complications are often serious.
The risks for the heart are particularly noteworthy here: These exist in particular for people whose immune system is severely weakened, but can also occur in healthy people. Both inflammation of the heart muscle (myocarditis) and inflammation of the pericardium (pericarditis) or a combination of both (perimyocarditis) are possible.
An inflammation of the heart often becomes noticeable due to a loss of performance, but it can also occur without any symptoms at all. Signs of inflammation can be detected by recording heart activity (ECG), a blood test, and imaging tests. The prognosis for existing inflammation is mostly good, but in some cases it can be associated with permanent heart muscle damage (dilated cardiomyopathy and heart failure).
In order to minimize the risks for the heart in the context of Pfeiffer's glandular fever, the treatment suggestion of the doctor should be followed and attention should be paid to physical rest until the disease has healed.
Read more about this under Symptoms of myocarditis
An initial infection of the pregnant mother with glandular fever is usually not dangerous for mother and child.
If the pregnant woman has a normally developed immune system, she can fight the virus effectively and thus also protect the child from the infection. Adequate treatment of the disease can be given in immunocompromised pregnant women. Therefore, a new infection with Pfeiffer's glandular fever during pregnancy is not a cause for concern.
Due to the similarity to more serious diseases such as rubella, however, the symptoms should be clarified precisely. Due to hormonal changes during pregnancy, the virus may reactivate in mothers who have already been infected. This usually manifests itself in weakened symptoms. In this case, too, there is no danger to the unborn child. Since symptoms such as fever, sore throat and tonsillitis can be very unpleasant, the symptoms should be treated under certain circumstances. However, this must be agreed with the attending physician beforehand and adapted to the pregnancy, as many drugs are not approved for pregnant women.
Read more on the topic: Glandular Pfeiffer fever in pregnancy
The normal course of Pfeiffer's glandular fever begins with a long incubation period that lasts for over a month.
This is followed by a fever, headache and fatigue. Later, the lymph nodes swell and the tonsils and throat become inflamed. In addition to the lymph nodes, organs such as the spleen or liver can swell, which can lead to serious complications.
Overall, it can be said that the older the affected people are, the more severe the disease. That is why children are usually completely fit again after a few weeks; in adults, the disease can drag on for several months.
Above all, the reduction in performance and fatigue are symptoms that remain for a very long time. In about 5% of affected people, additional rashes appear after about a week. These can also affect the mouth and roof of the mouth.
The pathogen itself is still in the body of the person concerned even after the actual illness and can stay there for years without being noticeable. From time to time the virus reactivates, which most people do not notice, but which can sometimes manifest itself in the form of a fever. In this phase, the affected people are contagious again and can transmit the virus via saliva.
Find out more about the topic here: Course of Pfeiffer's glandular fever
The incubation time in Pfeiffer's glandular fever varies greatly and depends, among other things, on the age of the person affected.
While children usually show the first symptoms within a week, at most within a month of being infected, it can take much longer for adults. Here, an incubation period of several weeks to two months can be expected. Corresponding to the longer incubation period for adults, the disease also lasts longer.
Read more about the topic here: Incubation period of Pfeiffer's glandular fever
The course of the disease in glandular fever is very variable and can vary from person to person.
Children under the age of ten are usually not very ill and the symptoms of the infection only last for a few days. In adolescents and adults, however, the symptoms of glandular fever usually last two to five weeks. If further complications arise, the disease may drag on for months.
In some patients, even after the symptoms have subsided, a feeling of weakness and fatigue often remains, which can last for up to a year. In this case, however, the infected person will never get sick with this virus again, since from that point on they have already formed antibodies against the virus and the body no longer triggers an immune response.
More on this topic on our website Duration of Pfeiffer's glandular fever
Anyone who has gone through Pfeiffean glandular fever once cannot catch the virus again. The immune system has formed certain antibodies against the infection and can defend itself so effectively if there is renewed contact that the disease does not break out again.
However, the body fails to completely remove the virus. Instead, it slumbers somewhere in the body and can reactivate itself. Affected people usually do not notice anything, at most a slight exhaustion and fatigue occur. However, they can transmit the virus to other people during the active period.
As a rule, acute Pfeiffer glandular fever heals after 3 weeks. Even after the disease has healed, performance may be reduced in the months thereafter. Chronic Pfeiffer glandular fever must be distinguished from this. If the symptoms of the disease last at least 6 months, it is referred to as chronic infection. In contrast to earlier, chronic courses occur more frequently in all affected age groups.
Typical symptoms of a chronic infection with the virus are recurring attacks of fever, swollen lymph nodes, inflammation of the tonsils, as in acute illness, and unspecific symptoms such as exhaustion, difficulty concentrating and inner restlessness. Even if the organs liver and spleen are enlarged over a long period of time, this can be an indication that the disease has become chronic.
In rare cases, inflammation of the eye, pneumonia or epilepsy are related to the chronic disease. Chronic persistence of the virus can be prevented primarily by strict physical rest during the acute illness.
Find out more about the topic here: Chronic Pfeiffer's glandular fever
In addition to the swellings of the lymph nodes in the neck area, you can also find enlarged lymph nodes in the armpit and in the groin area. When examining or specifying the throat, the tonsils may be red and swollen with a white-yellow coating.
Further diagnostics result from the blood count, positive Paul Bunnel test and the detection of specific EBV antibodies.
Liver enzymes are also measured in the blood serum. The values are moderately increased in 40-100% of cases. Bilirubin, a breakdown product of the red blood pigment hemoglobin, is also elevated in a third.
You might also be interested in: Pfeiffer's glandular fever in pregnancy and diagnosis of glandular fever
Pfeiffer's glandular fever can be diagnosed with the mononucleosis rapid test. This test determines whether antibodies to the Epstein-Barr virus have been made in the person's blood.
In order to obtain blood for the sample, affected people have to prick their fingertips with a so-called lancet (a small needle). The drop of blood is then applied to the test strip. After a few minutes you can read the result on the strip. The rapid test is available without a prescription for around € 15 on the Internet or in pharmacies. The costs for this are not covered by the health insurance. Despite the easy to perform test at home, one should consult a doctor if Pfeiffer's glandular fever is suspected.
Changes in the blood count with the atypical lymphocytes already mentioned also occur in infections with hepatitis viruses, human cytomegalovirus (CMV) and other herpes viruses.
In these, however, no heterophilic antibodies are formed (see Paul Bunnel test).
There is no specific treatment for Pfeiffer's glandular fever, only treatment for symptoms (symptomatic treatment).
The focus is on treating the fever and pain. Ibuprofen or paracetamol can be taken as pain relievers, but no acetylsalicylic acid preparations, e.g. Aspirin®, as it can be used in the case of surgical removal of the tonsils (Tonsillectomy) bleeding problems can occur.
This should be carried out in the case of a severe course of Pfeiffer's glandular fever with permanent fever, narrowing of the airways and shortness of breath, as this removes the location of the greatest virus replication. In addition, in the case of severe throat symptoms and a high fever, prednisolone, a drug that inhibits the immune system, can be taken briefly, which will lead to rapid improvement.
Secondary infection with bacteria, e.g. with streptococci, is treated with penicillin. However, ampicillin or amoxicillin must not be taken, as these often lead to skin reactions such as an acute skin rash (exanthema).
Read more on the topic:
In Pfeiffer's glandular fever, therapy is usually very symptom-oriented. Homeopathic remedies such as globules can also be used for this.
Aconitum napellus is often used against sore throats. Apis mellifica and Belladonna also have an effect in the throat area, but are mainly applied to the tonsils.
In the event of a fever and swelling of the spleen, Ceanothus americanus and Cininum arsenicosum are the drugs of choice. Lachesis can be used for swallowing difficulties. However, it is important to consult your doctor, especially if you have a high fever. A complication such as a ruptured spleen should also be clarified.
More on this: Homeopathy for glandular fever
Pfeiffer's glandular fever is a disease that can traditionally be treated by a pediatrician or family doctor (depending on the age of the person concerned). However, if the diagnosis is not entirely clear, the ear, nose and throat doctor is often involved in the treatment, as he is supposed to assess the tonsillitis.
If complications such as spleen or liver swelling occur, internists are also involved in the treatment. In this case, therapy usually takes place in the hospital. If the infection spreads to the brain, neurologists can also be called in.
Around 95% of adults worldwide are infected with EBV. The infection usually occurs in childhood and is usually symptomless or as a slight inflammation of the pharynx mucous membrane (Pharyngitis). After the initial infection, lifelong immunity remains, which protects the body against the virus. Pfeiffer's glandular fever occurs in 75% of cases in young adults between 17 and 25 years of age, but only extremely rarely after the age of 40.
The transmission occurs through droplet infection, more precisely through intensive contact with infectious saliva, especially when kissing ("kissing disease"), but probably also when drinking from the same bottle. The tissues of the mouth, throat and salivary glands are initially attacked, where the virus then multiplies and, as a result, a group of white blood cells (B lymphocytes) takes place. Some of these infected B-lymphocytes are not captured by the immune system and reach a latent state in which they serve as a repository for the virus and thus participate in the reactivation and new infections of epithelial cells.
Pfeiffer's glandular fever is one highly contagious disease. The causative virus for this infection is that Epstein-Barr Virus. This can be transmitted in a wide variety of ways. The most common transmission happens through Mouth-to-mouth contact through the saliva. Therefore, the disease is popularly referred to as the "kiss sickness". But also the spread as Droplet, contact or smear infection is conceivable.
Up to the age of 30 are estimated to be around 95% of the European population are carriers of this virus. Many of them never had the distinctive clinical picture of Pfeiffer's glandular fever or the infection was mistaken for a banal flu-like infection. But are already in their blood Antibodies to this virus so that re-infection is unlikely. You have lifelong immunity to this virus. So you yourself are not at risk of infection, but can - without noticing it - become contagious again if the virus particles that have remained in your body become active again. Accordingly, it applies to sick people who show symptoms of glandular fever that they definitely contagious for the duration of the disease phase are. The risk of infection then decreases significantly as the symptoms subside, but it cannot be completely ruled out.
The acute form of Pfeiffer's glandular fever subsides over the course of a few weeks and is usually healed after two months. Deaths are extremely rare.
A vaccine is not available.
Contact with saliva and those who are acutely ill should be avoided, but this is not always easy, as most people in the population have gone through an EBV infection and the course of the disease is often associated with very unspecific symptoms.
If none of the very rare complications occur, the prognosis for Pfeiffer's glandular fever is very good.
It usually takes two to four weeks and heals without any consequences. Because antibodies against the virus form in the body, there is usually lifelong immunity after the first infection.
Long-term effects that occur as a result of Pfeiffer's glandular fever usually result from complications.
These often affect the liver and spleen, as they are most likely to be attacked by the Epstein-Barr virus. Spleen swelling can acutely rupture the organ, which can result in removal of the spleen. This has an impact on the immune system, which is why affected people have to get more vaccinations against various diseases.
A swelling of the liver can cause temporary and in severe cases permanent liver dysfunction.
Anemia can also be triggered by Pfeiffer's glandular fever. However, like a decrease in platelets or other blood cells, it is usually temporary. The blood regenerates itself after a few months.
Inflammation of the brain can also occur as part of Pfeiffer's glandular fever. In this condition, called encephalitis, brain damage can be left behind. If the heart is affected by the infection, heart muscle inflammation often occurs. In extreme cases, this can be fatal. If physical exertion is not avoided during the illness, the heart can be permanently damaged, which leads to lifelong cardiac insufficiency. Rare sequelae of Pfeiffer's glandular fever are cancers that develop in the lymph nodes or in the throat.
Read more about this: Late sequelae of Pfeiffer's glandular fever
Pfeiffer's glandular fever is associated with various types of cancer.
On the one hand, it affects the mouth and throat area. This is inflamed for a long time during the infection, which leads to increased death of the mucous membrane cells. They therefore have to regenerate more quickly. The more cells that are newly formed, the greater the risk that new cells will develop incorrectly and, after years, degenerate into cancer. The lymphatic system can also develop tumors associated with Pfeiffer's glandular fever. This type of cancer is called lymphoma.
Pfeiffer's glandular fever in children is usually much more harmless than in adolescents or adults.
Often the disease is not even recognized, since most children under ten years show almost no symptoms and only a few days more tiredness and a little fever. This is often confused with a common cold. Children are usually infected by kissing their parents who are carriers of this virus.
If there are no further complications such as very high fever or skin rashes, the therapy is purely symptomatic. During this time, sick children should drink plenty of fluids and eat easily and easily digestible food. In addition, they should keep bed rest as far as possible and infection of other people in the household should be prevented through increased hygiene measures. Since it is a viral infection, antibiotics have no effect. On the contrary, the administration of penicillins such as amoxicillin in this clinical picture can lead to a skin rash, which under certain circumstances can lead to a life-threatening clinical picture, Lyell's syndrome.
Read more on the topic: Glandular fever in the child
In babies, the infection with the Epstein-Barr virus is usually very unspecific, which is why the disease is often not recognized in babies.
The leading symptoms are fever, tiredness and fatigue. This is often accompanied by headache and body aches. However, babies cannot yet specify these. Rather, babies who are infected with glandular fever are very cranky and restless. They scream a lot, but are often tired at the same time. In babies, too, deposits can develop on the tonsils and the associated tonsillitis.
The cervical lymph nodes are also often swollen. However, other lymph nodes throughout the body are also affected. In addition to the neck, this is especially the case under the armpits and in the groin. The spleen can also be classified as a quasi-huge lymph node. This can also swell in babies with Pfeiffer's glandular fever. The babies can also suffer from a rash as part of the infection, which is often very fine-grained. Depending on the severity, it can resemble the rash in measles or rubella, which is why a pediatrician should be clarified. Only in this way can the correct therapy be initiated. Overall, the EBV infection in babies is usually very mild or even so that you go unnoticed, as the severity of the disease increases with age.
For more information, see: Glandular fever in babies
An infection with the Eppstein-Barr virus can have different courses and last for different lengths of time depending on the age and immune status of the person affected. As long as symptoms such as tiredness, fatigue or fever are present, physical activity should definitely be avoided. Most of the time, however, this also happens by itself, since the infected person usually feels very weak and has no motivation to continue exerting himself. In addition, especially in team sports, the risk of infection for other players should be considered during this time. It is therefore sensible to wait until the symptoms have completely subsided and there is no longer any risk of infection from the person concerned.
In addition, it should be noted that a temporary enlargement of the spleen is possible as part of this disease. This can then tear preferentially during exertion and under certain circumstances a life-threatening rupture of the spleen (spleen rupture) with dangerous bleeding can occur. However, this can be clarified in advance with the help of an ultrasound examination in order to avoid further complications.
Read more on the topic: Glandular fever and exercise
Pfeiffer's glandular fever is a serious infectious disease that often lasts for several weeks.
The incubation period alone, i.e. the phase between infection with the virus and the appearance of the first symptoms, can be between a week and a month. It is important that the symptoms have completely healed before starting to exercise again. This also includes tiredness, exhaustion and reduced performance. Once all of these symptoms have subsided, you can start exercising again after a few weeks. It is advisable to start training easily before resuming full stress.
One of the principles of therapy for Pfeiffer's glandular fever is physical rest. If sport is nevertheless carried out, there is a risk that the disease will become chronic and remain in the body for a very long time.
Furthermore, there may be a relapse with a worsening of the symptoms. Normally, due to the poor general condition, especially at the beginning of the disease, it is not possible to think about performing any sporting activities. The disease is usually healed after about 2-3 weeks. Only then should you start exercising gently. If the immune system is overwhelmed by the strain, the virus could multiply and lead to relapse. If the body is weakened by exercise and the disease becomes chronic, the duration of the disease can be expected to last up to 12 months.
Since the incubation period in Pfeiffer's glandular fever is very long, children have usually passed the pathogen on before the first symptoms appear.
Nevertheless, children who have glandular fever should not go to school for a while. This is primarily due to the fact that they should take care of themselves due to the symptoms of the disease. Otherwise, serious complications such as swelling of the spleen up to a rupture of the spleen or an infection of the heart muscles can occur. Usually the children are fit enough for school again about a week after the symptoms have subsided. However, you can leave the child at home longer if they are still tired or exhausted.
Notifiable diseases are mostly infectious diseases that cause particularly serious infections or that can be transmitted from person to person very quickly.
Pfeiffer's glandular fever is a very infectious disease, but it is mainly transmitted through contact with saliva, which is why there is no such great risk for outside people. In addition, the disease is usually quite harmless. Therefore, Pfeiffer's glandular fever is not notifiable.
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