Introduction
The diagnosis of Pfeiffer’s glandular fever is mainly made clinically and then confirmed by laboratory diagnostic tests. The correct diagnosis is particularly important, since the therapies for the differential diagnoses are different and sometimes contraindicated. It should also be possible to take the right measures early on to alleviate the symptoms and avoid complications.
Even today, safe diagnostic procedures still only provide reliable results after a few days. A good description of the symptoms is important for the treating physician. You can find general information here: The Pfeiffer’s glandular fever
This is how it can be diagnosed
The basis for the diagnosis of Pfeiffer’s glandular fever is a detailed description of the patient’s medical history and a thorough physical examination. Important aspects are the inspection of the throat, palpation of the lymph nodes all over the body and the examination of the spleen and liver, sometimes by means of an ultrasound evaluation. There it can be quickly measured whether the spleen and liver are enlarged, as can occur in infectious mononucleosis.
In the throat, the classic diagnosis is bilateral enlargement of the pharyngeal tonsils with grayish-white coatings. Blood is then taken from the patient and examined in the laboratory for various parameters. A so-called blood smear is taken from the blood, which allows the individual blood cells to be assessed under the microscope.
Pfeiffer cells and an increase in lymphocytes can be seen there. Subsequently, the blood serum is examined for certain antibodies, which the human immune system forms and activates when the Epstein Barr virus attacks the organism. When all these parameters are combined, a well-founded diagnosis can then be made.
Investigation
The clinical physical examination is the most important factor on the way to the diagnosis of Pfeiffer’s glandular fever. Due to possible differences in the occurrence of symptoms, in some cases many years of clinical experience are necessary to choose the right one among the potential differential diagnoses. Inspection of the throat, palpation of the lymph nodes all over the body, temperature measurement, inspection of the eardrums, examination of the skin for possible rashes and palpation of the liver and spleen are obligatory.
In severe clinical cases, involvement of the heart, kidneys, brain and joints should be ruled out early on. There are some laboratory values that can give an indication of infection with the Epstein Barr virus even before receiving the antibody test. For example, LDH, the lactate dehydrogenase, is a non-specific indicator of cell death and is significantly elevated in cases of glandular fever.
It is also important to examine liver values (AST and ALT), as these can be elevated in EBV. In addition, the blood count may show an increase in lymphocytes. In addition, the laboratory values may possibly rule out other diseases.
In the course of clinical diagnostics, a smear of the pharyngeal tonsils may also be taken. A classic symptom of Pfeiffer’s glandular fever is tonsillitis with greyish-white coatings. By smearing these coatings with a cotton swab, it is possible to determine whether the tonsillitis was caused by bacteria.
If this is the case, treatment with antibiotics is necessary. For a diagnosis of the Epstein Barr virus, however, this smear is not sufficient, since the statement is not clear enough. The smear therefore serves much more for the important exclusion of differential diagnoses.
An ELISA test (Enzyme-linked Immunosorbent Assay), a method of protein analysis, allows the interaction between antibodies and antigens to be examined. IgM antibodies, which in this case are VCA IgM antibodies against the viral capsid antigen, are used for the detection of an acute infection. They are acutely elevated and return to normal values after a few weeks.
VCA IgG antibodies only become positive after a few weeks, but remain detectable in the blood for a lifetime. Antibodies against the Epstein-Barr virus nuclear antigen Anti-EBNA-1 (IgG) indicate that the infection has healed. And Early Antigen Anti-EA IgGs are a marker for the onset of disease even before IgM antibodies increase.
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