Synonym
- Kissing Disease – Virus
- EBV
- Pfeiffer’s disease
- Infectious Mononucleosis
- Mononucleosis infectiosaund
- Monocyteangina
An initial infection with the Epstein Barr virus in adolescence or adulthood causes unspecific flu-like symptoms. Patients show an elevated temperature between 38.5° and 39° Celcius, limb and body pain, as well as fatigue and exhaustion. Furthermore, the lymph nodes in the neck and throat are often swollen.
There may also be a swelling of the lymph nodes in the armpits or in the groin (lymphadenopathy). Patients can also develop inflammation of the throat or tonsils (angina tonsillaris) and sometimes show a rather dirty-grey instead of white coating on the tonsils, which is accompanied by a bad-smelling bad breath (=foetor ex ore). The disease can last from several days to several weeks, during which time the patients are weakened.
The typical signs of an infection with the Epstein-Barr virus include flu-like symptoms, with which Pfeiffer’s glandular fever usually begins after an incubation period of 4-6 weeks: these include the occurrence of high fever, accompanying headaches and aching limbs as well as tiredness and the feeling of exhaustion. On the other hand, strongly swollen, pressure-painful, shifting lymph nodes can be noticeable, which are primarily located in the neck and throat area and occur less frequently in the armpit or groin region (lymphadenopathy). This can be accompanied by bad breath (foetor ex ore), difficulties in swallowing or even breathing (due to swelling of the throat in the case of severely enlarged tonsils), hoarseness or lispy speech.
In some cases, the cardinal symptoms just mentioned can be accompanied by other signs that indicate an Epstein-Barr virus infection. For example, the virus can occasionally trigger an enlargement of the liver (hepatomegaly) and/or inflammation of the liver (hepatitis), which can be detected by the increase in characteristic liver values in the blood during a blood test and an ultrasound examination. The spleen, as the host organ of many defence cells of the immune system, can also react during an EBV infection: the infection leads to an increased production and filtering of defence cells, which can lead to a swelling of the spleen (splenomegaly).
In rare cases (in 5-10% of patients) a raised, patchy rash may also appear, which can lead to severe itching. Very rare symptoms, which usually only occur in older patients with an existing immune deficiency, also include meningitis or paralysis, both manifestations accompanied by a significantly worse prognosis. The genetic information of the Epstein-Barr virus (EBV), the DNA, winds itself around a protein molecule called the core or nucleoid and is surrounded by a protein coat, the capsid.
This viral protein coat protects the genetic material of the virus from harmful external influences and performs important tasks in the infection of the host cell by the virus. The capsid is in turn surrounded by a virus envelope. This consists of a portion of the plasma membrane of the host cell or membranes surrounding structures within the host cell.
In addition, the envelope carries the virus’ own sugar proteins, which are necessary for the virus to dock to its host cell, and which enable the membranes to fuse together so that the viral hereditary material can be introduced into the cell. Antibodies produced by the host organism against the virus are directed against sugar proteins of the virus envelope. Enveloped viruses, unlike naked viruses, are very susceptible to external influences such as heat or dehydration.
The Epstein Barr virus attacks the epithelial cells in the mouth, nose and throat, as well as the B-lymphocytes, which belong to the white blood cells and perform important tasks in the defence against pathogens that have entered the body. The initial infection usually occurs in childhood and is usually asymptomatic. Adolescents and adults who are infected for the first time show flu-like symptoms, usually without complications.
The disease caused by the Epstein-Barr virus is called Student’s Kissing Disease, among other names, because the virus is transmitted from mouth to mouth, especially in young adults. The actual name Morbus Pfeiffer goes back to the name of Emil Pfeiffer, who practiced as a pediatrician around 1900. Other names for the disease caused by the Epstein-Barr virus are infectious mononucleosis, mononucleosis infectiosa and monocyte angina.The onset of the disease, associated complications and the course of the disease depend on many factors, some of which are not understood.
Among others, the strength of the immune system plays an important role. According to this, immunodeficiencies are the main cause of the disease. Up to the age of 30, an estimated 95% of the population is infected.
After the 40th year of life, an infestation of almost 100% (approx. 98%) is suspected. The virus goes through two developmental phases.
In the lytic first phase, it multiplies in the infected host cells, is then released in countless copies and can infect other cells, while in the second phase, also known as the latency phase, it rests in the host cell and eludes the host organism’s immune system, forming a reservoir that can break open and release viruses when reactivated. During an infection with the Epstein Barr virus, antibodies against the virus are produced, which can be detected in the blood of 95% of the population. The virus remains in the body for life and dwells in so-called memory cells of the white blood cells (B memory cells).
Reactivations occur when the immune system is weakened, but are usually successfully contained unnoticed by the body’s natural defenses. In this phase, viruses, for example, can be detected in the saliva, which can also infect other people unnoticed. In patients whose immune system is suppressed, for example HIV patients or organ transplant patients, the virus can spread unhindered in the body, multiply and lead to complications.
It is responsible for the development of various rare cancers such as Burkitt’s lymphoma. It is endemic in Africa, caused by a particular EBV species, which is locally restricted to a certain area. Burkitt’s lymphoma is a malignant, fast-growing tumor that occurs in Africa primarily in children.
In Asia, the virus is considered a risk factor for the development of nasopharyngeal carcinoma, a malignant tumor that infiltrates the nose, throat and larynx. Furthermore, the Epstein Barr virus is discussed as a cofactor in the development of breast cancer and malaria. The body’s own immune system reacts in its first line of defense by forming antibodies against certain components of the Epstein Barr virus that has entered the body, keeping it at bay at the beginning and then destroying it in the course of the disease.
These antibodies are certain proteins that are formed by specific blood defense cells (B lymphocytes) and are directed against certain components of viruses (antigens). Initially, these are antibodies of the IgM class, but a little later mainly antibodies of the IgG class are produced, which in the case of the Epstein-Bar virus are directed against certain protein components of the virus envelope or viral mantle (so-called Epstein capsid antigens; EBV-CA). These EBV-CA IgG antibodies are considered a specific early marker in the course of an Epstein-Barr virus infection and can be detected in the blood in a confirmatory test.
Epstein Barr virus is transmitted mainly by droplet infection or contact infection, especially with saliva, or by smear infection. Less common ways of transmitting the Epstein Barr virus include transplantation or blood transfusion, and possibly sexual contact with an infected person. Since the virus depends on its reservoir host, humans, to survive, it has tried throughout evolution to adapt to their life in order to infect human cells but not kill them.
The disease Pfeiffer’s glandular fever, which is caused by the Epstein-Barr virus (EBV), is therefore very rarely fatal. In most cases, an infection remains unnoticed due to a lack of symptoms, especially in the case of initial infections in childhood, and is therefore not diagnosed. The detection of Epstein-Barr virus antibodies in a patient’s blood can confirm a suspected diagnosis if the patient presents to the doctor with unspecific symptoms such as fatigue and exhaustion.
Various tests are available for this purpose, which can detect different types of antibodies produced by the host organism against the virus. With the help of these tests, fresh infections can also be distinguished from past infections. In most cases, but not necessarily, the concentration of white blood cells (leukocytes) in the blood is elevated (leukocytosis) and, above all, the B-lymphocytes show an increase (relative lymphocytosis) compared to the remaining leukocytes.In the blood smear, characteristic changes in the T-lymphocytes can be seen under the microscope, which are called Pfeiffer cells and are diagnostic.
Since the viruses can inhabit liver cells in addition to the epithelial cells of the nasopharynx, the liver values are usually elevated in infected persons. Asymptomatic courses of the Epstein Barr virus occur predominantly in small children. Patients with a chronic course of the disease suffer for months from persistent fatigue and exhaustion, as well as fever and reduced drive.
They often show chronic, painful lymph node swelling. Reactivations of the virus are not uncommon in herpes virus infections and usually show a weaker course. In about one in ten infected persons, a bacterial coinfection of the tonsils with streptococcus bacteria occurs.
Various rarer complications include inflammation of the brain (encephalitis), changes in blood cells or anemia, swelling of the liver and spleen (hepato- and splenomegaly), as well as inflammation of the heart muscle (myocarditis) and kidney (nephritis). Due to the swelling of the spleen and the associated risk of rupture of the spleen (splenic rupture), those affected should avoid strenuous activities such as sports and lifting heavy objects during the course of the disease and for a few weeks afterwards until the swelling of the spleen subsides. It is estimated that over 90% of the entire world population is infected with the Epstein-Barr virus.
The only striking fact is that only a part of them actually fall ill with the virus. In most cases, the virus invades the body unnoticed and remains there for the rest of one’s life without anything happening. At least as long as the immune system is intact and can keep the virus in check.
In other cases, however, the virus triggers different diseases, so that especially in Europe and North America, Pfeiffer’s glandular fever, in Africa Burkitt’s lymphoma (malignant lymph gland cancer) and in Southeast Asia nasopharyngeal carcinoma (malignant cancer of the nasopharynx) can be observed in connection with EBV infection. If a disease does indeed develop, however, it is usually mononucleosis (= Pfeiffer’s glandular fever), which usually heals without consequences. The reason for this, according to scientists, is the presence of differently aggressive Epstein-Barr virus strains with different genetic material, which occur in different latitudes and can therefore cause different diseases.
For example, Epstein-Barr viruses of the one strain with predominant occurrence in Southeast Asia preferentially infect the epithelia of the mucous membranes in the nasopharynx, where they can then induce the development of a malignant tumor. In contrast, the viruses of the other strains can only attack the B cells of the immune system and thus either cause Pfeiffer’s glandular fever or lead to an uncontrolled proliferation of genetically modified B cells in the blood, resulting in the development of Burkitt’s lymphoma. Overall, it has been found that about 20% of all Burkitt lymphoma patients also carry the Epstein-Barr virus in their bodies, while in patients with a malignant nasal revenge tumor, the figure is 80-90%.
There is no specific therapy for Pfeiffer’s glandular fever. Fever requires a sufficient fluid intake, possibly antipyretic medication and, above all, plenty of rest. The disease can also be treated symptomatically with painkillers and, if an additional bacterial infection occurs, with antibiotics.
Since Pfeiffer’s glandular fever is a viral infection, there is no causal therapy to treat the disease. The administration of antibiotics would be ineffective in this case, since the bacteria are not the ones to be fought. It is only indicated if an additional bacterial infection (superinfection) is present or suspected in addition to the already existing Pfeiffer’s glandular fever in order to avoid a complicated course.
However, antibiotics from the group of aminopenicillins (ampicillin, amoxicillin) should be strictly avoided, as these can lead to a very itchy skin rash (ampicillin exanthema) in the case of EBV infection. Thus, only treatment and alleviation of the symptoms occurring during the infection is possible: in addition to rest and physical rest, sufficient fluid intake is important, especially when the infection is accompanied by fever and fluid loss occurs. If necessary, antipyretic, anti-inflammatory and analgesic drugs can be taken to reduce the fever – after consultation with the treating physician.B.
Ibuprofen, paracetamol). These can also relieve sore throats and difficulty swallowing. The analgesic acetylsalicylic acid (ASA; aspirin) should not be given, as this increases the risk of secondary bleeding in the course of a severe tonsillectomy.
Cold neck compresses and mouthwashes with analgesic, disinfected solutions or chamomile tea can also help against sore throat and swollen, painful cervical lymph nodes. In severe cases of Epstein-Barr virus infection, medication prescribed by the doctor to prevent the virus from multiplying (antivirals) may be indicated, so that taking e.g. acyclovir or ganciclovir is a sensible therapy measure. If threatening complications occur, such as meningitis, anemia caused by the infection or severe swelling of the airways, cortisone should be administered as quickly as possible to contain the excessive or spreading inflammatory reactions.
If a complication of a splenic swelling occurs in the course of the disease and possibly also tears (splenic rupture), an immediate emergency operation must be initiated. The spleen, as an organ with a very high blood supply, can lead to a rapid, large loss of blood in the event of a rupture, so that the therapy of choice is the fastest possible surgical removal of the spleen. In order to avoid a rupture of the spleen from the outset, physical protection should be taken into account as long as there is a detectable swelling of the spleen.
Since Pfeiffer’s glandular fever cannot be treated causally as a viral infection (antibiotics are ineffective since it is not a bacterial infection), only therapeutic measures to alleviate symptoms can be initiated. This may also include the use of homeopathic remedies: it is possible, for example, to take Belladonna, Aconitum or Gelsemium to reduce fever, to administer Phosphorus C7 to prevent the development of an inflammation of the liver (hepatitis) and to take Phytolacca decandra C5 for throat and headaches. Taking Schüssler salts No.
3 (Ferrum Phosphoricum), No. 4 (Potassium Chloratum), No. 5 (Potassium Phosphoricum), No. 10 (Sodium Sulfuricum) and No. 11 (Silicea) can also be used for homeopathic treatment of EBV infection.
