Symptoms
- Severe sore throat and difficulty swallowing, pharyngitis.
- Tonsillitis with yellowish-white coatings.
- Narrowing of the isthmus faucium (constriction formed by the palatal arches).
- Fever
- Fatigue
- Feeling sick, fatigue
- Lymph node swelling, especially in the neck, armpits and groin.
- Limb and muscle pain
- Headache
- Skin rash (only in about 5%).
- Lymphocytosis (increased lymphocyte count in the blood).
The disease is preceded by nonspecific symptoms such as fatigue, headache, limb and muscle pain and fatigue.
Course
The course and intensity of symptoms vary widely. Transmission of the virus may be asymptomatic or mild to fulminate. Acute illness occurs mainly in adolescents and young adults who had not contracted the virus in childhood. In children under 10 years of age, it is usually asymptomatic (subclinical) or mild. In adults over 30, it is rare and may be atypical. Fever, muscle pain, and especially fatigue can last weeks to several months and result in absence from school or work; this often occurs at a critical time (graduation from school or apprenticeship, college, career planning). An asymptomatic course is also possible in adolescents or older adults.
Cause
Infection with Epstein-Barr virus (EBV), a DNA virus from the herpesvirus group. The virus replicates primarily in B lymphocytes and persists in memory cells throughout life. Over 90-95% of the adult population carries the virus.
Transmission
During adolescence and in young adults, primarily via saliva during kissing (“The Kissing Disease”). A certain constellation is necessary for transmission: Of the kissing couple, one partner must have already undergone the disease and be excreting virus particles, and the other must not yet have been infected. Since the virus is also excreted in male and female genital secretions, sexual transmission cannot be ruled out in rare cases. Transmission via a large amount of blood or during transplantation has also been shown. The incubation period is 4 to 8 weeks, and infectivity is 1.5 years to lifelong.
Complications
- Sleep disturbance due to severe throat and swallowing pain.
- Obstruction of the airways due to severe swelling of the tissues
- Spleen swelling
- Splenic rupture (pain in the left upper abdomen)
- Liver swelling, jaundice, hepatitis.
- Pancreatitis, meningitis, myocarditis.
- Chronic fatigue syndrome (chronic fatigue).
- Drug exanthema during the administration of amoxicillin or ampicillin.
- Risk factor for: Burkitt’s lymphoma, carcinoma in nasopharynx, and multiple sclerosis.
- Other complications
Severe complications are rare.
Risk factors
Adolescents and young adults who do not yet carry the virus and kiss the boyfriend or girlfriend. Because it primarily affects young people, mononucleosis is more common in collectives of young people (school, college campuses, military service).
Diagnosis
Under medical treatment. It should be noted that confusion is possible with other diseases caused by viruses, bacteria and parasites, whose clinical picture is very similar. These are difficult to exclude only on the basis of symptoms. These include trivial sore throat (common cold) caused by viruses, streptococcal angina, acute infection with cytomeglovirus, diphtheria, acute HIV infection, and toxoplasmosis. Initial infection with human herpesvirus HHV-6 (three-day fever) in adulthood causes symptoms similar to mononucleosis.
Nonpharmacologic treatment
Physical activity is discouraged because of the risk for splenic rupture. Athletes should stop exercising for a sufficient period of time. Adequate fluid intake (parenteral in some circumstances).
Drug treatment
Treatment to date has been purely symptomatic. Effective antiviral agents are not yet available on the market. Analgesics administered internally are effective against pain and some additionally against fever.Because the sore throat can be very severe, adequate pain management should be prescribed (possibly opioids! ):
- Paracetamol
- NSAIDS
- Opioids, e.g. codeine, also in combination with paracetamol (antipyretic).
Topical local anesthetics in the form of sprays, gargles or lozenges numb the pain locally:
- Ambroxol
- Oxybuprocaine
- Lidocaine
- Other pharyngeal therapeutics
Food substitutes for severe throat and swallowing problems:
- E.g. drinking food, high-calorie food (see also under loss of appetite).
- Electrolyte replacement solutions
Sleeping pills:
- Possibly for sleep disorders at night
Antiviralia:
- Aciclovir and other nucleoside analogues have not shown benefit in clinical trials in terms of duration or severity of disease.
Glucocorticoids:
- Are not indicated for routine use, but only in special situations, such as severe swelling of the throat.
Antibiotics:
- Penicillins (eg, phenoxymethylpenicillin) are sometimes prescribed when streptococcal angina cannot be ruled out. However, antibiotics are not effective against viruses (!) Amoxicillin and ampicillin should not be given because they can often cause drug exanthema in patients with mononucleosis (in about 90%!).
Herbal and alternative medicines:
- Eg sage, mucilage drugs, lemon balm, clove, mouthwashes.
Measures against fatigue (see there).
Things to know
Naming: Pfeiffer (1846-1921), a pediatrician, was the first to describe the disease. Epstein and Barr studied B lymphocytes in the 1960s and detected the viral particles.
