Brief overview
- Symptoms: Sore throat, swollen lymph nodes, fatigue, fever, enlarged spleen; often asymptomatic in children
- Causes and risk factors: Infection with the Epstein-Barr virus (EBV) via saliva during kissing or other bodily fluids (sexual intercourse, blood); every infected person is potentially contagious in phases for life
- Diagnostics: Blood test for EBV and EBV antibodies, throat swab, palpation of spleen and lymph nodes, rarely lymph node biopsy
- Treatment: Symptomatic treatment of pain and fever, cortisone in severe cases; treatment of possible complications
- Course of the disease and prognosis: Usually without symptoms in children; otherwise subsides after around three weeks, usually heals without consequences; serious complications possible; suspected connection with chronic fatigue syndrome, for example
- Prevention: Avoid contact with confirmed infected persons
What is mononucleosis?
Pfeiffer’s glandular fever (infectious mononucleosis, mononucleosis infectiosa, monocyte angina) is an infectious disease caused by the Epstein-Barr virus (EBV), which belongs to the group of herpes viruses.
Symptoms are tonsillitis and pharyngitis with severely swollen lymph nodes, fever and fatigue. In children, however, there are often no symptoms. Severe cases are possible, especially in adults.
Pfeiffer’s glandular fever is not notifiable.
Causes and risk factors
Pfeiffer’s glandular fever is contagious. The disease is triggered by the Epstein-Barr virus (EBV). The pathogen multiplies in white blood cells (lymphocytes) and in the mucous membrane cells in the throat. The virus does not survive for long outside the human body.
How can you get infected?
Infection occurs via body fluids. As the virus is mainly found in saliva, it is particularly easy to become infected through close physical contact and kissing. In English-speaking countries, Pfeiffer’s glandular fever is therefore referred to as “kissing disease”.
A particularly common route of infection is among small children, for example in kindergarten, where toys are often put in their mouths and exchanged. Particularly “kiss-active” population groups such as young adults are also infected more frequently (“student fever”).
Other routes of infection, such as through sexual intercourse, blood transfusions or organ donations, are also possible but much rarer.
Incubation period
How long is mononucleosis contagious?
Newly infected people pass on the virus particularly easily. During this phase, the infected person excretes a particularly large number of pathogens in their saliva. This is also the case long after the symptoms have subsided. To avoid infecting others, it is therefore advisable to be cautious about kissing in the first few months after the initial infection and to avoid unprotected sexual intercourse.
Once infected with mononucleosis, a person remains a carrier of the virus for life. A healthy immune system keeps the pathogen in check so that the disease does not usually break out again. If the immune system is weak, EBV reactivation is possible, which causes symptoms.
But even without symptoms, it is possible for the virus to be increasingly released into the saliva from time to time. All virus carriers are therefore contagious to others for the rest of their lives, even after the symptoms have subsided.
Infection with mononucleosis during pregnancy
If the mother has already had an EBV infection, she also transfers her protection against the virus to the newborn. The baby is thus protected against mononucleosis for the first six months of its life. The child is therefore usually not infected until after this period at the earliest.
What symptoms and late effects can occur?
Pfeiffer’s glandular fever mainly manifests itself in the form of tonsillitis and pharyngitis with severely swollen lymph nodes, (sometimes high) fever and fatigue. Some patients with mononucleosis also experience inflammation of the eyes.
In children, the infection is often asymptomatic, as their immune system does not yet react strongly to the pathogen. In adults, mild cases are often mistaken for a flu-like infection. However, severe courses with complications are also possible.
Main symptoms
Throat inflammation: Typical of mononucleosis is severe sore throat with intense reddening of the pharyngeal mucosa and pronounced difficulty swallowing. The tonsils and lymph nodes swell and some patients develop a high fever. A foul breath may also be a consequence of the infection.
Pronounced fatigue: Patients feel extremely exhausted and weak in the acute phase of the disease. They usually recover within one to two weeks.
In athletes in particular, a sudden drop in performance is often the first, sometimes even the only, sign of the disease. In some cases, the pronounced fatigue lasts for several months.
Many sufferers also describe aching limbs as a symptom.
Swollen spleen (splenomegaly): The spleen plays an important role in the body’s defense against disease and filters dead blood cells from the blood. It is particularly challenged during an infection with the Epstein-Barr virus. During the course of the disease, it can therefore swell considerably and even rupture in some cases.
Complications and late effects
Most cases of mononucleosis are uncomplicated. However, serious, sometimes life-threatening complications caused by EBV are also possible. For people with a pronounced immune deficiency, infection with the virus (EBV) is sometimes fatal.
In people with a healthy immune system, glandular fever does not normally have any long-term consequences.
Severely swollen throat: It becomes dangerous if the immune system reacts so strongly to the virus that the mucous membranes in the throat become very swollen. This may make swallowing impossible and even hinder breathing.
Liver inflammation (hepatitis): In some cases, the virus also affects the liver and causes liver inflammation. If this is severe, the skin turns yellow (jaundice, icterus) due to the impaired liver function caused by Pfeiffer’s glandular fever.
Skin rash: Around five to ten percent of patients develop a patchy, raised (square) skin rash, the so-called maculopapular exanthema.
Paralysis symptoms: If the virus reaches the nervous system, in some cases it triggers inflammation there with symptoms of paralysis, which may also threaten breathing.
Inflammation of the brain: In some cases, the virus reaches the brain, where it causes inflammation of the brain or meninges.
Examinations and diagnosis
The diagnosis of mononucleosis 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, mononucleosis is therefore not recognized at all or only recognized late.
A targeted examination for mononucleosis is usually only carried out if the fever does not go down or the patient complains of fatigue for weeks or a severe throat infection does not subside.
Physical examination
Throat examination: During the physical examination, the doctor first examines the throat and tonsils. In the case of mononucleosis, they are reddened and often very swollen. The plaque also provides an indication of the type of infection: Whereas in bacterial streptococcal tonsillitis they look more like specks, in Pfeiffer’s glandular fever they appear white and flat.
Palpation of the lymph nodes: By palpating the neck under the angle of the jaw, the armpits and the groin region, the doctor determines whether and which lymph nodes are swollen.
Palpation of the spleen: With mononucleosis, 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. However, if the swab contains the Epstein-Barr virus, this is not sufficient for a reliable diagnosis of mononucleosis. The pathogen is not only found on the mucous membrane during an acute infection. It can also be detected if the virus has been in the body for some time and has merely been reactivated.
Diagnosis by blood test
Antibodies: For a reliable diagnosis of mononucleosis, specific antibodies against the Epstein-Barr virus can be detected in the blood.
Elevated liver enzymes: If the liver is affected by the virus, a blood test will also show an increased concentration of liver enzymes (transaminases).
Only in rare cases is it necessary to take a tissue sample (biopsy) from a lymph node.
Treatment
Pfeiffer’s glandular fever is a viral disease. Antibiotics therefore do not help, as they only work against bacterial infections.
Treatment therefore focuses on alleviating symptoms such as pain, difficulty swallowing and fever. For this purpose, common remedies such as ibuprofen or paracetamol are used.
An important treatment principle for mononucleosis is physical rest. This can significantly reduce the risk of serious complications. Doctors advise taking it easy, which includes a strict ban on sport, for a while after the acute symptoms of the disease have passed.
If complications arise, further treatment may be necessary. If the pharyngeal mucosa swells up dangerously or symptoms such as fatigue and fever are very pronounced, treatment is also given with cortisone or other active substances that dampen the activity of the immune system.
A ruptured spleen must be operated on immediately, otherwise the patient is at risk of bleeding to death.
“Clearing” the virus with alternative medicine?
In alternative medicine, the concept of not only combating the virus but also “eliminating” it is well known. This means removing it completely from the body. Various homeopathic and naturopathic preparations are said to help with this.
From a scientific and medical evidence-based point of view, such an effect cannot be proven and is extremely controversial.
Course of the disease and prognosis
Pfeiffer’s glandular fever lasts up to three weeks. It usually heals without permanent consequences. However, if complications are suspected or the blood values deteriorate dramatically, patients are treated in hospital for monitoring.
In very rare cases, mononucleosis becomes chronic. This means that the symptoms persist for months or even years. Only very rarely, however, does glandular fever lead 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 (e.g. B-cell lymphomas, Burkitt’s lymphoma, Hodgkin’s disease).
A connection with chronic fatigue syndrome, which seems to affect women in particular (see above), as well as with multiple sclerosis and rare throat tumors is also being discussed.
Prevention
As the Epstein-Barr virus is very widespread in the population (the “infection rate” is 95 percent), it is almost impossible to protect yourself against it. Ideally, you should avoid contact with people who are acutely infected. Vaccination is still being researched. This is considered sensible because the Epstein-Barr virus is associated with some late effects such as chronic fatigue syndrome or multiple sclerosis.
However, if you do fall ill, there are a number of things you can do to prevent a severe course of glandular fever.
Avoid alcohol and fatty foods
The infection often puts considerable strain on the liver. It is therefore advisable to strictly avoid alcohol during 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 checks are necessary and you should avoid alcohol even after the symptoms have subsided in order to prevent permanent liver damage.
It is also important to pay attention to your diet after an infection with the Epstein-Barr virus (EBV) if liver inflammation has occurred in this context. It is then advisable to avoid particularly heavy and fatty foods that put a strain on the liver.
Adjust medication
Be careful with sport!
In the acute phase or in the case of severe infections, it is better to avoid sport altogether; later on, light exercise training may be possible in consultation with your doctor.
If the spleen swells considerably with mononucleosis, there is a risk that the organ, which is very rich in blood, will rupture during physical exertion or as a result of external force. This can cause severe internal bleeding, which can be life-threatening. For this reason, contact and combat sports should be strictly avoided during the acute phase of the disease.
