Pfeiffer’s glandular fever or infectious mononucleosis is an infectious disease that is very common. The leading symptoms caused by the Epstein-Barr virus (EBV) are lymph node swelling and fever.
What is glandular fever?
In general, glandular fever is a very common, harmless viral disease. It is caused by the Epstein-Barr virus. The infection can be easily detected by blood tests. It is estimated that over 90% of the population is infected with glandular fever by the age of 30. At least in children up to the end of the 10th year of age, glandular fever runs its course without major symptoms. In older people, flu-like symptoms appear, which in the rarest cases are accompanied by complications. Typical symptoms of glandular fever include swelling of the lymph nodes, sore throat or tonsillitis, dizziness and disorientation. The viruses attack the organs of the lymphatic ring of the throat. By all means, the liver, heart and spleen may also be affected.
Causes
Transmission of the causative agent of glandular fever occurs primarily through saliva. Other transmission routes may be the so-called contact, droplet, or smear infection. Since the main mode of transmission is from mouth to mouth, glandular fever is also known as “kissing disease” or “student’s disease”. Once infected with the pathogen, it remains in the body for life, as with other herpes infections. Even after an outbreak of Pfeiffer’s glandular fever or after the end of the disease, the virus can still be transmitted to non-immune people via saliva. Likewise, after the disease is completely cured, a new outbreak of symptoms can always occur in infected individuals. This new outbreak of the disease can be detected at any time by an appropriate blood count.
Symptoms, complaints, and signs
Because the period from infection to the outbreak of the disease is very long in glandular fever, the typical symptoms appear late. There is a difference between the symptoms in adults and those in children. Since the immune system of children is not yet fully mature and therefore does not react as strongly to the virus, they often remain completely asymptomatic. In contrast, adults are much more affected by the effects. They suffer from fatigue and a general feeling of illness, feeling weak and weary. This lassitude can last for a very long time before it is recognized as a sign of illness. Unpleasant sore throat, accompanied by redness of the throat and difficulty swallowing are possible. Sometimes the lymph nodes swell and the patient becomes feverish. In the further course, additional, but individually completely different, symptoms may occur. There are patients in whom the disease causes hepatitis; recognizable by the yellowing of the skin and the sclera of the eyes. The spleen may also be affected and swell as a result. In isolated cases, a nodular rash appears, which is raised and spreads in spots on the skin. Rare complications in the form of paralysis and inflammation of the meninges occur only when the virus affects the nervous system.
Course of the disease
The incubation period of mononucleosis in children is seven to thirty days. In adults, this time may well range from four to seven weeks. Glandular fever usually begins with fever, aching limbs, and fatigue, relatively “normal” cold symptoms. The lymph nodes swell (possibly also under the armpits and in the groin) and the tonsils become inflamed. Typical of Pfeiffer’s glandular fever is the dirty gray coating on the tonsils, which causes a foul mouth odor. In addition, some sufferers also experience hoarseness and speech disorders. Usually the disease lasts a few weeks, but in rare cases this can extend to 1-2 months. If the disease is asymptomatic, fatigue and persistent weakness may be added over a period of a few months to two years.
Complications
The complications that can occur with glandular fever are diverse but rare. They are also largely treatable, but may necessitate hospitalization.The situation is different for people with a weakened immune system (especially children). Here, the disease can take a severe or lethal course. For example, swelling of the liver or spleen may occur. Both are painful to the touch and limit the function of the affected organs. Vigorous exertion and dislocation should be avoided if there is swelling of the spleen, as it can lead to rupture of the spleen. Jaundice may also occur. Inflammation of the lungs, heart muscles, or kidneys may occur and most require treatment. Kidney and heart inflammations in particular carry a risk of destruction of vital tissue and can cause consequential damage accordingly. Anemia or a reduced platelet count is possible. Thus, the debilitating phase of illness is worsened and bleeding (nosebleeds, bleeding from injury, etc.) may be more difficult to control. The key here is to avoid exertion and injury. Brain inflammation may also occur. It requires special medical attention because it can affect the nerves – and thus the motor and cognitive abilities of the affected person.
When should you see a doctor?
If the child has swollen lymph nodes, sore throat, or high fever, a doctor should be consulted. The physician can make a diagnosis based on the white blood cell count and initiate treatment immediately if necessary. Medical advice is particularly needed in the event of increasing symptoms that cannot be alleviated by home remedies and bed rest. If glandular fever does not subside on its own, the pathogen must be treated with medication. The doctor may also prescribe fever suppositories and other remedies. Pfeiffer’s glandular fever is treated by the family doctor or pediatrician or a specialist in internal medicine. If the Epstein-Barr virus has spread to the respiratory tract, the ear, nose, and throat specialist must be involved in treatment. Depending on whether complications occur, inpatient treatment may also be necessary. With appropriate drug treatment, symptoms should resolve within a few days to weeks. If this is not the case, the doctor must be informed. Parents should involve a medical professional on the basis of the risk of infection alone.
Treatment and therapy
Unfortunately, there is no specific medication for the treatment of Pfeifferschen glandular fever. In any case, it is necessary to drink a lot of fluids, as is generally advised in febrile illnesses. It is also helpful to take fever-reducing medication and in any case plenty of time to rest. In some cases, a bacterial infection may occur, which must be treated with antibiotics. In general, it is important to contact a doctor who will decide on the intake. In general, care should be taken that the doctor does not prescribe broad-spectrum antibiotics, such as amoxicillin or ampicillin. These can cause extensive rashes with itching all over the body. This rash may continue to develop for up to three days after the antibiotic is taken. The rash can take up to two weeks to clear and is sometimes very painful. This is not an allergy, but “only” an overreaction.
Aftercare
Pfeiffer’s glandular fever is a long-lasting disease. Aftercare includes rest and regular checkups with a physician. Patients should rest for at least four to six weeks. If the course is positive, the doctor should be consulted weekly. Follow-up care is provided by the internist or general practitioner in charge. The physician will draw the patient’s blood and perform a physical examination. Follow-up care also includes taking a medical history to clarify unanswered questions and assess the patient’s current health status. After glandular fever has been cured, no further follow-up is usually necessary. Should complications arise, medical advice is needed. The doctor will first check typical symptoms, such as yellow skin and increased body temperature, to determine or rule out involvement of the internal organs. Subsequently, hospitalization may be necessary. In the event of a complicated course, further follow-up examinations by the relevant specialists are necessary.The physician must examine the internal organs to rule out organ damage and concomitant diseases. Depending on the cause of the Pfeiffer’s glandular fever, further medical appointments must be made after the follow-up. The trigger of the disease must be identified and corrected before treatment can be completed.
Outlook and prognosis
The outlook for complete cure is very good for glandular fever. Usually, the disease heals within two to three weeks, with no complications or sequelae. However, people whose immune system is weakened, e.g. by an HIV infection or after an organ transplant, are at increased risk of developing complications. Possible sequelae include inflammation of the heart, liver, kidneys or brain. There is a risk of additional infections with bacteria or viruses, which worsen the prognosis. In very rare cases, rupture of the enlarged spleen may occur. This is an emergency and requires immediate surgery. In immunocompromised individuals, lymphomas develop in some cases. These are tumors that develop from altered white blood cells and can later degenerate into malignant tumors. After an infection with glandular fever, antibodies against the Epstein-Barr virus are formed. As a rule, there is lifelong immunity after the first infection. However, re-infection is quite possible in immunocompromised individuals. To avoid re-infection, contact with infected people should be avoided. Since infection occurs only through direct contact, this can reduce the risk of re-infection.
What you can do yourself
For supportive therapy of Pfeiffer’s glandular fever, the very first thing is bed rest when the fever attacks occur. Physical rest provides the body with the strength it needs to fight off the virus. Good results in terms of reducing fever can be achieved by using calf wraps. For sick people in general, for children in particular, it is necessary to pay more attention to sufficient fluid intake, as well as to the administration of easily digestible food during the infection. In addition to fevers, patients often experience severe sore throats. These can be relieved by gargling with sage tea or warm salt water. Furthermore, inhaling with chamomile flower tea can have a positive effect on the sore throat. If the sore throat develops into bacterial angina, a doctor must be consulted, as the administration of antibiotics is then indicated. Severe headaches and aching limbs can be counteracted with commercially available painkillers. However, patients must make sure that the painkiller used is not based on acetylsalicylic acid. This could lead to bleeding. After the symptoms of the disease have subsided, patients should continue to take it easy for four to eight weeks. Lifting heavy loads during this time is particularly dangerous, as it can easily lead to a ruptured spleen. In general, there is a risk of injury to the spleen if physical stress is applied too soon.
