Piping glandular fever

Medical: Pfeiffer glandular fever, infectious mononucleosis, mononucleosis infectiosa, monocyte angina, Pfeiffer disease. Engl. : kissing disease

Definition

Pfeiffer’s glandular fever is an acute feverish infectious disease caused by the Epstein-Barr virus (EBV). Teenagers and young adults are particularly affected. The incubation period is approximately seven to nine days in children, four to six weeks in adolescents and young adults. The disease usually takes two months to heal completely. The disease is named after the pediatrician Dr. Emil Pfeiffer (1846-1921).

Causes of Pfeifferschem glandular fever

The pathogen is the Epstein-Barr virus (EBV), a DNA virus from the herpes virus family. It only infects B lymphocytes (immune cells that form antibodies) and epithelial cells of the throat and nose, since these are the only cells that have a docking site (receptor) for EBV. The multiplication and release of the virus takes place mainly in the infected epithelium.

During the multiplication phase, the virus produces early and late proteins, against which the body forms important antibodies for diagnostics. In the acute phase of Pfeiffer’s glandular fever, only about one in 1000 B lymphocytes is infected, and after recovery, one in a million. However, few of these produce EBV.

With the viral antigens on their surface, the infected B-lymphocytes cause an immunological defense reaction. In the process, a strong multiplication of other groups of white blood cells (T-lymphocytes and macrophages) takes place. The pathological changes in mucous membranes and lymphatic tissue are consequences of this immunological defense reaction. In case of a congenital or acquired defect of the immune system, infected B-lymphocytes cannot be suppressed sufficiently, which is why malignant tumors of the lymphatic tissue (malignant lymphomas) can occur due to uncontrolled multiplication.

Symptoms with the Pfeifferschen glandular fever

Whistling glandular fever in children usually goes unnoticed and only 25-50% of infected adults show the typical symptoms. Symptoms that can occur before the onset of the disease are headache, tiredness and aching limbs. After the long incubation period of a few weeks, pharyngitits, swelling of the lymph nodes in the neck, headaches and fever, which can rise to 40°C, occur in almost all patients.

In addition, inflammatory swelling and redness of the tonsils (tonsils) with white-yellowish coatings may occur. In most cases, the patient has difficulty swallowing, coughs and has to breathe through the mouth because his nasopharyngeal cavity is blocked, for example, by swelling of the lymphatic tissue in the pharyngeal wall. Small, punctiform bleedings (petechiae) may be visible on the palate and the oral mucosa and gums may be inflamed.

In about 50% of patients, splenomegaly (enlargement of the spleen) occurs. A tear in the spleen (splenic rupture), on the other hand, is extremely rare, but it must be treated surgically immediately. In 25% of patients, there is an enlargement of the liver (hepatomegaly) with a slight yellowing of the skin and conjunctiva (icterus).

Rarely, a rash of whistling glandular fever occurs. The most common neurological symptom is an inflammation of the meninges (meningitis), but paralysis of individual nerves may also occur. Sometimes an inflammation of the conjunctiva can also occur, rarely an inflammation of the optic nerve.

Patients with chronic infection have a pronounced subjective feeling of illness, which manifests itself over months in fatigue, fever, headaches, weight loss and swelling of the lymph nodes. To the main article: By these symptoms you can recognize the Pfeiffer’s glandular feverAlthough fever and the inflammation of the palatal tonsils are the main symptoms of the Pfeiffer’s glandular fever, there can also be atypical courses of disease without the development of fever. In about 10% of the cases no fever occurs.

Especially in small children these courses of the disease can occur, even without symptoms or with only very weakened symptoms. The fever that occurs during the course of the disease often lasts for 10-14 days and is in the rather low range of 38-39°C. If a fever has not yet occurred, it is possible that it will only reoccur during the course of the disease.

A temporary defever is also not uncommon.In summary, if other findings and complaints fit into the overall picture, it can be a case of glandular fever, even if no fever occurs over the entire course of the disease. If the course of the disease is largely asymptomatic and the disease is suspected, a blood test can provide certainty. A strong inflammation of the tonsils is typical of Pfeiffer’s glandular fever.

This is often accompanied by whitish coatings, which can also cause severe bad breath. The inflammation of the tonsils usually also causes the entire throat and pharynx area to become inflamed and reddened. This leads to sore throat and difficulty swallowing.

Due to the strong tonsillitis, Pfeiffer’s glandular fever is often confused with bacterial tonsillitis, which is why it is wrongly treated with antibiotics, which can also cause a skin rash. Coughing in the case of Pfeiffer’s glandular fever is usually caused by the inflammation in the throat and tonsils. This causes the mucous membranes in the throat area to dry out more quickly, causing a coughing irritation.

In addition, coughing is a natural defence mechanism of the body, whereby the pathogen should be transported out. Due to the inflammation of the throat, coughing is often very painful. In addition, swallowing disorders and hoarseness are often added as symptoms.

Diarrhea is not a typical symptom of whistling glandular fever. In contrast to many other infectious diseases, the gastrointestinal tract is spared any discomfort when infected with the Epstein-Barr virus. However, drugs such as fever reducers can act on the gastrointestinal tract and thus trigger secondary symptoms such as nausea, vomiting, abdominal pain and diarrhea.

In the case of abdominal pain and diarrhoea, however, swelling of the spleen and liver should be ruled out in the first instance. Earache is also not among the classic symptoms of whistling glandular fever. However, due to the connection between the ears, the nose and the throat, pain can also occur at the ears.

This can have two causes: One possibility is that the inflammation spreads from the throat to the ears, where it also causes an inflammation with pain. The other possibility is that the sore throat and swollen tonsils close off the access between the throat and the ears. As a result, the pressure on the ears is not sufficiently equalized, which can cause ear pain.

Fatigue and exhaustion are symptoms that are most characteristic of Pfeiffer’s glandular fever, along with fever and tonsillitis. While most symptoms subside after a few weeks, fatigue can persist for several months. This pronounced fatigue is also known as fatigue in the technical language.

Pfeiffer’s glandular fever can even lead to a chronic fatigue syndrome that lasts for several years. The exact cause of this persistent fatigue has not been sufficiently researched scientifically and therefore cannot be treated causally. Just like the lymph nodes, the spleen can also swell strongly in the case of whistling glandular fever.

The spleen is like a large lymph node in our body and is primarily responsible for fish-ing out old cells from the blood. In the case of Pfeiffer’s glandular fever, changes occur in many different blood cells, causing some of these cells to be damaged or destroyed. The spleen has to sort out all these cells from the blood and can therefore easily be overwhelmed.

Excessive swelling of the spleen can lead to a rupture of the spleen. This is an absolute emergency because of the heavy bleeding. The rash caused by the Pfeiffer’s glandular fever can range from small reddish spots to large swellings and wheals.

According to the textbook the rash, also called exanthema, is very large-spotted, the red spots seem to flow into each other. The most common areas of this rash are the face, abdomen, chest, back, arms and legs. It usually forms about a week after the infection has started.

More rarely, more severe house changes such as itchy wheals or shooting disk-shaped itchy skin changes occur. All these rash types have in common that they are accompanied by severe itching. About 30% of the affected persons also suffer from oedema (i.e. water retention) on the face.

This symptom is also usually found within the first week after infection.In general, the rash caused by Pfeiffer’s glandular fever can be further aggravated by incorrect therapy. If the disease is confused with acute tonsillitis due to the severe swelling of the tonsils, amoxicillin is often prescribed as an antibiotic. This, however, increases the rash in the case of infection with the Epstein-Barr-Virus, i.e. Pfeiffer’s glandular fever, or causes it in the first place.