Glandular Pfeiffer Fever

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Glandular Pfeiffer Fever
Glandular Pfeiffer Fever
Video: Glandular Pfeiffer Fever
Video: Epstein Barr Virus and Infectious Mononucleosis (pathophysiology, investigations and treatment) 2023, February

Glandular Pfeiffer fever

The Epstein-Barr virus is a member of the herpes viruses (human herpes virus 4) and occurs worldwide. Often the transmission occurs when kissing. Pfeiffer's glandular fever (infectious mononucleosis) is therefore also known as "kissing disease". However, the virus can also be transmitted by droplets. In Europe, around 90 percent of the population undergoes an EBV infection up to the age of 30. In children the infection is usually symptom-free or extremely mild. In adolescents and adults, flu-like symptoms are common, and serious complications are very rare.


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  • ">How is Pfeiffer's glandular fever transmitted?


  • What are the symptoms?
  • What complications can arise?
  • How is the diagnosis made?
  • How is glandular fever treated?
  • Whom can I ask?
  • How are the costs going to be covered?


How is Pfeiffer's glandular fever transmitted?

The virus first multiplies in the mucous membrane cells of the nasopharynx. It then attacks the B lymphocytes, which are distributed throughout the body via the blood and lymph vessels. In the lymph nodes and internal organs such as the spleen and liver, they produce certain substances that cause the lymph nodes and organs to swell.

The infection mostly occurs with the saliva when kissing - small children from their parents, teenagers and young adults from one another. Other possible, but much rarer, transmission routes are, for example, sneezing, coughing, using the same cutlery or toothbrush.

In people with an intact immune system, the disease usually only occurs once. They develop antibodies and cytotoxic T cells against the virus and are thus protected against renewed infection for life. However, the virus remains latent in the body and can be reactivated in bursts over a long period of time and excreted via the nasopharynx. During this time, anyone who is not yet infected with the virus can become infected. In addition, the disease can recur - albeit mostly in a severely weakened or symptom-free form, for example if the immune system is temporarily weakened.

So far there is no vaccination against Pfeiffer's glandular fever. The risk of infection can be reduced by avoiding close contact with sick people - especially saliva contact from kissing or sharing cutlery, glasses or toothbrushes.

What are the symptoms?

The first signs of the disease appear around ten to 50 days after infection. These include flu-like symptoms:

  • Tiredness (even lasting for weeks),
  • Difficulty concentrating,
  • Loss of appetite,
  • Muscle and limb pain,
  • A headache,
  • general feeling of illness.

In the further course the following symptoms can typically arise:

  • Swollen lymph nodes: on the neck and neck, sometimes other parts of the body;
  • Fever: up to about 39 degrees Celsius;
  • Monocyte angina: sore throat with swollen tonsils, thick coating, difficulty swallowing, hoarseness and bad breath.

A fine-spotted rash occurs less frequently for a short time. Swelling of the liver and spleen can cause nausea, abdominal pain, and jaundice. In addition, those affected sometimes suffer from mood swings through to depression and disorientation.

In small children there are often no symptoms at all, in children under ten the infection is usually much more harmless than in adolescents and adults.

The disease usually heals within about three weeks. For some patients, however, it can take weeks to months before they feel completely healthy and productive again. In very rare cases, the disease becomes chronic and lasts more than six months.

In addition, the Epstein-Barr virus is considered a risk factor for certain rare cancers, particularly Burkitt's lymphoma and nasopharyngeal cancer. It is also discussed as a possible trigger for multiple sclerosis.

What complications can arise?

Complications are rare, but some of them can be serious, including:

  • Meningitis,
  • Myocarditis,
  • Inflammation of the kidneys,
  • Ruptured spleen,
  • Inflammation of the liver with jaundice,
  • Lung infection,
  • Joint inflammation,
  • Low numbers of blood cells (anemia) and platelets (thrombocytopenia)
  • Superinfection with streptococci.

In people with an immunodeficiency (e.g. AIDS or after organ transplantation), severe disease courses with pronounced lymph node growths up to B-cell tumors are possible.

How is the diagnosis made?

In addition to the swollen lymph nodes, the oropharynx is also examined. Blood tests will follow for the final clarification. When the infection starts, the number of white blood cells is greatly reduced (leukopenia). After a few days, the "colorful blood count" characteristic of Pfeiffer's glandular fever appears with a noticeable increase in the number of white blood cells (leukocytosis) and altered mononuclear cells (so-called Pfeiffer cells).

In many cases, further examinations are necessary for the differential diagnosis, e.g. the serological detection of antibodies and EBV antigens in the blood or a pathogen-specific PCR (EBVPB). The liver and spleen can be assessed with an ultrasound scan.

How is glandular fever treated?

There is no causal treatment. In the first few weeks of the illness, it is particularly important to ensure that you take sufficient care of yourself. Antipyretic and analgesic drugs (e.g. ibuprofen or diclofenac) can be used to relieve the symptoms. In addition, moist neck wraps and mouthwashes (e.g. with herbs such as marshmallow or ribwort) can be helpful for sore throats.

Antibiotics are only administered if there is a confirmed bacterial superinfection. Penicillins are to be avoided, however, as they can lead to skin rashes, especially in the case of glandular fever. In some cases, antivirals (e.g. acyclovir) or antibody therapies (e.g. rituxumab) can be effective.

Severe swelling that makes swallowing and / or consuming food difficult can be treated with corticosteroids. In these cases, as well as in the event of severe symptoms or complications, hospitalization is indicated.

Note In the case of acute and severe illness, sporting activities should be avoided, as there is a risk of a ruptured spleen.

Whom can I ask?

The first point of contact is a doctor specializing in general medicine or a specialist in paediatrics.

How are the costs going to be covered?

All necessary and appropriate therapies are covered by the health insurance carriers. Your doctor or the outpatient clinic will generally settle accounts directly with your health insurance provider. However, you may have to pay a deductible with certain health insurance providers (BVAEB, SVS, SVS, BVAEB).

However, you can also use a doctor of your choice (ie doctor without a health insurance contract) or a private outpatient clinic. For more information, see Costs and Deductibles.

When hospitalization is required

In rare cases, hospitalization may be required. The hospital costs are billed for. The patient has to pay a daily contribution to the costs. Further medication treatment at home is carried out by prescription from the general practitioner or the specialist.

For more information, see What does a hospital stay cost?

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