Infectious mononucleosis

The glandular fever, also glandular fever, mononucleosis, infectious mononucleosis, infectious mononucleosis, Monocytic, Crohn Pfeiffer or even kiss disease called, is a very common and usually harmless viral disease that is caused by the Epstein - Barr virus. An estimated 95 percent of all Europeans are infected by the age of 30 with the virus, which can be detected by antibodies in the blood. In most people, especially in children under ten years, the disease usually has no symptoms; in adults occur mostly flu-like signs of disease and rarely complications.

Especially with the few young people who have symptoms, swollen lymph node and can also occur a sore throat or tonsillitis. Furthermore, an enlarged spleen, stomach, muscle pain or headaches, loss of appetite, depression, mood swings, general weakness, rash, dizziness or disorientation, chills, dry cough, nausea and night sweats may occur.

The viruses infect the lymph nodes and organs of the lymphatic pharyngeal ring, but also the liver, spleen and heart. In general, the disease occurs only once in one's life, but as with other herpes viruses, the Epstein -Barr virus remains in the body for life and can be intermittently activated again (often incorrectly referred to as re-infection ).

Prolonged disease processes that extend in a weakened form sometimes over months and years, are rare and not to be confused with post-infectious generalized weakness and fatigue with a duration of up to one year, as may occur also for other viral infections.

The disease name goes back to the pediatrician Emil Pfeiffer ( 1846-1921 ). He described the first as idiopathic disease adenitis.

Pathogen

The disease cause is Epstein -Barr virus ( EBV), an enveloped, double-stranded DNA virus ( dsDNA). This virus is a gamma - herpes virus belonging to the family Herpesviridae.

The EBV as well as other members of this virus family two development phases: the first lytic phase serves the production and release of the virus and its spread. In the subsequent latent phase, the virus reaches a quiescent state in which it is largely outside the immunological control. In this way, in the infected host a reservoir adapted to receive a production and release of infectious virus particles after reactivation.

Transmission

The pathogen is transmitted primarily via saliva. As more transmission paths are droplet infection and contact infection or contact infection suspected, even though studies have shown to students and military personnel that roommates are not exposed to increased risk of infection. Especially among young couples where the transfer is very often by word of mouth, which is why the disease popularly often. Well as Kiss illness, students or student illness fever, English kissing disease is called.

The pathogen infects the epithelial cells of initially nose, mouth and throat and a type of white blood cells, B lymphocytes, in this area. About 95 percent of all German adults EBV antibodies are detectable, they have therefore become infected in the course of their lives with EB virus.

After an infection, the pathogen remains - like all herpes viruses - live long in the human body and becomes latent in memory B lymphocytes. To escape a counter- reaction of the immune system, only ten of the nearly 100 viral genes are expressed in the latent phase of infection, the virus which allows a largely unrecognized by the immune system resistance. Even a few weeks after cessation of symptoms, the virus via saliva to non- immune individuals is transferable. It also comes after the healing of the disease again and again to reactivations of persistent viral infection. Of these, the person usually noticed nothing, he then divorce but again virus in saliva. Such reactivations are also detectable in the blood (including through increase in IgG antibodies against the viral capsid antigen VCA and EBV -PCR).

Diagnosis

A definite diagnosis is made by the detection of Epstein -Barr virus antibodies and often a conspicuous increase in the leukocyte count (leukocytosis ) 10000-25000 per mm ³ with 60 to 80 percent lymphoid ( mononuclear ) cells, of which a part of atypical lymphocytes. The liver values ​​are elevated in many cases. Serological are indicative:

• Detection of heterophile antibodies in the Paul- Bunnell reaction or derived from tests
• IgM antibodies to early antigen (EA ) and / or
• IgM antibodies to viral capsid antigen (VCA) with negative EBNA -1-IgG assay ( Epstein-Barr Nuclear Antigen -1 IgG assay).

High levels of EBNA- 1 IgG (positive EBNA-1 IgG test ), however, include a fresh infection from virtually since these antibodies are produced in the course of several weeks to months after the onset of symptoms by the immune system.

The glandular fever is often overlooked by doctors, not the diagnosis. In case of unclear prolonged fatigue, and weakness of a patient should therefore be tested for Epstein -Barr infection always.

Differential Diagnosis

Differential diagnosis includes infection with the cytomegalovirus ( CMV) or with the HIV virus is clarified. At the beginning of the disease is often a sore throat in the foreground, which must be distinguished from a purulent angina, eg by group A streptococci. The frequent lymph node swelling must, among other infectious diseases are thought (eg, toxoplasmosis, cat scratch disease, tuberculosis ) also an autoimmune disease and malignant disease such as malignant lymphoma.

Disease course and symptoms

The Epstein -Barr infection is indeed often very debilitating, but generally proceeds without complications. Deferred, recurrent or chronic cases are rare. However, the infection also applies in these cases as non-hazardous.

The role of the immune system

Especially in infections with pathogens that are highly adapted already to the man, the reservoir host - as is the case with the Epstein -Barr virus - also plays the state of the immune system of the organism concerned an important role.

Whether after such an infection actually occurs a disease depends on the amount and virulence of the pathogen and the state of the immune system of the person concerned. The observation that the glandular fever by no means all of the contact persons also fall ill, has various causes. Thus, the virus dose or virulence may become evident immunity, may be too low for a disease outbreak or the immune system is able, in spite of infection to prevent disease symptoms ( inapparent infection or silent Feiung ). Especially with an intact immune system strong and defensive and low pathogen dose, the disease can either does not break or take a less severe course.

Ordinary course

The incubation period is seven to 30 days for children. In adolescents and young adults is four to seven weeks already considerably longer.

After a primary infection, the disease often begins with flu-like symptoms such as fever ( 38-39 ° C ), pain, abdominal pain and severe fatigue. In addition, the lymph nodes swell of the sick, throat, neck, rarely also in the armpits and on the strips on ( lymphadenopathy). Many of those affected also forms a sore throat or tonsillitis ( tonsillitis), in which a rather dirty- formed on the tonsils instead of white covering that fits over not on the surroundings of the tonsils ( tonsils ). Quite striking is therefore in many patients an offensive breath ( halitosis ), hoarseness or speech problems may be added, often Nachtschweißigkeit as a symptom of an infectious disease. Furthermore, a spleen or sometimes enlarged liver, stomach, muscle pain or headaches, loss of appetite, depression, mood swings, general weakness, rash, dizziness or disorientation, chills, dry cough, and nausea may occur. The illness usually lasts only a few weeks, but may also extend over one to two months. After the acute symptoms subside is usually a lifelong carrier state, so that it can come even after many years, such as immunosuppression, to recur.

Unusual course

Asymptomatic gradients are possible, especially with small children.

In addition, this disease can be also chronic. Those affected suffer then months or years from fever, fatigue, exhaustion, depressive moods, feelings of listlessness and chronic lymph node swelling, totaling a strong feeling of illness similar to the chronic fatigue syndrome ( CFS).

In rare cases, as with many other viral diseases such as influenza occur over a months to a year or two ongoing weakness and fatigue, however, is not caused by the virus itself. The actual infection has subsided here within a few weeks, but in these cases is then an overreaction of the immune system. Until this has returned to normal after the successful defense of the virus can persist for up to several months, swollen and / or painful lymph nodes, sore throat, weakness, fatigue.

In addition, in a weakening of the immune system is re- becoming active (reactivation) of the Epstein -Barr virus - like all herpes viruses - always possible, however, then the disease is in these cases to a lesser extent.

Complications

Rare complications include encephalitis (encephalitis ), equine infectious anemia ( autoimmune hemolytic anemia), platelets poverty (thrombocytopenia ), severe reduction in granulocytes ( agranulocytosis), swelling of the liver ( hepatomegaly ) or enlargement of the spleen (splenomegaly ), pneumonia, heart muscle inflammation ( myocarditis), inflammation of the kidneys ( nephritis) and jaundice (icterus). When these symptoms occur, a hospital stay may be necessary.

As long as there is a swelling of the spleen, physical exertion should be avoided because of the risk of a Milzrisses.

As with all infectious diseases can take a very serious or even fatal course in children with congenital or acquired immunodeficiencies this disorder.

It is believed that the Epstein- Barr virus ( CFS), rare tumors of the pharynx, rare lymphomas ( Burkitt 's lymphoma ) and multiple sclerosis could play a role in the genesis of chronic fatigue syndrome. Proved or clearly proves this is not, however, until today.

There are many rumors about the glandular fever, but few are true. To produce this disease, for example, no impotence.

Therapy

A special preparation with the glandular fever does not yet exist. In fever it is necessary for fluid balance, much to drink and when appropriate also to take fever-reducing medications. In addition, the patient should necessarily enough rest.

In about 10 percent of the cases, it also leads to a bacterial infection, which may need to be treated with antibiotics. Not only for this reason, you should definitely consult a doctor in this disease. However, the doctor must make sure that certain antibiotics can cause severe skin rash with itching all over the body in an acute EBV infection. Several sources expressly point out that particularly the broad-spectrum antibiotics ampicillin and amoxicillin should not be used for therapy, as this in up to 90 percent of cases in the formation of the rash (so-called Ampicillinexanthem ) and pruritus leads. This rash may, even after taking the antibiotic to enter and usually requires about three days to fully spread across the body. After that, he sounds very slowly back until it disappears completely after about two weeks. This is not is an allergy, so that in subsequent antibiotic therapies continue to penicillin and its derivatives ( ampicillin, too) can be used.

Post -infectious immunity

Since form antibodies against the virus as part of the infection is a life-long immunity following initial infection usually. The conditions under which a recurrence or reactivation takes place, as is the frequency of occurrence of such renewed or prolonged illnesses have so far not been thoroughly investigated scientifically.

Prevention

Prevention can be only by avoiding contact with sick people, since there is still no vaccine.