Mononucleosis – Glandular fever: symptoms, infection, course

Mononucleosis – Glandular fever: symptoms, infection, course

Pfeiffer’s glandular fever (mononucleosis) is a viral disease with which almost everyone is infected in the course of life. It is usually transmitted via saliva and is therefore also called kissing disease. However, the disease often does not break out or goes unnoticed. If adults fall ill, the symptoms are often particularly severe and manifest themselves as sore throat, swollen lymph nodes, fever and dullness. Find out here about the most important signs, ways of infection and therapies.

Mononucleosis (glandular fever): short overview

Main symptoms: Sore throat, swollen lymph nodes, fatigue, fever, enlarged spleen

Infection: Via saliva during kissing or via body fluids (sexual intercourse, blood)

Diagnosis: blood test for Epstein-Barr virus (EBV) and EBV antibodies, throat swab, palpation of spleen and lymph nodes

Treatment: Symptomatic treatment of pain and fever, in severe cases cortisone

Complications: Threatening swollen throat, ruptured spleen, inflammation of the liver, meningitis, paralysis, skin rash

Mononucleosis (glandular fever): Symptoms

Pfeiffer’s glandular fever (infectious mononucleosis, mononucleosis infectiosa, monocyte angina) is caused by the Epstein-Barr virus (EBV). The disease manifests itself mainly in the form of tonsillitis and pharyngitis with severely swollen lymph nodes, fever and fatigue due to whistling glandular fever.

In children, the infection is often asymptomatic because their immune system does not yet react strongly to the pathogen. In adults, mild courses can be confused with a flu-like infection. However, severe courses with complications are also possible.

For persistent sore throats with swelling of the lymph nodes, especially in the typical young age of infection. Often the tonsils have a yellowish or greyish coating, so that one usually assumes a bacterial sore throat and possibly prescribes antibiotics somewhat hastily. If the patient does not feel better afterwards, further smear and blood tests are carried out. Some patients also specifically ask for clarification.

Is it dangerous? Yes and no. Although the acute infection is sometimes extremely painful, persistent and gruelling, it is not really dangerous – unless you exercise too early and risk a rupture of the liver or spleen, as these organs are sometimes swollen. Unfortunately, the Epstein-Barr viruses can cause cancer later in life – about two percent of all cancer cases worldwide are said to be caused by them. Unfortunately, there is no vaccination to protect against this.

Which are the symptoms in adut and children? They are actually very different. Especially in children, the disease often progresses with only very mild symptoms, whereas some adults suffer for months, especially from exhaustion and increased susceptibility to infections. But usually the worst is over after a few weeks. And there’s the small consolation of knowing that you only catch it once in a lifetime..

Mononucleosis (glandular fever): Main symptoms

Sore throat: Pfeiffer’s glandular fever is characterized by severe sore throat with an intense redness of the pharyngeal mucosa and pronounced difficulty in swallowing. The tonsils and lymph nodes swell, some patients get high fever.

Pronounced weariness: Patients feel extremely exhausted and powerless in the acute phase of the disease. They usually recover within one to two weeks.

In others, however, fatigue, listlessness and the general feeling of illness can persist for a long time – even without the typical symptoms of mononucleosis (glandular fever) having occurred beforehand.

Especially for athletes, a sudden performance weakness is often the first, sometimes the only sign of the disease. In some cases the pronounced dullness lasts for several months.

Swollen spleen (splenomegaly): The spleen plays an important role in the defence against disease and filters dead blood cells from the blood. During an infection with the Epstein-Barr virus, it is particularly challenged. In the course of the disease it can therefore swell considerably and sometimes even tear.

Mononucleosis (glandular fever)r triggers the displayed symptoms. Other systemic symptoms are fever, chills, headaches and fatigue.

Mononucleosis (glandular fever): complications

Usually mononucleosis (glandular fever) is uncomplicated. However, serious, sometimes life-threatening complications can also occur.

Heavily swollen throat: It becomes dangerous when the immune system reacts so strongly to the virus that the pharyngeal mucosa swells very strongly. This can make swallowing impossible and even hinder breathing.

Rupture of the spleen: A severely swollen spleen can rupture due to shocks or falls. Then a life-threatening situation arises due to the strong internal bleeding. Patients in this condition should therefore strictly avoid the risk of impact injuries.

Inflammation of the liver (hepatitis): The virus can also attack the liver and cause inflammation of the liver. If this is severe, the skin turns yellow (jaundice) due to the limited liver function in cases of glandular fever.

Skin rash: In about five to ten percent of those affected, a patchy, raised (square) skin rash forms, the so-called maculopapular exanthema.

Paralysis: If the virus reaches the nervous system, it can cause inflammation with paralysis, which can also threaten respiration.

Inflammation of the brain: The virus can reach the brain. There it can cause meningitis.

Mononucleosis (glandular fever): infection and causes

Mono glandular fever is contagious. It is caused by the Epstein-Barr virus (EBV). The pathogen multiplies in the lymphocytes and in the mucosal cells in the throat. Outside the human body, the virus cannot survive for long.

The Epstein-Barr virus triggers the mononucleosis (glandular fever). It is transmitted via body fluids – especially via saliva.

Infection routes

EBV is transmitted via body fluids. Since the virus is mainly found in saliva, it is particularly easy to become infected during close physical contact and kissing. In the English-speaking world, Pfeiffer’s glandular fever is therefore called “Kissing Disease”, in German also called “Kusskrankheit”, In Italy “malattia del bacio” and in some Spanish speaking countries as “enfermedad del beso”.

A particularly common route of infection is among small children, for example in kindergarten, where toys often get into the mouth and are exchanged among themselves. Particularly “kiss-active” population groups such as young adults also become infected more frequently (“student fever”). 95 percent of people over 30 are infected with the mononucleosis (glandular fever) pathogen.

Other ways of infection, such as through sexual intercourse, blood transfusions or organ donations are also possible, but far less common.

Mononucleosis (glandular fever): incubation period

The incubation period, i.e. the period between infection and the onset of the disease, is long in the case of mononucleosis (glandular fever). There are usually four to six weeks between infection and outbreak of the disease. During this time, however, the infected person can already infect other people without suspecting that he himself is ill.

How long is mononucleosis contagious?

Freshly infected persons pass on the virus particularly easily. In this phase, a particularly large number of pathogens are excreted via saliva. This is still the case long after the symptoms have subsided. In order not to infect others, one should therefore be cautious with kissing in the first months after the initial infection and avoid unprotected sexual intercourse.

Mononucleosis (glandular fever) how long it is contagious?

A person who has once been infected with mononucleosis remains a lifelong carrier of the virus. The immune system then keeps the pathogen in check, so that the disease usually does not break out again.

From time to time, however, the virus is released into the saliva in increased quantities. All virus carriers can therefore infect others for the rest of their lives even after the symptoms have subsided.

The Epstein-Barr virus attacks mucous membrane cells and white blood cells. The body forms antibodies against the virus, which often remains in the body for life.

Mononucleosis during pregnancy

There is evidence that initial infection during pregnancy is associated with a higher rate of miscarriage or malformation. However, most women of child-bearing age are infected with the Epstein-Barr virus long before pregnancy. Therefore, only a few get infected for the first time during pregnancy.

If the mother has already been through an EBV infection, she transmits her protection against the virus to the newborn. This lasts for the first half of the baby’s life. The child can therefore usually only become infected afterwards.

Mononucleosis (glandular fever): examinations and diagnosis

The diagnosis of mononucleosis (glandular fever) is often difficult. 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 (glandular fever) is therefore not recognized at all or only at a late stage.

Targeted examination for mononucleosis (glandular fever) is usually only carried out when the fever does not drop or the patient complains of fatigue for weeks or a severe pharyngitis does not subside.

The central aim of the investigation is to find out whether viruses such as the Epstein-Barr virus or bacteria such as streptococci cause the complaints. Antibiotics only help with bacterial infections, but not with viral infections. They would even put unnecessary strain on the patient.

Physical examination

Throat examination: During the physical examination the doctor will first examine the throat and the tonsils. With whistling glandular fever they are reddened and often strongly swollen. The coatings also provide an indication of the type of infection: While they look more like spots in bacterial streptococcal tonsillitis, they appear white and flat in whistling glandular fever.

Palpation of the lymph nodes: By palpating the neck under the angle of the jaw, the armpits and the groin region, the doctor can determine if and which lymph nodes are swollen.

Palpation of the spleen: With mononucleosis (glandular fever), the spleen often swells to such an extent that the doctor can palpate it clearly from the outside.

Throat swab: A throat swab can be used in the laboratory to determine whether bacteria are the cause of the disease. If the smear contains the Epstein-Barr virus, however, this is not yet sufficient for a reliable diagnosis of mononucleosis (glandular fever). The pathogen is not only found on the mucous membrane in an acute infection. It can also be detected when the virus has been in the body for a nice long time and has only been reactivated.

Diagnosis by blood test

Antibodies: For a reliable diagnosis of mononucleosis (glandular fever), specific antibodies against the Epstein-Barr virus can be detected in the blood.

Deformed lymphocytes: A blood test can also determine whether these white blood cells are altered. Since they have to be regenerated en masse during the infection, many of them are initially somewhat deformed. For this reason they are also called Pfeiffer cells or atypical lymphocytes.

Elevated LFTs: If the liver is attacked by the virus, a blood test also shows an increased concentration of liver enzymes (transaminases).

Mononucleosis (glandular fever): treatment

Mononucleosis (glandular fever) is a viral disease. Therefore, antibiotics do not help, because they only work against bacterial infections.

The treatment therefore focuses on alleviating symptoms such as pain, difficulty swallowing and fever. For this purpose, one uses the common agents such as ibuprofen, acetylsalicylic acid or paracetamol.

An important principle of treatment for mononucleosis (glandular fever) is physical rest. This considerably reduces the risk of serious complications. The discharge, which includes a strict ban on sport, should be maintained for a period of time beyond the existence of acute symptoms of the disease.

If complications occur, further treatment may be necessary. If the pharyngeal mucosa swells threateningly or if symptoms such as fatigue and fever are very pronounced, treatment with cortisone or other agents that dampen the activity of the immune system is also used.

A rupture of the spleen must be operated on immediately, otherwise the patient threatens to bleed to death.

What else is important in the treatment of mononucleosis (glandular fever), you can read in the article Pfeiffer’s glandular fever – mononucleosis treatment.

Mononucleosis (glandular fever): course of the disease and prognosis

Mononucleosis (glandular fever)r lasts up to three weeks. It usually heals without lasting consequences. However, if complications are suspected or blood values deteriorate dramatically, patients are treated in hospital for monitoring.

In very rare cases, whistling glandular fever becomes chronic. This means that the symptoms persist for months or even years. Only very rarely, however, does Pfeiffer’s glandular fever lead to permanent damage due to complications such as inflammation of the liver and meningitis.

It is believed that EBV infection increases the risk of some blood cancers (e.g. B-cell lymphomas, Burkitt lymphoma, Hodgkin’s disease).

Mononucleosis (glandular fever): What you can do yourself

Since the Epstein-Barr virus is very widespread in the population (the “infestation rate” is 95 percent), it is hardly possible to protect oneself from it. In case of illness, however, there are some things you can do to prevent a serious course of the disease in case of glandular fever.

Avoid alcohol

The infection also often places a considerable burden on the liver. You should therefore strictly avoid alcohol during the illness phase in order not to put additional strain on the liver. In some cases, liver values remain elevated for months, so regular blood checks are necessary and you should avoid alcohol even after symptoms have subsided to avoid permanent liver damage.

Adjusting medication

Since many drugs are also broken down in the liver, some active ingredients must be replaced by fewer liver-damaging substances for the duration of the disease in consultation with the doctor.

Be careful when exercising!

In the acute phase or in the case of serious infections, you should refrain from sport altogether; later, in consultation with your doctor, light exercise training may be possible.

If the spleen swells strongly in the case of whistling glandular fever, there is a risk that the organ, which is very rich in blood, will rupture under physical stress or through external violence. This causes severe internal bleeding which can be life-threatening. Therefore, contact and martial arts are to be strictly avoided in the acute phase of illness.


Sandra Eades

Hello I am Sandra Eades, physician, researcher and author from Australia. I am working currently as researcher for a private institution. I have studied in Britain and Australia, where I currently reside. I write about research topics in the organization of the public health government agencies. For the iMS I write about general medical conditions. I also research scholar sources to provide information to writers of other articles. I also check the citations of scholar papers. Finally, I read other articles before they are published. I am also a mother of three children!

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