This common virus can sometimes be life-threatening

What is Pfeiffer's glandular fever?

Pfeiffer's glandular fever, also known as infectious mononucleosis or monocyte angina, is an infectious disease caused by the Epstein-Barr virus (EBV), a member of the herpesvirus family. The virus initially multiplies in the mucous membranes and specific immune cells in the throat, the B lymphocytes, and then spreads via the lymphatic and blood systems throughout the body to reach lymph nodes and organs such as the spleen and liver. 

Typical symptoms include inflammation of the tonsils and throat, markedly swollen lymph nodes, fever and fatigue, while children often show no symptoms. Severe courses occur particularly in adults. 

How is it transmitted?

Infection with the Epstein-Barr virus (EBV), the cause of Pfeiffer's glandular fever, occurs through body fluids, especially saliva. The pathogen replicates in white blood cells (lymphocytes) and in the mucosal cells of the throat. Typical routes of transmission are direct contact with saliva, such as kissing, sharing drinking glasses or cutlery, and also exchanging toys among toddlers in daycare. Particularly affected are „kiss-active" population groups such as young adults, hence the term „student fever". Other infection routes like sexual intercourse, blood transfusions or organ donations are possible but less common. 

The incubation period is usually four to six weeks but can be up to three months. During this time, an infected person can infect others even if they have no symptoms themselves. Newly infected individuals are especially contagious as they shed many pathogens in their saliva. This phase can continue long after symptoms subside. Therefore, it is recommended to be cautious with kissing and to avoid unprotected sex during the first months after infection.

Once infected, a person remains a carrier of the virus for life, and EBV can reactivate with renewed symptoms if the immune system becomes weakened.

What are the symptoms of Pfeiffer's glandular fever?

Pfeiffer's glandular fever primarily presents as an inflamed tonsillar and pharyngeal region, accompanied by markedly swollen lymph nodes, occasional fever and a sense of exhaustion. Some affected people also develop eye inflammation. Children often show few symptoms. In adults the infection is sometimes mistaken for a simple cold. 

Typically the illness manifests with severe sore throat, redness of the pharyngeal mucosa and difficulty swallowing. The lymph nodes and tonsils swell, possibly accompanied by high fever and unpleasant breath. 

A pronounced fatigue and lack of energy are characteristic of the acute phase, which usually subsides after one to two weeks. Some patients, however, may continue to experience tiredness, lack of drive and general malaise even after the typical symptoms fade. In athletes, a sudden drop in performance can be an early sign of the disease. 

Muscle and limb pain and an enlarged spleen are other possible symptoms. In about half of the cases a palpable enlargement of the spleen is observed, because the spleen plays an important role in defending against disease and filtering dead blood cells from the circulation. During an Epstein-Barr virus infection it is particularly strained and in some cases may even rupture.

Patients often complain of headaches, loss of appetite, sweating or chills and cough. The swelling in the tonsil and throat area can be so pronounced that it causes not only difficulty swallowing but also breathing problems. 

What is the course of Pfeiffer's glandular fever?

Pfeiffer's glandular fever lasts for a period of up to three weeks and in most cases heals without lasting consequences. However, if complications are suspected or there are dramatic changes in blood values, patients are admitted to hospital for monitoring. 

In very rare cases Pfeiffer's glandular fever can become chronic and persist for months or even years, but this rarely leads to lasting damage from complications such as hepatitis or meningitis. 

An EBV infection may increase the risk of certain blood cancers such as B-cell lymphomas, Burkitt lymphoma and Hodgkin lymphoma. A connection is also suspected with chronic fatigue syndrome, multiple sclerosis and rare throat tumours.

What complications can occur?

Pfeiffer's glandular fever usually runs without complications, but it can also lead to severe, sometimes life-threatening complications. An Epstein-Barr virus (EBV) infection can be fatal in severely immunocompromised people. Long-term consequences are generally not expected if the immune system is intact.

In some cases the immune response can be so strong that the pharyngeal mucosa swells severely, which can impair swallowing and even affect breathing. A severely enlarged spleen increases the risk of a splenic rupture, which can be caused by blows or falls and may trigger life-threatening internal bleeding. The virus can also affect the liver and cause hepatitis, which can lead to jaundice.

Some patients develop a patchy, raised skin rash, known as a maculopapular exanthem. In rare cases the virus can attack the nervous system and cause inflammation with paralysis that may affect breathing. The virus can also reach the brain and cause encephalitis or meningitis.

People who have had Pfeiffer's glandular fever have an increased risk of certain cancers linked to EBV infection, including Burkitt lymphoma and nasopharyngeal carcinoma. Recent research also shows a link to other lymphoid cancers such as Hodgkin lymphoma. A specific viral protein appears to trigger cancer development. Globally, about 200,000 cancer cases each year are attributed to EBV infections.

In immunocompromised people, such as after organ transplantation or in AIDS patients, Pfeiffer's glandular fever can recur with symptoms.

What can you do yourself against Pfeiffer's glandular fever?

• Because the Epstein-Barr virus is widespread, direct contact with acutely infected people is hard to avoid. Nevertheless, caution is advised, especially with close physical contact such as kissing or sharing food and drinks.
• There is currently no vaccine against Epstein-Barr virus, but research is ongoing. A potential vaccine could reduce the risk of late consequences such as chronic fatigue syndrome or multiple sclerosis.
• Since Pfeiffer's glandular fever is a viral infection, antibiotics are ineffective. Treatment focuses on relieving symptoms such as pain, difficulty swallowing and fever using painkillers like ibuprofen or paracetamol.
• Rest is an important principle in treating Pfeiffer's glandular fever to minimise the risk of serious complications. Stay in bed and avoid strenuous physical activity, especially during the acute phase of the illness.
• If complications such as a severely swollen throat, splenic rupture or hepatitis occur, immediate medical intervention is required to prevent life-threatening situations.
• To avoid further burdening the liver, alcohol and fatty foods should be avoided during the illness.
• In hepatitis the liver values often remain elevated, so regular blood checks are important to prevent permanent damage.
• Some medications can strain the liver, so it is important to replace them with less liver-damaging alternatives in consultation with the doctor during the illness.
• Contact and combat sports should be avoided during the acute phase of Pfeiffer's glandular fever because of the risk of splenic rupture. At a later stage, light exercise may be possible in consultation with the doctor.
• Drink plenty of fluids, especially when you have a fever, to replace the body's fluid loss.
• More frequent and gentle tooth brushing and gargling can improve oral hygiene and reduce the risk of infections.
• In case of high fever, cooling leg wraps can help, or fever-reducing drugs can be taken after consulting a doctor.
• For complaints such as swollen tonsils or neck lymph nodes, cooling compresses or soothing teas like chamomile can help relieve symptoms.
• Discuss all measures and treatments with your doctor to ensure they are suitable for your individual case.

Pfeiffer's glandular fever can temporarily upset our balance, but most people make a full recovery from this viral illness. While unpleasant, the disease also demonstrates the impressive power of our immune system and reminds us to take care of our health so we can get back on our feet quickly.