What is Mononucleosis?
The Infectious Mononucleosis is a very common and usually harmless viral disease, which is caused by the Epstein-Barr virus. An estimated 95 percent of all Europeans infected up to 30 years with the virus, which can be detected by antibodies in the blood. For most people, especially in children under ten years of age, is the disease without symptoms; usually flu-like signs of disease and complications rarely occur in adults.
Especially in the few young people who have symptoms, swollen lymph nodes, and can also create a strep throat or tonsillitis. Furthermore, an enlarged spleen, stomach, muscles or headaches, loss of appetite, depression, mood swings, general weakness, rash, dizziness or disorientation, chills, dry cough, nausea, night sweats may occur.
The viruses infect the lymph nodes and organs of the lymphatic tonsillar ring, as well as liver, spleen and heart. In general, the disease occurs only once in a person's life, but as with other herpesviruses Epstein-Barr virus remains in the body for life and can be intermittently reactivated (often incorrectly referred to as reinfection).
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 for a period up to one year, as they can also occur for other viral infections.
Mononucleosis Diagnosis
A clear diagnosis can be made through the detection of Epstein-Barr virus antibodies and often also a conspicuous increase the white blood cell count (Leukocytosis) between 10,000 and 25,000 lymphocytes per mm³ with 60 lymphoid to 80 percent (mononuclear) cells, a part of them atypical. The liver enzymes are elevated in many cases. Serology are indicative:
-Proof of heterophile antibodies in the Paul-Bunnell reaction or it derived tests
-IgM antibodies to early Antigen (EA) or
-IgM antibodies to viral capsid Antigen (VCA) in negative EBNA-1-IgG test (Epstein-Barr nuclear antigen-1-IgG test).
High levels of EBNA-1 IgG (positive EBNA-1 IgG test), however, include a fresh infection from virtually since these antibodies are produced only in the course of several weeks or 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
The differential diagnosis of infection with cytomegalovirus (CMV) or with the HIV virus is clarified. At the beginning of the disease is often a sore throat in the foreground of a purulent tonsillitis, eg. has to be distinguished by group A streptococci. In the frequent lymph node swelling, among other infectious diseases (eg. As toxoplasmosis, cat scratch disease, tuberculosis) must also be considered an autoimmune disease and malignant disease such as malignant lymphoma.
Disease Progression and Symptoms of Mononucleosis
The Epstein-Barr infection, although often very debilitating, but generally proceeds without complications. Deferred, recurrent or chronic cases are rare. However, the infection is in these cases as non-hazardous.
The role of the immune system
Especially during infections with pathogens that are already heavily customized to man, the reservoir host - as is the case with the Epstein-Barr virus - also plays the immune status of the organism concerned an important role.
Whether after such an infection actually occurs a disease depends on the amount and virulence of the pathogens and the immune status of the person concerned. The observation that the mononucleosis not all contacts also contract, has various causes. Thus, the virus dose or virulenz may already exist 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 in an intact and strong defense immune system and lower pathogen dose, the disease can either does not break or take a less severe course.
Unusual History
Asymptomatic gradients are possible especially in young children.
In addition, this disease can also chronic. Sufferers then months or years with fever, fatigue, exhaustion, depressive moods, feelings of listlessness and chronic lymphadenopathy, totaling a strong feeling of illness similar to the chronic fatigue syndrome (CFS).
Rarely, as in many other viral diseases such as influenza occur over a months to a year or two persistent weakness and fatigue, which however is not caused by the virus itself. The actual infection has subsided again within a few weeks, but in these cases is then an overreaction of the immune system. Until this is back 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-Involved (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 inflammation of the brain (encephalitis), 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), kidney inflammation (nephritis) and jaundice (icterus). If this occurs, a hospital stay may be required.
As long as there is a swelling of the spleen, physical exertion should be avoided because of the risk of splenic rupture.
As with all infectious diseases can take a very serious or even fatal course in children with congenital or acquired immunodeficiencies this disease.
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 development of chronic fatigue syndrome. Proved or clearly proves this is not, however, until today.
There are many rumors of glandular fever, but few are true. To produce this disease, for example, not impotence.
Mononucleosis Treatment
A special preparation against glandular fever does not yet exist. Fever, it is necessary for fluid balance, much to drink and when appropriate to take antipyretic drugs. In addition, the patient should necessarily enough rest.
In about 10 percent of the cases it also results in a bacterial infection, which may need to be treated with antibiotics. Not only for this reason, you should consult a doctor in this disease. However, the physician must ensure that certain antibiotics can cause severe skin rashes with itching all over the body during acute EBV infection. Several sources explicitly point out that in particular the broad-spectrum antibiotics ampicillin and amoxicillin should not be used for therapy, as this in up to 90 percent of cases, the formation of the rash (called Ampicillinexanthem) and pruritus leads. This rash can also occur after taking the antibiotic and usually requires about three days to completely spread over the body. Then he sounds very slowly again until he disappears completely after about two weeks. This is not an allergy, so that in subsequent antibiotic therapies continue to penicillin and its derivatives (ampicillin, too) can be used.