Infectious mononucleosis

Last Updated: 2023-07-07

Author(s): Anzengruber F., Navarini A.

ICD11: 1D81.Z

  • Filatov, 1887
  • Pfeiffer, 1889

Pfeiffer's glandular fever, Pfeiffer's disease, mononucleosis infectiosa, monocytangina, kissing disease.

Infectious disease caused by Epstein-Barr virus (human herpes virus 4), which is characterised by fever, a necrotising angina and swelling of the lymph nodes.

  • Often epidemic in the spring
  • Mostly adolescents and young adults are affected
  • Totally asymptomatic in 50% of cases
  • In infancy, up to 90% inapparent course
  • Almost everyone has passed through the infection (often unknowingly) by the age of 30

  • Transmission: droplet infection, transfusions
  • Incubation period: 4-50 days

  • The proliferation of the virus takes place in the oral mucosa and salivary glands, where it remains latent and is sometimes detectable even after the disease. This is the reason for the name "kissing disease", as clinically healthy people can transmit the virus via saliva, for example. The EBV stimulates the B cells, which proliferate and form heterophilic antibodies.

  • Angina with pseudomembranous plaques and locoregional lymphadenopathy
  • Febrile temperatures (often >39°C), fatigue and exhaustion
  • In up to 15%, maculopapular exanthema occurs, which may appear morbilliform and rubeoliform
  • If treatment with ampicillin is given, the appearance of exanthema is almost obligatory
  • With immunosuppression, there is a risk of viral reactivation
  • In addition, there may be splenic swelling (here there is a risk of lethal splenic rupture), meningitis, meningoencephalitis, myalgia, interstitial pneumonia, thrombocytopenia, polyneuritis, pericarditis, myocarditis, glomerulonephritis, Guillan-Barré syndrome and hepatitis-induced jaundice. In individual cases, the disease may persist for months.
  • Erythema nodosum (rarely occurring)

  • clinic
  • Lab (initially leukopenia, then leukocytosis with monocoid cells, occasionally elevated liver enzymes)
  • Rapid tests: Paul-Bunnell rapid test (false negative in up to 15% of adults and 20% of children) and latex agglutination test
  • EBV-(VCA)-IgG, EBV-(VCA)-IgM
  • EBV immunoblot (viral capsid antigen, EBV-specific nuclear antigen, early antigen)
  • Upper abdominal sonography
  • CAVE: No splenic palpation due to risk of rupture

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