Mononucleosis and Chronic Throat Pain

Quick Summary on Mono Infection or Pfeiffer's Disease

Epstein Barr Virus is found throughout the world. Epstein Barr virus causes mono infection or pfeiffer's disease and presented as flu in children and young adults. Common symptoms of mono infection or pfeiffer's disease are fever, body ache, running nose, sore throat and fatigue. Symptoms improve without any treatment in 2 to 3 weeks. Flu like symptoms if continued after 3 weeks, then the patient is treated with antibiotics. Amoxicillin and aspirin may make the symptoms worse and should be avoided. Few cases infection may persist and often causes chronic throat pain.

What is Mono Infection or Pfeiffer's Disease?

Mono infection or pfeiffer's disease is a continuation of viral infection caused by Epstein Barr virus after 2 to 3 weeks. Pfeiffer's Disease or Mono Infection is a Viral Infection. If symptoms such as throat pain persist after 2 to 3 weeks, further blood examination is done. Blood examination concludes the diagnosis of mono infection or pfeiffer's disease. Mono infection or pfeiffer's disease may last for short period like three to six weeks or prolonged period for several years to life of few individuals. Prolonged symptoms of mono infection or pfeiffer's disease are fever, fatigue, and weakness is sometimes diagnosed as chronic fatigue syndrome.

Mononucleosis

Few cases of mono infection or pfeiffer's disease may result in prolonged chronic throat pain secondary to pharyngitis. Pharyngeal inflammation may continue with excessive drooling and salivation. In few cases may cause bad breath. Patient may not suffer with any other symptoms.

Mono infection or pfeiffer's disease can be serious in patients with suppress autoimmune system. Patient may develop enlarged spleen and liver with generalized lymph node swelling (lymphadenopathy). Heart, liver or kidney transplant patients are autoimmune compromised and must take precautions if in contact with patient suffering with mono infection or pfeiffer's disease.

Mono infection or pfeiffer's disease is more common in children, teenagers, adolescents and younger adults. Epidemiological study in USA has suggested 90 to 95% adults are infected with E-B virus at least once and has antibodies stored in vascular system. In few cases after first infection by E-B virus, virus may remain dormant in body for several years. Virus becomes active once a while and can be infectious and might cause mono infection or pfeiffer's disease. During the active phase individual patient is contagious and can transmit E-B virus to others if in close contact.

Incubation Period for Mono Infection or Pfeiffer's Disease

  • Incubation period for mono infection or pfeiffer's disease is between four to eight weeks- Symptoms may develop after four to six from the initial contact with infected individual.
  • Symptoms may appear earlier in two to three weeks in children under eight to ten years.

Mono Infection or Pfeiffer's Disease during Pregnancy

Mono infection or pfeiffer's disease during pregnancy has not shown any miscarriages or birth defects.

What are the Causes of Mono Infection or Pfeiffer's Disease?

Epstein Barr Virus or EB Virus or EBV causes mono infection or pfeiffer's disease.

  • Epstein Barr Virus or EB Virus or EBV is a member of herpes virus family and is quite common human viruses.
  • Most people become infected with Epstein Barr Virus or EB Virus or EBV sometime during their lives.
  • In USA, as many as 95% of adults between age of 35 to 40 have had this infection.
  • Infants become susceptible to EBV as soon as maternal antibody protection (present at birth) disappears.
  • Many children become infected with EBV, and these infections usually cause no symptoms or are indistinguishable from the other mild, brief illnesses of childhood.
  • Prolonged or recurrent infection of Epstein Barr Virus or EB Virus or EBV during adolescence or young adulthood result in mono infection or pfeiffer's disease, which is observed in 35% to 50% of infected patients.
  • Dormant EBV virus causes persistent pharyngitis not responding to conservative and anti-viral treatment.
  • EBV virus remains dormant in throat or blood in few cases after initial infection.
  • Dormant period may last for several years to lifetime of individuals.
  • Dormant period may be asymptomatic or symptomatic.
  • Diagnosis is difficult unless virus is reactivated and viruses are found in saliva.

Contamination and Transmission of the Epstein Barr Virus or EB Virus or EBV

Transmission of the Epstein Barr Virus or EB Virus or EBV through Sputum

If person is infected with EBV causing mono infection or pfeiffer's disease:

  • Cover face while communicating with others or coughing,
  • Try not to kiss an infected individual.
  • Avoid Contacts- Sharing toothbrushes, Utensils, drinking glasses etc.

Transmission of the Epstein Barr Virus or EB Virus or EBV through Blood

Transmission of the Epstein Barr Virus through blood is rare and uncommon.

Transmission of the Epstein Barr Virus or EB Virus or EBV from Healthy Individuals

Healthy individuals hosting Epstein Barr Virus or EB Virus or EBV virus in mouth and saliva are primary reservoir for transmission from person to person.

Signs and Symptoms of Mono Infection or Pfeiffer's Disease

The following are the symptoms of mono infection or pfeiffer's disease:

  • Fever
  • Sore throat, which is quite severe and does not seem to get better in spite of using antiviral and antibiotic medications.
  • Sweating during night
  • Fatigue
  • Weakness
  • Salivation and drooling
  • Presence of rash on skin
  • Dyspnea
  • Changes in color of skin where it gets a yellowish tinge.
  • Acute headache or body ache.
  • Loss of appetite along with weight loss.
  • Anorexia.

Below mentioned are the signs of mono infection or pfeiffer's disease:

  • Swollen neck gland.
  • Generalized lymphadenopathy lasting 1 to 4 weeks.
  • Splenomegaly:
    • Swelling of spleen
    • Symptoms such as soreness, pain and tenderness in the upper left quadrant of abdomen below ribs.
    • Rupture spleen- rare complication, needs immediate surgery.
  • Heart disease.
  • Swelling of lymph nodes and glands along with tonsillitis.
  • Hepatomegaly.

Rare Complications for Mono Infection or Pfeiffer's Disease

The below are the rare but possible complications for mono infection or pfeiffer's disease:

  • Anemia
  • Thrombocytopenia
  • Heart inflammation
  • Encephalitis
  • Meningitis
  • Guillain-Barre syndrome
  • Swollen tonsils.

Investigations to Diagnose Mono Infection or Pfeiffer's Disease

Blood Examination for Mono infection or Pfeiffer's Disease

  • White blood cells are normal to moderately elevated in mono infection or pfeiffer's disease.
  • Lymphocytes increased total number of lymphocytes, greater than 10% atypical lymphocytes.
  • Mono Spot test is positive during active mono infection or pfeiffer's disease.
  • Paul-Bunnell heterophile antibody test positive, moderate-to-high levels of heterophile antibodies are seen during the first month of illness and decrease rapidly after week 4.
  • False-positive results may be found in a small number of patients, and false-negative results may be obtained in 10% to 15% of patients, primarily in children younger than 10 years of age.
  • Direct detection of EBV in blood or lymphoid tissues is not routinely done. Test is time consuming and difficult to perform in normal lab setting.

Specific Laboratory Tests for Epstein Barr Virus or EB Virus or EBV

Below mentioned are the specific lab tests conducted for recognizing Epstein Barr Virus or EB Virus or EBV:

  • Antibody Test - Effective laboratory diagnosis can be made on a single acute-phase serum sample by testing for antibodies to several EBV-associated antigens simultaneously.
  • Antibody Titration - Patient with negative "mono spot" test are considered for antibody titration test. Antibody titrations of four markers are performed:
    • IgM and
    • IgG to the viral capsid antigen,
    • IgM to the early antigen, and
    • Antibody to EBNA.
  • EBNA antibodies are absent during acute phase and only seen with immunofluorescent test after 4 weeks of infection.
  • EBV infection antibodies are non-specific and do not confirmed the diagnosis. Similar antibodies are observed in healthy individuals with history of EBV infection.
  • Antibody test differs in primary infection, past infection, chronic infection and reactivation. Interpretation of result must be done.

Also Read:

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: October 27, 2015

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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