32.3 CASE STUDY

What causes the swollen glands and fatigue?

In the context of infectious mononucleosis caused by the Epstein-Barr virus (EBV):

• Swollen Glands (Lymphadenopathy): The swelling of the glands, or lymph nodes, is a result of the immune system's active response to the infection. When B cells are infected by EBV, the immune system responds by producing more lymphocytes to combat the infection. Lymph nodes are sites where B cells, T cells, and other immune cells congregate, communicate, and get activated. As the immune response intensifies, these lymph nodes become enlarged due to the increased number of activated immune cells they contain. This lymph node enlargement is commonly observed in the neck (cervical lymphadenopathy) during infectious mononucleosis but can also be seen in other parts of the body.

• Fatigue: The exact cause of the profound fatigue associated with infectious mononucleosis is multifactorial and not entirely understood. Several factors contribute to it:

• Cytokine release+ Liver and spleen enlargement + Energy expenditure+ Sleep

  • The body's immune response to the infection can result in the release of cytokines (proteins that regulate the immune response) that induce symptoms of fatigue.

  • The liver and spleen can be affected in infectious mononucleosis. An enlarged spleen (splenomegaly) or liver involvement can contribute to the feeling of malaise and fatigue.

  • The body is expending a significant amount of energy to combat the infection, leading to tiredness.

  • Disruption of regular sleep patterns due to illness and discomfort can further exacerbate feelings of fatigue.

It's worth noting that while fatigue is a hallmark symptom of infectious mononucleosis, it can persist for weeks to months even after other symptoms have resolved. This post-infectious fatigue is sometimes referred to as post-viral fatigue syndrome.

What causes swollen glands and fatigue?

Swollen Glands (Lymphadenopathy)

• Immune system response

  • Increased lymphocytes production

  • B cells infected by EBV

• Lymph nodes

  • Sites for immune cells

  • Enlargement due to activated immune cells

• Commonly observed in the neck (cervical lymphadenopathy)

Fatigue

• Multifactorial cause

• Cytokine release

• Liver and spleen enlargement

• Energy expenditure

• Sleep disruption

Cytokine release

• Immune response

• Release of cytokines

• Induces fatigue

Liver and spleen enlargement

• Affected in infectious mononucleosis

• Enlarged spleen (splenomegaly)

• Liver involvement

• Contributes to malaise and fatigue

Energy expenditure

• Body expends energy to combat infection

• Leads to tiredness

Sleep disruption

• Illness and discomfort

• Disrupts regular sleep patterns

• Exacerbates fatigue

Note: Fatigue can persist even after other symptoms have resolved, known as post-viral fatigue syndrome.