Glandular fever

Glandular fever (also known as infectious mononucleosis) is a common illness in adolescents and young adults. Most people recover from the infection within a few weeks. However, in a very small number of cases it can cause more serious complications.

About glandular fever
Symptoms of glandular fever
Complications of glandular fever
Causes of glandular fever
Diagnosis of glandular fever
Treatment of glandular fever
Prevention of glandular fever

About glandular fever

Glandular fever is caused by infection with the Epstein-Barr virus (EBV), one of the herpes viruses. Glandular fever is just one of the illnesses caused by EBV. It can also cause a number of mild illnesses in children, including ear infections, diarrhoea and sore throats.

Once you have been infected with glandular fever, it’s unlikely that you will get it again because your immune system learns how to control the infection. The virus will still be in your body but, unlike other herpes viruses, EBV can live in your body without causing any illness. You can carry and spread the virus intermittently throughout your life.

More than nine out 10 adults carry antibodies to EBV in their blood – this shows that they have been infected at some time.

Symptoms of glandular fever

It's possible that you will be infected with EBV but not show any symptoms.
Once you have been infected with the virus, it may take anything from four to six weeks for symptoms to appear. These include:

• sore throat – ranging from mild discomfort to severe tonsillitis
• fever and/or chills
• swollen lymph glands – these will probably be most noticeable in your neck but other lymph glands, under the arms or in the groins for instance,  may be affected
• fatigue and lethargy – you may find that these continue after your other symptoms have cleared up
• lack of appetite
• headaches
• muscle and joint aches
• rash

You will probably find that the main symptoms begin to clear up after about two to four weeks. However, you may still feel tired and run-down for some weeks or months afterwards.

Complications of glandular fever

Around half of all people who have glandular fever get an enlarged spleen. Your spleen is an organ near your stomach and forms part of your immune system. Rarely, an enlarged spleen can rupture (break or tear) and this is likely to require urgent surgery. To reduce the risk of rupture your GP will probably advise you not to play contact sports, including football, for about eight weeks.

Occasionally, glandular fever may also lead to other health problems including hepatitis (inflammation of your liver), which can cause temporary jaundice (yellowing of your skin and the whites of your eyes).

The infection can produce the same symptoms as bacterial tonsillitis and so sometimes your GP may consider prescribing antibiotics. Amoxicillin or ampicillin, which are penicillin-based antibiotics, often cause a severe rash in people who have glandular fever. Doctors are advised not to prescribe these antibiotics for a sore throat where glandular fever is a possible cause.
Other much rarer complications include:

• nerve problems, including a facial palsy (similar to Bells palsy) and balance or coordination problems
• meningitis or encephalitis (inflammation of your brain or the linings of your brain) – this may also affect other nerves
•  

These complications tend to come on early in the glandular fever illness.

Causes of glandular fever

You can get glandular fever at any age but it’s most common in adolescents and young adults. The virus is passed from person to person in saliva – that is why it’s sometimes called the ‘kissing disease’ –  and possibly through breathing in droplets of saliva or mucus that are left in the air after someone coughs or sneezes. You may be able to pick up the virus by sharing food or drink from the same container as an infected person. People who have been infected with EBV can carry and spread the virus intermittently throughout their life. However, the virus isn’t highly contagious and it doesn’t live for a long time outside the body, so you’re unlikely to pick it up from door handles, handrails, etc.

Diagnosis of glandular fever

If you think you have glandular fever, see your GP who will ask you about your symptoms and examine you, including your glands to see if they are swollen. He or she may do a blood test to look for unusual cells and to see if your blood contains specific antibodies.

Treatment of glandular fever

Glandular fever is an illness that usually gets better on its own. The main aim of treatment is to relieve the symptoms.

• Get plenty of rest during the early stages when the symptoms are most severe.
• Don’t take strenuous exercise in the first month after having glandular fever as this may increase the risk of your spleen rupturing.
• Drink enough fluids.
• Take painkillers such as paracetamol or ibuprofen if you have aches and pains, and try gargling with soluble aspirin if you have a sore throat.
• It’s probably best if you don’t drink alcohol, although there is no strong evidence that having glandular fever makes it especially harmful to the liver. 

As glandular fever is a viral infection, antibiotics aren’t effective and there is no specific medicine available. However, if you have very severe symptoms, including difficulty breathing because of throat swelling, your GP may prescribe you a course of steroid medication, probably prednisolone.

It’s possible to get a bacterial throat infection on top of the viral infection and you may be given antibiotics for this. As with all medicines, including over-the-counter painkillers such as paracetamol, you should always follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist or GP for advice.
Glandular fever is only passed on through saliva and rarely through coughing or sneezing so you don't need to stay away from work or school to protect other people, unless you feel too unwell to go.

Prevention of glandular fever

There is currently no vaccine against glandular fever. People who have had EBV infection in the past can be long-term carriers, even when they are well. For this reason it’s very hard to prevent infections.