Glandular Fever

What is glandular fever?

Glandular fever is a viral infection caused by the Epstein-Barr virus. This virus can be passed from person to person by close contact (especially kissing). It can possibly also be caught by sharing cups, toothbrushes, etc. It can take up to six weeks for the symptoms to develop after first being infected with this virus. This is called the 'incubation period'.

Who gets glandular fever?

Glandular fever can affect people of any age, but is most common in young adults and teenagers. The immune system makes antibodies during the infection. This then usually provides lifelong immunity. This means that it is rare to have more than one episode of glandular fever.

What are the symptoms of glandular fever?

One or more of the following symptoms commonly occur for about a week or so. Symptoms then usually gradually settle.

• Sore throat. This may be mild, but commonly the throat is very sore, red, and swollen. Glandular fever is typically suspected when a 'tonsillitis' is severe and lasts longer than usual. Swallowing is often painful and saliva may pool in your mouth.
• Swollen glands. As your body's immune system fights off the virus it causes the lymph glands to swell. Any lymph gland in the body can be affected but the glands in the neck are usually the most prominent. They can become quite large and tender.
• Flu-like symptoms. Like other virus infections, glandular fever often causes fever (high temperatures), muscle aches, headaches and can make you feel quite unwell.
• Malaise. A feeling of intense tiredness often develops with glandular fever. This is often the last symptom to go.
• Swelling around eyes. About 1 in 5 people with glandular fever become quite puffy and swollen around the eyes. This goes in a short time.
• Spleen. This is an organ under the ribs on the left side of the abdomen. It is part of the immune system. Like the lymph glands, it swells and can sometimes be felt below the ribs if you have glandular fever. Very occasionally, it causes mild pain in the upper left abdomen.
• No symptoms. Many people become infected with this virus but do not develop symptoms. This is called a sub-clinical infection.

How is glandular fever diagnosed?

As the symptoms caused by glandular fever are similar to symptoms due to other viruses, it can be difficult to diagnose glandular fever just by your doctor examining you.

A blood test can detect the antibody and confirm if you have glandular fever. If you blood test is negative but your doctor suspects you have glandular fever then you may have your blood test repeated in few weeks later.

Complications and unusual symptoms

Most people with glandular fever do not have complications or rare symptoms. If complications do occur, they may include:

• Damaged spleen. This is serious, but rare. A swollen spleen is more delicate than normal. A damaged spleen may occur if the left side of the chest or abdomen is injured, for example, after a fall. The spleen normally settles down to its normal size after about 6-8 weeks. Therefore, you should not play rough or contact sports such as rugby for up to eight weeks after having glandular fever.
• Rash. A widespread, non-itchy, red rash occurs in some people with glandular fever. This usually fades quickly.
• Jaundice. Mild inflammation of the liver sometimes occurs causing mild jaundice (yellowing of the skin). This is not serious and quickly goes.
• Malaise and depression. It is common to feel tired and low for the duration of the illness, and for a week or so afterwards. Some people develop 'post viral fatigue' for variable periods. This usually clears in time.

What is the treatment for glandular fever?

Usually no specific treatment is needed. Antibiotics do not work against viruses. However, it is important to have plenty to drink. It is often tempting not to drink very much if it is painful to swallow. This can lead to mild dehydration, particularly if you also a fever. Mild dehydration can make headaches and tiredness much worse. It can be worthwhile taking paracetamol or ibuprofen to ease pain, headache and fever.

Some studies have looked at the use of steroids for people with glandular fever. However, there is currently not enough evidence to recommend the use of steroids to treat people with glandular fever.

To prevent spread, you should avoid kissing and close body contact with other people whilst you are ill. It is also best not to share cups, towels, etc, whilst you are ill. There is no need to miss any school if you have glandular fever, unless you feel very unwell. You should see your doctor if any unusual, severe or unexplained symptoms develop.

If you drink alcohol when you are unwell with glandular fever, you can feel much worse that usual because of the effect of glandular fever on the liver. You should therefore not drink alcohol if you have glandular fever.

A full recovery is usual within a couple of weeks. Some people have a lingering tiredness that lasts a few weeks, sometimes longer. It is rare to have glandular fever again.

References

• Cunha BA; Infectious Mononucleosis.; eMedicine; October 2008.
• Candy B, Hotopf M; Steroids for symptom control in infectious mononucleosis. Cochrane Database Syst Rev. 2006 Jul 19;3:CD004402. [abstract]
• Katz BZ, Shiraishi Y, Mears CJ, et al; Chronic fatigue syndrome after infectious mononucleosis in adolescents. Pediatrics. 2009 Jul;124(1):189-93. [abstract]