Lloydspharmacy.com Health - Glandular fever (infectious mononucleosis)

Reviewed by Dr John Pillinger, GP

What is glandular fever?

Infectious mononucleosis, commonly known as glandular fever, is a viral infection that's caused by the Epstein-Barr virus.

The disease is characterised by a sore throat, swollen lymph nodes (usually in the neck) and extreme fatigue.

Young people aged between 10 and 25 years are most vulnerable to this infection. The treatment is to ease the symptoms, and the illness usually passes without serious problems.

How is glandular fever contracted?

The infection is caused by the Epstein-Barr virus that's transferred from one person to another in saliva. Kissing is one obvious way by which the disease can be transmitted. But the infection is also spread via airborne droplets.

The incubation period from infection to when the symptoms first appear is between 30 and 50 days.

What are the symptoms of glandular fever?

It's possible to become infected with this virus and to develop no symptoms. This is referred to as a subclinical infection.
Before the disease breaks out, one to two weeks may pass with symptoms that are similar to those of flu.
A sore throat, with swollen tonsils that are heavily covered by a white coating.
Fever.
Severe fatigue.
Muscle pains.
In 20 per cent of cases: swelling and puffiness may develop around the eyes, settling after one to two days.
Headache.
Tendency to sweat.
Like the lymph glands, your spleen is part of the immune system and can become swollen. If this occurs, it can sometimes be felt below the ribs on the left-hand side of the abdomen and may occasionally cause mild pain.
Swollen and sore lymph nodes in the neck, armpits and the groin.
The liver may become enlarged and yellow jaundice may develop.
There may be a non-itchy widespread, red rash that quickly disappears.

How does the doctor make the diagnosis?

The diagnosis is made on the grounds of the symptoms, blood samples and a throat swab.

Good advice

Hot drinks can relieve the sore throat.
Drink plenty of fluids when you run a fever.
Rest when you're tired or are running a fever.
Resume physical activities slowly.
Wait at least eight weeks before resuming activities, involving heavy physical strain.
It's sensible to avoid drinking alcohol for six weeks, while recovering from glandular fever.

Can I exercise while I am ill?

Theoretically, there's a risk of damage to the spleen while participating in heavy physical activities – such as those involving body contact. Therefore, it's recommended not to exercise until four weeks after the disease has ended.

Because of the severe fatigue, it may take several months before the patient is perfectly fit again after glandular fever. But the majority of people recover much more quickly.

Future prospects

Glandular fever usually takes two to four weeks and resolves itself without complications. In about 3 per cent of all cases, it goes on longer. After having the disease, a person will have lifelong immunity to it – so will not catch it again.

Possible, but rare, complications of glandular fever include the following.

The respiratory passages may become partially blocked and require a short course of oral steroid therapy to help to reduce the inflammation.
Pneumonia requiring antibiotic therapy.
The spleen may rupture – this happens in 0.1 to 0.2 per cent of all cases.
Very rarely, the central nervous system may be infected by the virus and can cause complications like meningitis or encephalitis.
Anaemia.
The number of blood platelets may decrease (thrombocytopenia).
Rarely, the disease may lead on to chronic fatigue.

How is glandular fever treated ?

There's no efficient treatment of infections caused by the Epstein-Barr virus other than to ease the symptoms.

Based on a text by Hanne Korsholm, GP

Last updated 07.12.2009