It is caused by the Epstein-Barr virus (EBV). It is one of the most common viruses that can affect humans. Most EBV infections occur during early childhood. They usually produce few or no symptoms. Afterwards, the virus will remain in the body for life, lying dormant in a number of throat and blood cells.
According to Medilexicon's medical dictionary:
Infectious mononucleosis is an acute febrile illness of young adults caused by the Epstein-Barr virus, a member of the Herpesviridae family; frequently spread by saliva transfer; characterized by fever, sore throat, enlargement of lymph nodes and spleen..."
When an EBV infection occurs during the teenage years, or early adulthood, it will lead to the development of glandular fever. This is why the majority of glandular fever cases occur in teenagers and young people aged between 15 and 25. Nonetheless, the condition can affect people of any age group.
During the infection, the immune system fabricates antibodies to fight the virus. This then provides lifelong immunity. Therefore, it is rare to have more than one bout of glandular fever.
The virus is contagious. It can be passed on by coming into contact with the saliva of someone who is currently infected with the condition. As may occur when kissing, hence its other name - the kissing disease, via coughs and sneezes and when sharing cutlery and crockery, such as cups, plates and spoons.
A person remains contagious for at least two months after initial infection with EBV. Some people can have EBV in their saliva for up to 18 months after infection.
There is no cure for glandular fever. In most cases, the majority of the symptoms should pass within four to six weeks without treatment. Fatigue can sometimes persist for longer. In most people, fatigue will end after three months. Full recovery is usual.
Complications of glandular fever are uncommon, but can be serious. They include a ruptured spleen, which would require emergency surgery, or a secondary infection of the lungs such as pneumonia.
What are the signs and symptoms of glandular fever?A symptom is something the patient feels or reports, while a sign is something other people, including a doctor, may detect. For example, a headache may be a symptom, while a rash may be a sign.
Glandular fever has an incubation period of about one to two months, perhaps earlier in children. Incubation period is the time elapsed between initial infection and the appearance of signs and symptoms.
- Flu-like symptoms. As is the case with many virus infections, glandular fever often causes fever and temperature, aches, headaches, and feeling sick.
- A skin rash can appear in some individuals. Widespread, red, non-itchy.
- Loss of appetite.
- Malaise. A feeling of intense tiredness and weakness often develops.
- Sore throat. The tenderness may be mild, but commonly the throat is very sore, red, and swollen. It resembles a bad bout of tonsillitis. Glandular fever is typically suspected when 'tonsillitis' is severe and lasts longer than usual. Swallowing is often painful.
- Spleen. This organ is under the ribs on the left side of the abdomen and part of the immune system. Like the lymph glands, it swells and can sometimes be felt below the ribs. Occasionally, it causes mild pain in the upper left section of the abdomen.
- Swelling around eyes. About 1 in 5 people with glandular fever become quite puffy and swollen around the eyes. This disappears rapidly.
- Swollen glands. As the body's immune system fights off the virus the lymph glands swell. Any lymph nodes in the body can be affected, but the glands in the neck and the armpits are usually the most prominent. They can become swollen and tender.
- No symptoms. This is called a sub-clinical infection. Many people become infected with this virus but do not develop symptoms.
- The liver can be affected. In some cases, the infection can affect the liver. This can cause jaundice (yellowing of the skin and the eyes). It is more common in people who are over 30 years of age.
Many people with glandular fever will also experience mild inflammation of the liver or hepatitis with symptoms such as:
- Intolerance to alcohol
- Loss of appetite
The symptoms of a sore throat and fever improve usually after two weeks. Fatigue and swollen lymph nodes may persist for longer, occasionally for several months.
What are the causes of glandular fever?Glandular fever is caused by the Epstein-Barr virus (EBV) mostly. If a person does not have immunity to glandular fever and comes into close contact with infected saliva, the lining of the inside of the throat will become infected first, and then the B lymphocytes (type of white blood cells) nearby, which then spread the infection to other parts of the body, including the liver and spleen
Glandular fever may also be caused by Cytomegalovirurs (CMV) and Rubella (German measles). Glandular fever-like symptoms may also appear in cases of toxoplasmosis, a parasitic infection. Non-EBV causes of glandular fever may harm the fetus/embryo. Pregnant women who become infected may need special treatment with antibiotics and antibodies.
Diagnosis of glandular feverPhysical examination. Medical evaluation will include a description of the symptoms and a physical examination in order to detect swollen lymph nodes, tonsils, liver and spleen.
Blood tests. Blood tests may be recommended in order to confirm the diagnosis. There are two blood tests that can usually help to diagnose glandular fever:
- Antibody test. To detect specific antibodies to the Epstein-Barr virus (EBV).
- White blood cell test. If white blood cell numbers are higher than normal, it usually means the patient has an infection. Pregnancy - tests to determine whether there is rubella or toxoplasmosis (EBV does not harm the unborn baby).
What are the treatment options for glandular fever?Currently, there is no cure for glandular fever. However the symptoms can be controlled with:
- Plenty of rest. Patients recover much faster if they are able
to get complete rest during the initial month after symptoms. In fact,
rest is sometimes the only option, because the patient is too tired and
feels too sick to go about his/her daily business.
The National Health Service (NHS), UK, advises patients to do some light exercises after symptoms have gone, in order to regain muscle strength.
- Drink. Drinking plenty of fluids helps prevent dehydration, especially if there is fever. If sore throat symptoms are severe, the infected person may not want to drink - he/she should be monitored carefully to make sure fluid intake is adequate.
- Pain. Painkillers, such as ibuprofen or Tylenol
(paracetamol) which can be bought over-the-counter (OTC) may help bring
down a fever and reduce pain. Patients under 16 years of age must not be
- Gargling. Pharmacists may be able to help choose a
suitable gargling solution. Some patients find that gargling with salt
water helps sore throat symptoms.
- Antibiotics . Glandular fever is caused by a virus, not a
bacterium. Antibiotics are used for killing bacteria. However, the
doctor may prescribe antibiotics to prevent secondary infections.
- Steroids . If the tonsils are very inflamed, a short course of steroids may be prescribed.
What are the complications of glandular fever?
- Ruptured spleen
- Secondary infections, such as pneumonia, meningitis or heart inflammation. Secondary infections are rare, but are a risk for patients with weakened immune systems.
- Prolonged fatigue