Glandular Fever

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Introduction

Introduction

Glandular fever is a type of viral infection that mostly affects young adults.

It is also known as infectious mononucleosis, or "mono".

Common symptoms include:

While the symptoms of glandular fever can be very unpleasant, most of them should pass within two to three weeks. Fatigue, however, can occasionally last several months.

Read more about the symptoms of glandular fever.

When to seek medical advice

You should contact your GP if you suspect that you or your child has glandular fever.

While there is little your GP can do in terms of treatment, they can provide advice and support to help you control your symptoms and reduce the risk of passing the infection on to others.

You should go to your local accident and emergency (A&E) department or dial 999 for an ambulance if you have glandular fever and you:

  • develop a rasping breath (stridor) or have any breathing difficulties
  • find swallowing fluids difficult
  • develop intense abdominal pain

These symptoms can be a sign of a complication of glandular fever that may need to be treated in hospital.

What causes glandular fever?

Glandular fever is caused by the Epstein-Barr virus (EBV). This virus is found in the saliva of infected people and can be spread through:

  • kissing - glandular fever is often referred to as the "kissing disease"
  • exposure to coughs and sneezes
  • sharing eating and drinking utensils, such as cups, glasses and unwashed cutlery

EBV may be found in the saliva of someone who has had glandular fever for several months after their symptoms pass, and some people may continue to have the virus in their saliva on and off for years.

If you have EBV, it's a good idea to take steps to avoid infecting others while you are ill, such as not kissing other people, but there's no need no need to avoid all contact with others as the chances of passing on the infection are generally low.

Read more about the causes of glandular fever.

Who is affected?

Glandular fever can affect people of all ages, but most cases affect teenagers and young adults.

Most EBV infections are thought to occur during childhood and cause only mild symptoms, or no symptoms at all.

However, if a person develops an EBV infection during early adulthood, they can develop glandular fever.

Once you have had glandular fever, it is unlikely you will develop it again. This is because people develop lifelong immunity after the initial infection.

How glandular fever is diagnosed

To diagnose glandular fever, your GP will first ask about your symptoms before carrying out a physical examination. They will look for characteristic signs of glandular fever, such as swollen glands, tonsils, liver and spleen.

Your GP may also recommend a blood test to help confirm the diagnosis and rule out infections that can cause similar symptoms, such as cytomegalovirus (CMV), rubella, mumps and toxoplasmosis.

How glandular fever is treated

There is no cure for glandular fever, but there are a number of simple treatments and measures that can help reduce the symptoms while you wait for your body to control the infection.

These include:

  • drinking plenty of fluids
  • taking over-the-counter painkillers, such as paracetamol or ibuprofen
  • getting plenty of rest and gradually increasing your activity as your energy levels improve

Occasionally, antibiotics or corticosteroids may be used if you develop complications of glandular fever.

Some people with particularly severe symptoms may need to be looked after in hospital for a few days.

Read more about treating glandular fever.

Possible complications

Complications associated with glandular fever are uncommon, but when they do occur they can be serious. They can include:

  • further infections of other areas of the body, including the brain, liver and lungs
  • severe anaemia (a lack of oxygen-carrying red blood cells)
  • breathing difficulties as a result of the tonsils becoming significantly swollen
  • a ruptured (burst) spleen, which may need to be treated with surgery

Read more about the complications of glandular fever.

Symptoms of glandular fever

Symptoms of glandular fever

Symptoms of glandular fever are thought to take around one to two months to develop after infection with the Epstein-Barr virus (EBV).

Main symptoms

The most common symptoms of the condition are:

  • a high temperature (fever)
  • sore throat - this is usually more painful than any you may have had before
  • swollen glands in your neck and possibly in other parts of your body, such as under your armpits
  • fatigue (extreme tiredness)

Other symptoms

Glandular fever can also cause:

  • a general sense of feeling unwell
  • aching muscles
  • chills
  • sweats
  • loss of appetite
  • pain around or behind your eyes
  • swollen tonsils and adenoids (small lumps of tissue at the back of the nose), which may affect your breathing
  • the inside of your throat to become very red and ooze fluid
  • small red or purple spots on the roof of your mouth
  • a rash
  • swelling or "puffiness" around your eyes
  • a tender or swollen tummy
  • jaundice (yellowing of the skin and whites of the eyes)

Some of these symptoms may develop a few days before the main symptoms mentioned above.

How the condition progresses

Most symptoms of glandular fever will usually resolve within two or three weeks. Your throat will normally feel most sore for three to five days after symptoms start before gradually improving, and your fever will usually last 10 to 14 days.

Fatigue is the most persistent symptom and often lasts a few weeks, although some people may feel persistently fatigued for several months after the other symptoms have passed.

When to seek medical advice

You should contact your GP if you suspect that you or your child has glandular fever.

While there is little your GP can do in terms of treatment other than provide advice and support, blood tests may be needed to rule out less common but more serious causes of your symptoms, such as hepatitis (a viral infection that affects the liver).

You should go to your local accident and emergency (A&E) department or dial 999 for an ambulance if you have glandular fever and you:

  • develop a rasping breath (stridor) or have any breathing difficulties
  • find swallowing fluids difficult
  • develop intense abdominal pain

If you have these symptoms, you may need to be looked after in hospital for a few days.

Read more about treating glandular fever.

Causes of glandular fever

Causes of glandular fever

Glandular fever is caused by the Epstein-Barr virus (EBV). EBV is most often spread through the saliva of someone who carries the infection.

For example, it can be spread through:

  • kissing - glandular fever is sometimes referred to as the "kissing disease"
  • sharing food and drinks
  • sharing toothbrushes
  • exposure to coughs and sneezes

Small children may be infected by chewing toys that have been contaminated with the virus.

When you come into contact with infected saliva, the virus can infect the cells on the lining of your throat.

The infection is then passed into your white blood cells before spreading through the lymphatic system.

This is a series of glands (nodes) found throughout your body that allows many of the cells that your immune system needs to travel around the body.

After the infection has passed, people develop lifelong immunity to the virus and most won't develop symptoms again.

Many people are first exposed to EBV during childhood, when the infection causes few symptoms and often goes unrecognised before it eventually passes.

Young adults may be most at risk of glandular fever because they might not have been exposed to the virus when they were younger, and the infection tends to produce more severe symptoms when you're older.

EBV carriers

Not everyone who can pass on EBV will have symptoms themselves. These are known as asymptomatic carriers.

Some people can have the virus in their saliva for a few months after recovering from glandular fever, and may continue to have the virus in their saliva on and off for years.

This is because the virus remains inactive in the body for the rest of your life after you have been exposed to it. For most people, the inactive virus won't cause any symptoms.

However, there is a chance of the virus periodically becoming reactivated, which may mean it re-enters the saliva. This reactivation may be without any symptoms, or it may cause symptoms to recur for a short time.

Treating glandular fever

Treating glandular fever

There is currently no cure for glandular fever, but the symptoms should pass within a few weeks. There are things you can do to help control your symptoms.

Fluids

It is important to drink plenty of fluids (preferably water or unsweetened fruit juice) to avoid dehydration.

Avoid alcohol, as this could harm your liver, which may already be weakened from the infection.

Painkillers

Painkillers available over the counter, such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, can help reduce pain and fever.

Children under 16 years old should not take aspirin because there is a small risk it could trigger a rare but serious health condition called Reye's syndrome.

Regularly gargling with a solution of warm, salty water may also help relieve your sore throat.

Rest

It is important you take plenty of rest while you recover from glandular fever, although complete bed rest is no longer recommended because it may make the fatigue last longer.

You should gradually increase your activities as your energy levels return, but avoid activities you cannot manage comfortably.

For the first month after your symptoms begin, avoid contact sports or activities that put you at risk of falling. This is because you may have a swollen spleen that it is more vulnerable to damage, and a sudden knock could cause it to burst (rupture).

Preventing the spread of infection

There is no need to be isolated from others if you have glandular fever as most people will already be immune to the Epstein-Barr virus (EBV).

You can return to work, college or school as soon as you feel well enough. There is little risk of spreading the infection to others as long as you follow commonsense precautions while you are ill, such as not kissing other people or sharing utensils.

It is also important to thoroughly clean anything that may have been contaminated by saliva until you have recovered.

Antibiotics and steroids

Antibiotics are not effective in treating glandular fever because they have no effect on viruses, but they may be prescribed if you also develop a bacterial infection of your throat or lungs (pneumonia).

A short course of corticosteroids may also be helpful if:

  • your tonsils are particularly swollen and are causing breathing difficulties
  • you have severe anaemia (a lack of oxygen-carrying red blood cells)
  • you have problems affecting your heart, such as pericarditis (inflammation of the sac that surrounds the heart)
  • you have problems affecting your brain or nerves, such as encephalitis

Read more about the complications of glandular fever.

Hospital treatment

Most people are able to recover from glandular fever at home, but hospital treatment may be necessary for a few days if you or your child:

  • develop a rasping breath (stridor) or have any breathing difficulties
  • find swallowing fluids difficult
  • develop intense abdominal pain

Treatment in hospital may involve receiving fluids or antibiotics directly into a vein (intravenously), corticosteroid injections and pain relief.

In a small number of cases, emergency surgery to remove the spleen (splenectomy) may be needed if it ruptures.

Complications of glandular fever

Complications of glandular fever

Most people with glandular fever will recover in two or three weeks and won't experience any further problems.

However, complications can develop in a few cases. Some of the main complications associated with the condition are described below.

Prolonged fatigue

More than 1 in every 10 people with glandular fever will experience prolonged fatigue, which lasts for six months or more after the initial infection. It is not known why fatigue lasts longer in some people.

Some experts think it may be a form of chronic fatigue syndrome (CFS). This is a poorly understood condition that causes persistent fatigue and a range of other symptoms, such as headaches and joint pain.

Adopting a gradual exercise plan to rebuild your strength and energy levels may help prevent and reduce prolonged fatigue.

Reduction in blood cells

In a few cases, glandular fever can lead to a reduction in some blood cells. It can reduce levels of:

  • red blood cells (anaemia) - this can make you feel tired and out of breath
  • white blood cells (neutropenia) - this can make you more prone to developing a secondary infection
  • platelets - this can make you bruise and bleed more easily

In most cases, the reduction in the number of blood cells is small and only causes mild symptoms. These problems should get better by themselves within a few weeks or months.

Ruptured spleen

Around half of people who develop glandular fever will have a swollen spleen. This does not present any immediate health problems, but there is a small risk of it rupturing (bursting).

The main sign of a ruptured spleen is sharp pain in the left of the tummy (abdomen).

Go to your local accident and emergency (A&E) department or dial 999 for an ambulance if you have glandular fever and you develop intense abdominal pain.

The risk of the spleen rupturing is small, occurring in just 1 in every 500 to 1,000 cases of glandular fever, but it can be life threatening because it may cause severe internal bleeding.

In some cases, emergency surgery may be required to remove an enlarged or ruptured spleen (splenectomy).

A ruptured spleen usually occurs as a result of damage caused by vigorous physical activities, such as contact sports.

It is therefore very important to avoid these activities for at least a month after the symptoms of glandular fever begin.

Be particularly careful during the second and third week of your illness, as this is when the spleen is most vulnerable.

Neurological complications

In less than 1 in every 100 cases, the Epstein-Barr virus (EBV) can affect the nervous system and trigger a range of neurological complications, including:

  • Guillain-Barré syndrome - where the nerves become inflamed, causing symptoms such as numbness, weakness and temporary paralysis
  • Bell's palsy - where the muscles on one side of the face become temporarily weak or paralysed
  • viral meningitis - an infection of the protective membranes that surround the brain and spinal cord; although unpleasant, viral meningitis is much less serious than bacterial meningitis, which is life threatening
  • encephalitis - an infection of the brain

These complications will often need specific treatment, but more than four out of every five people with them will make a full recovery.

Secondary infection

In a small number of cases, the initial infection weakens your immune system and allows bacteria to infect parts of the body. This is called a secondary bacterial infection.

Possible secondary infections that can develop during glandular fever include serious conditions such as pneumonia (infection of the lung) and pericarditis (infection of the sac that surrounds the heart).

Secondary infections usually occur in people who have a very weak immune system, such as people with HIV or AIDS, or those having chemotherapy.

If you have a weakened immune system and you develop glandular fever, as a precaution you may be referred to hospital for specialist treatment. This will allow for your health to be carefully monitored and any secondary infections to be treated.