Glandular fever (infectious mononucleosis or “mono”) causes symptoms similar to influenza (the flu) that vary in severity and can persist for several weeks or longer.
Almost anyone, at any age, can catch glandular fever. However, it most commonly occurs in mid to late adolescence and early adulthood. Studies suggest the infection occurs slightly more often in males than in females.
Glandular fever is caused by infection with the Epstein-Barr virus (EBV), which is a member of the herpes virus family. Most people will be exposed to the Epstein-Barr virus, and will have developed some degree of immunity to it, by the time they reach adulthood.
After an episode of glandular fever, the Epstein-Barr virus lies latent in the cells of the body for life. Infection with the virus is usually sufficient to provide long-term immunity from the condition. However, it is possible for the condition to recur. If it does, it is usually in the first year following the initial infection.
Signs and symptoms
The incubation period for glandular fever is usually relatively lengthy (approximately four to six weeks). The first signs and symptoms of the infection may not appear until approximately four to eight weeks after exposure to the virus.
Symptoms are generally at their worst about a week after they first appear and most symptoms will have resolved within three weeks. However, the severity and duration of symptoms can vary considerably between individuals. Symptoms are generally less severe in young children, who may have either no symptoms or only a mild flu-like illness. The older the person when they develop glandular fever, the more severe the symptoms are likely to be. It is possible for symptoms to persist for several weeks and even for several months.
Initial symptoms commonly include:
- Loss of appetite
- Mental and physical fatigue/weakness
- Aching muscles.
- These symptoms are usually followed 2-3 days later by:
- Sore, reddened throat with enlarged tonsils
- Swollen glands in the neck, armpits and/or groin.
In a small percentage of cases a blotchy red rash can occur. Jaundice occurs rarely and, when it does, it generally only lasts 1-2 days.
The spleen is swollen in about 50% of cases. An enlarged spleen is not an immediate health problem but there is a small risk of it rupturing (bursting). A sharp pain in the left side of the upper abdomen may indicate a ruptured spleen and medical attention should be sought immediately.
The doctor will take a full history of the symptoms and will perform a physical examination. This will include an assessment of whether there is:
- Redness of the throat and swelling of the tonsils
- Enlargement of the lymph nodes
- Enlargement of the spleen
- A rash (especially on the chest).
As these symptoms are so characteristic of glandular fever they are usually sufficient to make a diagnosis. In some cases, the doctor may take blood tests to check for the presence of the Epstein-Barr virus or to rule out less common but more serious causes of the symptoms, such as hepatitis B or hepatitis C virus infection.
Treatment and recovery
It is considered to be a self-limiting infection that resolves with time. Getting plenty of rest and drinking lots of fluid is very important during recovery. Pain and discomfort can usually be adequately treated with pain relief medication such as paracetamol. In severe cases, steroid medication (eg: prednisone) may be prescribed to reduce pain and swelling of the lymph nodes.
Occasionally the sore throat present with glandular fever can be associated with strep throat, caused by streptococcal bacteria. Antibiotics may be prescribed in these cases in order to combat the bacteria.
An enlarged spleen can be easily damaged. For this reason, it is recommended that strenuous activity and exercise, as well as contact sports, be avoided for at least four weeks after the first symptoms appear, or until the spleen returns to a normal size. As glandular fever can also cause inflammation of the liver, it is important to avoid alcohol while the condition is present.
Most people with glandular fever recover in two to three weeks. In some cases, however, glandular fever can lead to complications that affect other body systems. These possible complications include:
- Impaired breathing caused by swollen tonsils
- Inflammation of the liver
- Inflammation of the heart muscle (myocarditis)
- Inflammation of the sac that surrounds the heart (pericarditis)
- Inflammation of the nervous system, including the membranes surrounding the brain and spinal cord (meningitis), the nerves (Guillain-Barre syndrome), and the brain itself (encephalitis)
- Bell's palsy, which is a temporary paralysis of the muscles on one side of the face
- Pneumonia, which may require treatment with antibiotics and/or hospitalisation
- Enlargement of the spleen, which in extreme cases may lead to the spleen rupturing (bursting).
- Destruction of red blood cells leading to anaemia
- Destruction of platelets, which makes people more prone to bruising and bleeding
- Destruction of white blood cells, which may increase the risk of infection.
PreventionGlandular fever is not considered to be a highly infectious condition. Nevertheless, steps should be taken to prevent spreading the virus to others.
The transmission of saliva from one person to another is the most common way of spreading the Epstein-Barr virus. Because of this, glandular fever is often called “the kissing disease”. Coughing and sneezing, as well as sharing drink bottles and utensils, can spread the virus. All of these activities should be avoided. Regular and thorough hand washing can also help stop the virus from spreading.
The virus remains in the mouth and throat for some time after a person has recovered. It is estimated that a person remains infectious for many months after contracting glandular fever. It is advisable, where possible, to avoid close contact with anyone who has, or has recently had, glandular fever.
There is no vaccine against the Epstein-Barr virus to help prevent the spread of glandular fever.
ReferencesHealthinfo (2015). Glandular Fever (Pamphlet PDF). Christchurch: Canterbury District Health Board. http://www.healthinfo.org.nz/ [Accessed: 20/07/16]
Mayo Clinic (2016). Mononucleosis (Web Page). Rochester: Mayo Foundation for Medical Education and Research. http://www.mayoclinic.org/diseases-conditions/mononucleosis/home/ovc-20165827 [Accessed: 28/07/16]
NHS choices (2014). Glandular fever (Web Page). Leeds: Health and Social Care Information Centre. http://www.nhs.uk/Conditions/Glandular-fever/Pages/Introduction.aspx [Accessed: 28/07/16]
O’Toole, M.T. (Ed.) (2013). Gastroenteritis. Mosby’s Dictionary of Medicine, Nursing & Health Professions (9th ed.). St Louis: Elsevier Mosby.
Last Updated: July 2016