Glandular fever

Glandular fever (also known as infectious mononucleosis, or mono) is an infectious disease caused by a virus called Epstein-Barr virus (EBV).

Glandular fever is a common illness and is sometimes called the ‘kissing disease’ because the virus is spread through saliva and commonly affects teenagers and young adults.

Symptoms of glandular fever

Symptoms of glandular fever, which typically appear 4 to 8 weeks after being infected with EBV, include:

  • sore throat, which can be severe;
  • enlarged lymph nodes (glands), usually in the neck;
  • fever;
  • tiredness;
  • swollen tonsils;
  • headache; and
  • muscle aches.

These symptoms are common among teenagers and young adults with glandular fever. Younger children infected with EBV often experience few or no symptoms.

Other symptoms

Sometimes a fine skin rash may appear if certain antibiotics (amoxycillin or ampicillin) have been prescribed in the mistaken belief that the symptoms have been caused by a bacterial throat infection.

In about 50 per cent of people with glandular fever the spleen (a large organ in the upper left side of your abdomen) becomes enlarged. An enlarged spleen (splenomegaly) generally causes no symptoms, but in rare cases the spleen can rupture, causing sudden and intense abdominal pain.

Severe cases of glandular fever can also be associated with liver inflammation (hepatitis) and jaundice (yellowing of the whites of the eyes and skin).

How do you get glandular fever?

Glandular fever is caused by an infection with Epstein-Barr virus (EBV). The virus is transmitted through saliva, and can be passed from person to person through kissing. It can also be spread via sneezing, coughing or sharing eating utensils, drinking containers or by sucking on toys.

Most adults have been exposed to EBV at some time in their lives and are immune to glandular fever. Because many people are infected with EBV during childhood and experience few or no symptoms, they are not aware that they have been exposed.

Tests and diagnosis

Your doctor will ask about your symptoms and perform a physical examination.

Glandular fever can be diagnosed with a simple blood test called a mono spot test, which tests for antibodies to the Epstein-Barr virus. However, the mono spot test may not detect the infection during the first week of the illness. There are other antibody tests that can be used to test for glandular fever early in the illness.

Your doctor may also order another blood test called a full blood count (FBC) to check your white cell count. An increase in white blood cells (lymphocytes), particularly atypical lymphocytes, can be associated with glandular fever.

Treatment for glandular fever

There is no specific treatment for glandular fever, but getting plenty of rest and keeping up your fluid intake are important for recovery.

Glandular fever is a viral illness, so antibiotics are not helpful (antibiotics are useful only in treating bacterial infections).

Gargling with salt water several times a day may help relieve a sore throat.

Pain relievers such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) can be used to treat pain and fever. Aspirin should not be given to children under the age of 16 years, because it can trigger a rare but serious condition called Reye’s syndrome.

People with glandular fever are sometimes treated with corticosteroids to help reduce severe swelling of the throat and tonsils.

Recovery

How long do the symptoms last?

Most people with glandular fever are unwell for 2 to 3 weeks, but tiredness and swollen lymph nodes can persist for several more weeks. In fact, it may take a few months before you feel completely well. It is important to take your time in getting back to normal.

Ongoing fatigue that lasts for 2-3 months is quite common. Epstein-Barr virus (EBV) infection, like a number of other viruses, may be a trigger for the development of chronic fatigue syndrome (CFS). However, chronic fatigue syndrome is NOT regarded as a chronic (ongoing) EBV infection and EBV is not considered a specific cause of CFS.

When can I return to my normal activities?

You should rest as much as needed during the initial phase of the illness. Once your sore throat and fever are better and you start to feel less tired, increase your activities gradually, being careful not to push yourself too hard.

Contact sports, vigorous activities and heavy lifting should be avoided for at least a month because of the risk of rupturing the spleen, even in people who do not have a noticeably enlarged spleen.

Does my child have to stay away from school or child care?

Children should stay home from school or child care while they are feeling unwell, but there is no specific recommended time frame for staying away from school or day care.

When to see your doctor

If your symptoms are not improving after a couple of weeks, or your symptoms return after a period of improvement, you should see your doctor.

Complications

Glandular fever is a very common illness, and most people recover without any problems.

In rare cases, complications develop. Some of the possible complications include the following.

  • Blood cell problems – anaemia (reduced red blood cells) or thrombocytopenia (reduced platelets, which are involved in blood clotting).
  • Problems with the nervous system, including meningitis (inflammation of the membranes surrounding the brain), encephalitis (inflammation of the brain) and Guillain-Barre syndrome (an autoimmune disorder in which the body's immune system attacks the peripheral nerves – the nerves connecting the brain and spinal cord to the rest of the body).
  • Heart problems, including inflammation of the heart (myocarditis) or the membrane around the heart (pericarditis).
  • Ruptured spleen is a serious but very rare possible complication.

Preventing the spread of glandular fever

If you have glandular fever you can help prevent the spread of infection by limiting close contact with others. Avoid sharing food, drinks and utensils with others. Frequent hand washing also helps prevent the spread of disease.

The Epstein-Barr virus can be found in your saliva for months after an infection. In fact, once you’ve been infected with EBV, the virus remains in the body for life. Many people who have had glandular fever continue to intermittently shed the virus in their saliva. For this reason, there is no specific recommendation for children or teenagers with glandular fever to stay away from school or day care. Although, of course, you should stay at home until you are feeling better.

Last Reviewed: 8 March 2016
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References

1. Pharyngitis and/or tonsillitis (revised October 2014). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2015 Nov. http://online.tg.org.au/complete/ (accessed Mar 2016).
2. Mayo Clinic. Mononucleosis (last updated 11 Dec 2015). http://www.mayoclinic.org/diseases-conditions/mononucleosis/home/ovc-20165827 (accessed Mar 2016).
3. Merck Manual Professional Version. Infectious mononucleosis (reviewed Apr 2013). http://www.merckmanuals.com/professional/infectious-diseases/herpesviruses/infectious-mononucleosis (accessed Mar 2016).
4. National Health and Medical Research Council (NHMRC). Staying healthy: preventing infectious diseases in early childhood education and care services – 5th Edition (2013). https://www.nhmrc.gov.au/guidelines-publications/ch55 (accessed Mar 2016).
5. Centers for Disease Control and Prevention (CDC). Epstein-Barr virus and infectious mononucleosis (updated 7 Jan 2014). http://www.cdc.gov/epstein-barr/about-mono.html (accessed Mar 2016).
6. NHS Choices. Glandular fever (updated 29 Oct 2014).http://www.nhs.uk/Conditions/Glandular-fever/Pages/Introduction.aspx (accessed Mar 2016).
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