Everything you need to know about glandular fever, a viral infection that most commonly affects teenagers and young adults.
Glandular fever, medically known as infectious mononucleosis, is a viral infection that most commonly affects teenagers and young adults. But what are the common symptoms of glandular fever, is it a more serious condition than other viruses, can you prevent it from spreading and how long does it take to fully recover?
Dr Louise Wiseman looks at glandular fever symptoms, treatment, typical duration and how to prevent the virus from spreading:
What is glandular fever?
Glandular fever is caused by a virus called Epstein-Barr (EBV) and the condition is also called ‘infectious mononucleosis’. This name is because there are a high number of a certain type of white blood cell called monocytes in the bloodstream of those affected. Other viruses can also cause infectious mononucleosis but EBV is the most common.
Glandular fever is most common in the 15 to 24 age group but is possible at all ages. In younger children it is often asymptomatic and in older people there are more likely other complications.
Glandular fever is most common in the 15 to 24 age group but is possible at all ages.
It is thought that only about a quarter to a half of young people who are infected with EBV actually go on to develop infectious mononucleosis. If a person is infected with the virus and has no symptoms it is called a ‘subclinical infection’. Studies show that over 95 per cent of adults worldwide have been infected with EBV so have immunity.
In most people the infection is ‘self-limiting’ which means it goes away by itself over time. Occasionally the recovery can be prolonged and with complications.
Glandular fever symptoms
The main glandular fever symptoms are sore throat, swollen lymph nodes (lymphadenopathy) and a fever but there are variations. Common symptoms of glandular fever can also include the following:
- Sore throat
- Excessive lethargy
- High fever
- Swollen ulcerated tonsils
- Enlarged lymph glands in neck, groin and armpits
In straightforward cases these symptoms will resolve after 2 to 4 weeks.
Glandular fever severe symptoms
More severe symptoms of glandular fever can include the following:
- Tonsils swollen with pus or severe ulceration
- Persistent enlarged lymph glands
- High fever
- Difficulty swallowing
- Persistent tiredness for weeks or months occurs in about 1 in 10 people
Glandular fever very severe symptoms
Very severe but less common symptoms of glandular fever can include the following:
- Upper airways obstruction
- Hepatitisand jaundice with enlarged liver
- Liver function problems
- Vulnerability to other infections such as pneumonia, encephalitis, meningitis
- Enlarged spleen causing discomfort in left side of abdomen (this makes the spleen vulnerable to trauma or rupture – v rare only in 0.2 to 0.3% of patients)
- Low neutrophil count (neutropenia – neutrophils are a type of white cell that fights infection)
- Very rarely in immunocompromised patients EBV may result in malignant disease such as Hodgkin’s lymphoma or nasopharyngeal carcinoma.
Very rarely patients can develop a chronic EBV infection with severe, chronic or recurrent mononucleosis and this is very occasionally associated with the development of lymphoma.
Glandular fever transmission
How is glandular fever contracted or spread? The virus is actually not particularly contagious and is not passed from one person to another like the common cold, and even family members in close contact with one another hardly ever catch it from each other.
Glandular fever is most commonly seen in the teenage age group. It is spread mainly via saliva even though the carrier may have no symptoms at the time of infection. This could be via kissing or sharing kitchen utensils. Small children can alsobecome infected by toys contaminated after being placed in the mouth.
Glandular fever is spread mainly via saliva even though the carrier may have no symptoms at the time.
Transmission can also occur by sexual contact (blood and semen), blood transfusions, organ transplantation and transfer from mother to the baby in utero.
The incubation period is 4 to 7 weeks. The carrier is infectious during this time and while having symptoms. Some people have been proven to be infectious up to 18 months after having the infection.
Glandular fever diagnosis
How does the doctor diagnose glandular fever?
- The diagnosis is made on the pattern of symptoms, examination and blood tests. Occasionally a throat swab may be taken to exclude a bacterial infection.
- Typically the full blood count will show lots of white cells on the blood film and some abnormal white cells when the lab examine the sample.
- (Possible other diagnoses that could present similarly with abnormal white cells include rubella, mumps and HIV. )
- A ‘monospot’ blood test can be used to diagnose in adults. Sometimes this is negative at the beginning of the illness and needs to be repeated.
- In some cases viral serology tests will be performed if the diagnosis is unclear.
- Liver function tests are temporarily abnormal in about 90 per cent of patients with glandular fever. This tends to recover in the month after the illness.
Glandular fever treatment
Uncomplicated glandular fever cases just require supportive treatment and advice. There is no cure for the virus, just treatment to support the patient including the following:
✔️ Take paracetamol to relieve symptoms and discomfort, or anti-inflammatories if prescribed or advised by the doctor.
✔️ Rest assured that it should slowly pass.
✔️ Rest, especially when tired or with a fever.
✔️ Dink plenty of fluids, as warm fluids may soothe throat.
✔️ To prevent spread, avoid kissing or sharing utensils and towels.
Glandular fever complications
Sometimes patients are admitted to hospital and are given intravenous fluids and supportive treatment if symptoms are severe or complications arise. Antibiotics may be prescribed in hospital or at home if the doctor suspects a secondary bacterial throat infection.
Antibiotics will not treat the virus – only bacteria. Amoxycillin and other penicillin derivatives are avoided by doctors if they have any suspicions of glandular fever in a patient as they can cause a rash if someone has infectious mononucleosis. In this situation the rash is not an allergy. Alternative antibiotics are used.
Glandular fever and pregnancy
If you were to contract glandular fever during pregnancy, the virus is not known to damage a developing baby. It is actually rare to contract a primary (first) infection with EBV in pregnancy as most adult women are already immune. There are studies that have shown EBV can occasionally be reactivated during pregnancy due to changes in immunity due to stress.
If you are unwell during pregnancy with a high fever or lymph gland swelling you should always consult your doctor, so that any complications can be managed carefully to protect the health of you and your developing baby. In some cases swollen lymph glands may be due to other viruses that could potentially affect the fetus (eg toxoplasmosis) so these need to be excluded by your doctor.
Glandular fever recovery
You will recover better from glandular fever if your rest and recuperation is given time. There will theoretically be less of a chance of ‘post-viral’ or ‘chronic’ fatigue if rest is taken. To recover fully, try the following advice:
- Resume physical activities slowly.
- Wait at least eight weeks before resuming rough or contact sports, or lifting involving heavy physical strain. This is to prevent any risk to the spleen.
- It’s sensible to avoid drinking alcohol for six weeks, while recovering from glandular fever. This is imperative if the liver function tests were affected and should be checked to be normal before drinking any alcohol again or it could potentially lead to liver damage.
Because of severe fatigue, it may take several months before you feel perfectly fit again after glandular fever. However, the majority of people recover much more quickly.