Glandular fever - symptoms, diagnosis, treatment, recovery

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 (also known as infectious mononucleosis) causes symptoms similar to  that vary in severity and can persist for several weeks or longer. 

It is caused by the Epstein-Barr virus (EBB), 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.


Signs and symptoms


The incubation period for glandular fever is relatively lengthy. 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
  • Chills
  • Mental and physical fatigue/weakness
  • Aching muscles.
These symptoms are usually followed 2-3 days later by: 
  • Fever
  • Headache
  • Sore, reddened throat with enlarged tonsils
  • Swollen glands in the neck, armpits and/or groin.
The spleen is enlarged in about 50% of cases and the liver is enlarged in about 20% of cases. 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 doctor will take a full history of the symptoms and will perform a physical examination. This will include an assessment of whether there is: 
  • Fever
  • Redness of the throat and swelling of the tonsils
  • Enlargement of the lymph nodes
  • Enlargement of the spleen
  • A rash (especially on the chest).
The doctor is also likely to take blood tests to check for the presence of the Epstein-Barr virus.  A blood test performed in the early stage of glandular fever may return a negative result.  For this reason the doctor may recommend further blood tests a few days later. 


Treatment and recovery


As glandular fever is caused by a virus there is no specific treatment and antibiotics are of no benefit. It is considered to be a self-limiting infection which 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 (e.g. prisoner) may be prescribed to reduce pain and swelling of the lymph nodes.
Occasionally the sore throat present with glandular fever can be associated with 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 cause the liver to become enlarged, it is important to avoid alcohol while the condition is present.


Possible complications

Rarely, glandular fever can lead to complications that affect other body systems. These complications include: 

  • Inflammation of the heart muscle (myocardial)
  • Inflammation of the sac that surrounds the heart (pericardia)
  • Inflammation of the brain (encephalitis)
  • Pneumonia
  • Rupture of the spleen
  • Destruction of red blood cells and/or platelets.
In some people, glandular fever can lead to symptoms associated with chronic fatigue syndrome. This syndrome leaves the person feeling tired, weak and listless.  The symptoms can continue for an extended period after the infection seems to have cleared, but this is not common.


Transmission of the virus


Glandular fever is not considered to be a highly infectious condition. The transmission of saliva from one person to another is the most common way of spreading the 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. The virus can also be transmitted through blood transfusion and organ transplantation.
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 up to a year after contracting glandular fever.  Because of this, person to person transmission is difficult to trace.
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's usually in the first year following the initial infection.

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