Glandular fever: What to know

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Glandular fever, or infectious mononucleosis, is a common infection among teenagers, young adults, and college students. Symptoms include fever, sore throat, fatigue, and swollen lymph nodes and glands, and sometimes hepatitis.

It is normally caused by the Epstein-Barr virus (EBV) a highly contagious herpes virus. EBV is thought to be present in 90 to 95 percent of people worldwide, but it does not always cause symptoms, and it does not always lead to glandular fever.

There is no cure, and glandular fever usually passes without treatment, but the fatigue can last for some time.

Cytomegalovirurs (CMV) and rubella, or German measles, can also cause glandular fever, but the cause is not EBV and it is not mononucleosis. Toxoplasmosis can cause similar symptoms.

Fast facts on glandular fever:

Here are some key points about glandular fever. More detail is in the main article.

  • Glandular fever is usually caused by the Epstein-Barr virus (EBV).
  • EBV is a common herpes virus that many people have, often without symptoms.
  • Symptoms include a sore throat, fever, swollen glands, and fatigue.
  • The symptoms may continue for several weeks, and the fatigue may persist for several months.
  • There is no cure, and glandular fever usually passes without treatment.

Symptoms

Glandular fever involves swollen lymph glands and a sore throat.

Glandular fever has an incubation period of 4 to 6 weeks. In other words, symptoms appear 4 to 6 weeks after initial infection. The symptoms, and especially fatigue, may continue for several weeks.

They commonly include:

  • flu-like symptoms, including body aches and a headache
  • a temperature of 38 degrees Celsius or above
  • a skin rash that is a widespread, red, and does not itch
  • nausea and loss of appetite
  • malaise, fatigue, tiredness, and weakness
  • swelling and puffiness around the eyes
  • sore throat
  • swelling in the lymph glands
  • swollen spleen, leading to pain in the upper abdomen
  • liver pain and jaundice

Sore throat

The sore throat may be mild, but it is often very sore, red, and swollen, similar to that of tonsilitis. If a person has severe tonsillitis that lasts longer than usual, this may be glandular fever. Swallowing is often painful.

The lymph glands and the spleen

As the body’s immune system fights the virus, the lymph glands swell. This can affect any lymph node in the body, but the glands in the neck and the armpits are usually the most prominent. They can become swollen and tender.

The spleen is an organ that is part of the immune system. It is found under the ribs on the left side of the abdomen. Like the lymph glands, the spleen can swell, and it can sometimes be felt below the ribs. It may cause mild pain in the upper left section of the abdomen.

The liver

The virus can sometimes cause mild inflammation of the liver, known as hepatitis. It is more common in people over 30 years of age.

Symptoms of hepatitis include:

  • jaundice, a yellowing of the skin and eyes
  • intolerance to alcohol
  • loss of appetite
  • nausea

The symptoms of jaundice and hepatitis should disappear as the person recovers from glandular fever.

The sore throat and fever usually improve after 2 weeks. Fatigue and swollen lymph nodes may persist for longer, sometimes for several months.

People can be infected with EBV but have no symptoms. This is more likely in younger children and in people aged over 40 years.

Treatment

There is no cure for glandular fever, and most symptoms normally disappear within 4 to 6 weekswithout treatment, although fatigue may persist for up to 6 months in some cases. Most people make a full recovery.

Symptoms can be controlled with:

Rest

Complete rest will aid recovery, especially during the first month after symptoms appear. The patient often feels too tired and too unwell to continue with their regular routine. As the person recovers, light exercise may help them regain muscle strength.

Drinking fluids

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This will help prevent dehydration, especially if there is a fever. A sore throat can make it hard to swallow, but it is important to consume enough fluid.

Painkillers

Painkillers, such as ibuprofen or Tylenol (paracetamol) can be bought over-the-counter (OTC) or online. They may help control fever and pain. Aspirin is not suitable for anyone under 16 years of age.

Gargling

Gargling with salt water or a solution from the pharmacy may help relieve a sore throat.

Steroids

If the tonsils are very inflamed or breathing is difficult, a short course of corticosteroids may be prescribed. However, this is not normally recommended.

Causes

Most EBV infections occur during early childhood. When infection occurs, the immune system produces antibodies to fight the virus.

EBV infection does not always lead to glandular fever, and there may be few or no symptoms.

After infection, the virus will remain in the body for life, lying dormant in a number of throat and blood cells. The antibodies provide lifelong immunity, and glandular fever rarely comes back a second time.

Sometimes, however the virus becomes active again. This can occasionally cause symptoms, especially in a person with a weakened immune system.

A person who is infected with EBV during the teenage years or early adulthood is more likely to develop glandular fever. This is why most cases occur between the ages of 15 and 25 years.

At least 1 in 4 or young adults who are infected with EBV will develop glandular fever.

People can develop glandular fever at other ages, but it is less likely.

How does it spread?

EBV is contagious. It can be passed on through contact with the saliva of a person who has the infection, for example, through coughs and sneezes and when sharing cutlery and crockery, such as cups, plates and spoons.

It can also be passed on through kissing, and it is sometimes called the kissing disease.

A person remains contagious for at least 2 months after initial infection with EBV. Some people can have EBV in their saliva for up to 18 months after infection. If they do not have symptoms, they may not know that they have the infection.

If a person has not been infected with EBV in the past, and they come into contact with infected saliva, they may become sick, even if the other person is not showing symptoms.

First, the virus will infect the lining of the inside of the throat. Then, a type of white blood cells known as B lymphocytes can spread the infection to other parts of the body, including the liver and spleen.

A person can spread EBV if they have the infection, even if they have no symptoms. If the virus reactivates, it can also spread to others, however long it is since the original infection.

Other causes of glandular fever

Glandular fever may also be caused by cytomegalovirus (CMV) and rubella, or German measles. Similar symptoms may also appear in cases of toxoplasmosis, a parasitic infection.

Non-EBV causes of glandular fever may harm a fetus or embryo. A woman who becomes infected with any of these conditions during pregnancy may need special treatment with antibiotics and antibodies.

Diagnosis

The doctor will carry out a physical examination to detect swollen lymph nodes and to assess the tonsils, liver, and spleen.

If the physician suspects glandular fever, they may order some tests.

Two blood tests can help confirm a diagnosis:

  • An antibody test can detect specific antibodies to EBV.
  • A white blood cell test can find out whether there are more white blood cells than usual, suggesting an infection, or if white blood cells have an unusual appearance.

There may also be tests for liver function.

If a woman is pregnant, tests can show whether rubella or toxoplasmosis are present. EBV will not harm a fetus or an embryo.

Complications

Complications of glandular fever are rare, but they can be serious.

They include:

  • damage to the spleen
  • a secondary infection, such as pneumonia, meningitis, or heart inflammation
  • anemia, or a low level of red blood cells
  • a neurological condition, such as Guillan-Barre syndrome or Bell’s Palsy
  • upper airway obstruction

A person with a damaged spleen should avoid contact sports such as football for 8 weeks after having glandular fever.

Secondary infections are rare, but they are a risk for patients with weakened immune systems.

Studies have found that between 9 and 22 percent of patients continue to experience fatigue 6 months after infection.

Outlook

The fever usually lasts for 10 to 14 days, but fatigue may persist for several months. Most people make a full recovery.

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