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Glandular fever

Published by Bupa's health information team, February 2008.

This factsheet is for people who have glandular fever, or who would like information about it.

Glandular fever (also known as infectious mononucleosis) is a common illness in adolescents and young adults. Most people recover from the infection within a few weeks. However, in a very small number of people it can cause longer term complications.

• About glandular fever
• Symptoms
• Complications
• Causes
• Diagnosis
• Treatment
• Prevention
• Further information
• Questions and answers
• Sources

About glandular fever

Glandular fever is caused by infection with the Epstein-Barr virus (EBV), one of the herpes viruses. This group of viruses also includes varicella which causes chicken pox. Glandular fever is just one of the illnesses caused by EBV. It's possible that you will be infected with the virus but not show any symptoms. It can also cause a variety of illnesses in children including ear infections, diarrhoea and sore throats.

Once you have recovered from glandular fever, it's unlikely that you will get it again as you develop immunity to the infection. The virus will still be in your body but, like other herpes viruses, EBV can live in your body without causing any illness. Most adults carry antibodies to EBV in their blood - this shows that they have been infected at some time.

Symptoms

Once you have been infected, it may take anything from one to six weeks for symptoms to appear. These include:

• fever
• sore throat - ranging from mild discomfort to severe tonsillitis
• swollen lymph nodes - these will probably be most noticeable in your neck but other lymph nodes may be affected
• fatigue and lethargy - you may find that these continue after your other symptoms have cleared up
• lack of appetite (anorexia)
• headaches - these are usually associated with a fever
• rash - this is likely to be widespread but not itchy

You will probably find that the main symptoms begin to clear up after about two weeks. However, you may still feel tired and depressed for some weeks or months afterwards. It's also possible that you may develop glandular fever but have no symptoms at all.

Complications

Around half of all people who have glandular fever get an enlarged spleen. Your spleen is an organ near your stomach and it forms part of your immune system. In some rare cases, an enlarged spleen can rupture (break or tear) and this is likely to require urgent surgery. In order to try to prevent this, your GP will probably advise you not to play contact sports for about eight weeks to reduce the risk of rupture as a result of an injury to your stomach area.

Glandular fever may also lead to hepatitis (inflammation of your liver) which can cause temporary jaundice (yellowing of your skin and the whites of your eyes).

The infection can produce the same symptoms as bacterial tonsillitis, so sometimes the antibiotics amoxicillin or ampicillin may be prescribed. However, these cause a severe rash in people who have glandular fever and as a result most GPs advise that these antibiotics should not be used to treat sore throats where the cause is uncertain.

Other much rarer complications include:

• inflammation of your heart muscle (myocarditis) or the protective layers around it (pericarditis)
• meningitis or encephalitis (inflammation of your brain or the linings of your brain) - this may also affect other nerves
• blood disorders

Causes

You can get glandular fever at any age but it's most common in adolescents and young adults. The virus is passed from one person to another in saliva (this is why it's sometimes called the kissing disease) or through breathing in droplets of saliva or mucus that are in the air. These may be left behind after someone coughs or sneezes. You can also get the virus by sharing food or drink from the same container as an infected person.

Diagnosis

If you think you have glandular fever, see your GP who will ask you about your symptoms and examine you, including your glands to see if they are swollen. He or she may do a blood test to look for unusual cells and to see if your blood contains specific antibodies to EBV.

Treatment

There are lots of treatments that can help reduce the symptoms of glandular fever.

• Get plenty of rest during the early stages when the symptoms are most severe.
• Drink lots of fluids.
• Take painkillers such as paracetamol or ibuprofen (eg Nurofen) if you have aches and pains, and try gargling with soluble aspirin if you have a sore throat.
• It's best if you don't drink alcohol.

There is no specific medicine that you can take to treat glandular fever and antibiotics have no effect because the condition is caused by a virus. However, if you have very severe symptoms, your GP may prescribe you a course of corticosteroid medication, probably prednisolone. As with all medicines, including over-the-counter painkillers such as paracetamol, you should always follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist or GP for advice.

You are likely to recover from glandular fever within one to two months.

Prevention

There is currently no vaccine against glandular fever. However, if you are currently, or have recently been infected, you can help to prevent spreading the virus by:

• avoiding kissing or close bodily contact with people
• not sharing crockery, clothing or towels

Glandular fever is only passed on through saliva and rarely through coughing or sneezing so you don't need to stay away from work or school to protect other people, unless you feel too unwell to go.

Further information

• Health Protection Agency
  020 7759 2700 / 2701
  www.hpa.org.uk

Sources

• Murtagh J. General practice. 2nd ed. Sydney: McGraw-Hill, 1997: 171-173
• Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2006: 915
• Longmore M, Wilkinson IB, Rajagopalan S. Oxford Handbook of Clinical Medicine. 6th ed. Oxford: Oxford University Press, 2004: 570
• British National Formulary (BNF). Broad-spectrum penicillins. BMJ Publishing Group, 2007. 53: 283

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr James Quekett, BscMB ChB MRCGP DRCOG DFFP, General Practitioner (GP) and GP Appraiser, Gloucestershire, and Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: February 2008