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 cases it can cause more serious complications.

About glandular fever
Symptoms of glandular fever
Complications of glandular fever
Causes of glandular fever
Diagnosis of glandular fever
Treatment of glandular fever
Prevention of glandular fever

About glandular fever

Glandular fever is caused by infection with the Epstein-Barr virus (EBV), one of the herpes viruses. Glandular fever is just one of the illnesses caused by EBV. It can also cause a number of mild illnesses in children, including ear infections, diarrhoea and sore throats.

Once you have been infected with glandular fever, it’s unlikely that you will get it again because your immune system learns how to control the infection. The virus will still be in your body but, unlike other herpes viruses, EBV can live in your body without causing any illness. You can carry and spread the virus intermittently throughout your life.

More than nine out 10 adults carry antibodies to EBV in their blood – this shows that they have been infected at some time.

Symptoms of glandular fever

It's possible that you will be infected with EBV but not show any symptoms.
Once you have been infected with the virus, it may take anything from four to six weeks for symptoms to appear. These include:

  • sore throat – ranging from mild discomfort to severe tonsillitis
  • fever and/or chills
  • swollen lymph glands – these will probably be most noticeable in your neck but other lymph glands, under the arms or in the groins for instance,  may be affected
  • fatigue and lethargy – you may find that these continue after your other symptoms have cleared up
  • lack of appetite
  • headaches
  • muscle and joint aches
  • rash

You will probably find that the main symptoms begin to clear up after about two to four weeks. However, you may still feel tired and run-down for some weeks or months afterwards.

Complications of glandular fever

Around half of all people who have glandular fever get an enlarged spleen. Your spleen is an organ near your stomach and forms part of your immune system. Rarely, an enlarged spleen can rupture (break or tear) and this is likely to require urgent surgery. To reduce the risk of rupture your GP will probably advise you not to play contact sports, including football, for about eight weeks.

Occasionally, glandular fever may also lead to other health problems including 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 and so sometimes your GP may consider prescribing antibiotics. Amoxicillin or ampicillin, which are penicillin-based antibiotics, often cause a severe rash in people who have glandular fever. Doctors are advised not to prescribe these antibiotics for a sore throat where glandular fever is a possible cause.
Other much rarer complications include:

  • nerve problems, including a facial palsy (similar to Bells palsy) and balance or coordination problems
  • meningitis or encephalitis (inflammation of your brain or the linings of your brain) – this may also affect other nerves
  •  

These complications tend to come on early in the glandular fever illness.

Causes of glandular fever

You can get glandular fever at any age but it’s most common in adolescents and young adults. The virus is passed from person to person in saliva – that is why it’s sometimes called the ‘kissing disease’ –  and possibly through breathing in droplets of saliva or mucus that are left in the air after someone coughs or sneezes. You may be able to pick up the virus by sharing food or drink from the same container as an infected person. People who have been infected with EBV can carry and spread the virus intermittently throughout their life. However, the virus isn’t highly contagious and it doesn’t live for a long time outside the body, so you’re unlikely to pick it up from door handles, handrails, etc.

Diagnosis of glandular fever

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.

Treatment of glandular fever

Glandular fever is an illness that usually gets better on its own. The main aim of treatment is to relieve the symptoms.

  • Get plenty of rest during the early stages when the symptoms are most severe.
  • Don’t take strenuous exercise in the first month after having glandular fever as this may increase the risk of your spleen rupturing.
  • Drink enough fluids.
  • Take painkillers such as paracetamol or ibuprofen if you have aches and pains, and try gargling with soluble aspirin if you have a sore throat.
  • It’s probably best if you don’t drink alcohol, although there is no strong evidence that having glandular fever makes it especially harmful to the liver. 

As glandular fever is a viral infection, antibiotics aren’t effective and there is no specific medicine available. However, if you have very severe symptoms, including difficulty breathing because of throat swelling, your GP may prescribe you a course of steroid medication, probably prednisolone.

It’s possible to get a bacterial throat infection on top of the viral infection and you may be given antibiotics for this. 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.
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.

Prevention of glandular fever

There is currently no vaccine against glandular fever. People who have had EBV infection in the past can be long-term carriers, even when they are well. For this reason it’s very hard to prevent infections.
 

Tags:

This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.
 
 
Can glandular fever cause depression?
My boyfriend has glandular fever and I’m worried that I will get it. When can we start kissing again?
Does glandular fever cause chronic fatigue syndrome?

 
Can glandular fever cause depression?

It’s common for people to feel tired and worn out when they have glandular fever. As a result, some people may feel unhappy and depressed for the duration of the illness and for sometime afterwards. There are several things you can do if glandular fever is making you feel depressed.
 

Explanation

If you’re feeling depressed, it’s important that you find a way to share your feelings with a friend, family member or school/college counsellor.
 
You may not feel well enough to do vigorous exercise, but you should try gentle walks. Eat a well balanced diet and don’t smoke or drink excessive amounts of alcohol. Try to take care of yourself by doing things that make you feel good. You should set yourself realistic goals.
 
If you continue to feel low – for two weeks or more – and have the other symptoms of depression such as intrusive feelings of guilt or worthlessness, poor sleep, and reduced sex drive, you should talk to your GP. There are a number of treatments available for depression including guided self-help and exercise programmes. Antidepressants are available if your depression is severe or has lasted for a long time.
 

My boyfriend has glandular fever and I’m worried that I will get it. When can we start kissing again?

It’s hard to predict how long a person will be infectious so there is no easy answer.

Explanation

Glandular fever is known as the 'kissing disease' as it can be passed though saliva.
 
People infected with Epstein-Barr virus can spread the infection to others for a number of weeks before they have glandular fever and some can become long term carriers, spreading the virus, without ever developing symptoms themselves.
 
The time from when your boyfriend is infected with the virus to developing symptoms (the incubation period) can be anything up to six weeks. If you kissed your boyfriend within this time, you will already have been exposed to the virus and so it may be too late to prevent yourself becoming ill.
 
However, there is also a good chance that you will have only a mild response to the infection, or that you had EBV as a child and so are immune to getting glandular fever.
 
On balance, if your boyfriend feels well enough to be kissing, you probably shouldn’t worry too much about the risk of infection now.
 

Does glandular fever cause chronic fatigue syndrome?

It was previously thought that infection with Epstein-Barr virus (EBV) caused chronic fatigue syndrome. Research now suggests that Epstein-Barr virus (that causes glandular fever) may not cause chronic fatigue syndrome. However, a full recovery from glandular fever can be slow.
 

Explanation

The symptoms of glandular fever, including tiredness and feeling under-the-weather, can last for several weeks and usually clear up within four months. In some people the symptoms can last for longer.
 
The majority of individuals with glandular fever don’t develop chronic fatigue syndrome, but a small number of people do go on to develop it. However, there is no clear evidence to suggest that this is a direct result of glandular fever.

Further information

Sources

  • Fauci A, Kasper D, Longo L, editors. Harrison's principles of internal medicine 17th ed. New York: McGraw-Hill, 2008
  • Rea TD, Russo JE, Katon W, et al. Prospective study of the natural history of infectious mononucleosis caused by Epstein-Barr virus. J Am Board Fam Pract. 2001 Jul-Aug;14(4):234–42
  • Longmore M, Wilkinson IB, Turmezei T. Oxford handbook of clinical medicine. 7th ed. Oxford: Oxford University Press, 2007
  • Joint Formulary Committee. British National Formulary. 58th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008
  • Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2006: 915
  • Murtagh J. General practice. 2nd ed. Sydney: McGraw-Hill, 1997: 171–173
  • Epstein-Barr virus and infectious mononucleosis. Centers for Disease Control and Prevention. www.cdc.gov, accessed 25 October 2009
  • Glandular fever. Health Protection Agency.  www.hpa-nw.org.uk, accessed  26 October 2009

Related topics

  • Chronic fatigue syndrome (myalgic encephalomyelitis)

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