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Glandular fever

 

Glandular fever is a type of viral infection that mostly affects young adults. Common symptoms of glandular fever include:

  • a high temperature (fever) of 38ºC (100.4ºF) or above
  • sore throat
  • swollen nodes (glands) in the neck
  • fatigue (extreme tiredness)

See glandular fever - symptoms for more information.

Glandular fever is not usually a serious threat to a person's health, but it is an illness that can last for several weeks, and it can be unpleasant.

Causes

Most cases of glandular fever are caused by the Epstein-Barr virus (EBV), one of the most common viruses to affect humans.

Most EBV infections are thought to take place during childhood and causes very mild symptoms. However, if a person develops an EBV infection during early adulthood, they can develop the symptoms of glandular fever.

Glandular fever is spread through saliva. It can be spread through:

  • kissing - it is often referred to as the 'kissing disease'
  • exposure to coughs and sneezes
  • sharing eating and drinking utensils, such as cups, glasses and unwashed forks and spoons

Someone with glandular fever is contagious for at least two months after initially being infected with EBV. However, some people can have EBV in their saliva for up to 18 months after having the infection. A few may continue to have the virus in their saliva on and off for years.

Once you have had glandular fever, it is highly unlikely that you will develop a second bout of the infection. This is because almost everyone develops a life-long immunity to glandular fever after the initial infection.

See glandular fever - causes for more information.

Outlook

There is no cure for glandular fever. Treatment focuses on helping to relieve the symptoms, such as using painkillers, to reduce the symptoms of pain and fever.

The majority of the symptoms of glandular fever should pass within two to three weeks without treatment.  However, the symptoms of fatigue can sometimes last longer.

In most people, the symptoms of fatigue will resolve after three months, although around 1 in 10 people will experience fatigue for up to six months.

See glandular fever - treatment for more information.

Complications associated with glandular fever are uncommon, but when they occur they can be serious. They can include:

  • secondary infection of the brain or nervous system
  • breathing difficulties as a result of the tonsils becoming massively swollen
  • ruptured (burst) spleen, which is a life-threatening emergency; the spleen is an organ that plays an important role in fighting off infection (this complication is very rare, occurring in just 1 in 1,000 cases)

See glandular fever - complications for more information.

How common is glandular fever?

Glandular fever is an uncommon type of infection. It is estimated that 1 in every 200 people will develop glandular fever in any given year. Most cases affect young adults who are 15 to 24 years old, although cases have been reported in people of all ages. Both sexes are equally affected by glandular fever.

It may initially sound illogical, but due to the improving standards of hygiene in Western countries, particularly where young children are concerned, the number of cases of glandular fever is expected to rise.

This is because fewer children are being exposed to EBV during early childhood when the virus is less troublesome, which means that more are likely to develop the infection during early adulthood, possibly triggering a case of glandular fever.



The incubation period (the time it takes symptoms to develop after being infected with the Epstein-Barr virus) lasts for one to two months.

Common symptoms

The three most common symptoms of glandular fever are:

  • a high temperature (fever) of 38ºC (100.4ºF) or above
  • sore throat - this will usually be much more painful than any previous throat infection you may have had
  • swollen glands (nodes) in your neck and possibly in other parts of your body, such as under your armpits

In addition to throat pain, you may also have:

  • swollen tonsils
  • the inside of your throat may be very red and ooze fluid
  • swelling of your adenoids, which are two lumps of tissue at the back of your nose
  • small purple spots on the roof of your mouth

Other symptoms

Other symptoms of glandular fever include:

  • fatigue (extreme tiredness)
  • a general sense of feeling unwell
  • a headache
  • chills
  • sweats
  • loss of appetite
  • pain behind your eyes
  • swelling of your spleen - this may cause a noticeable and tender swelling or lump in the left side of your abdomen (tummy)
  • swelling or 'puffiness' around your eyes
  • swelling of your liver - this usually causes mild pain and tenderness in the lower right side of your abdomen jaundice
  •  - yellowing of the whites of your eyes and skin

The course of the infection

In most cases of glandular fever, the symptoms will resolve within two to three weeks of the initial infection. Your sore throat will be at its worst for three to five days after the onset of symptoms before gradually improving.

Your fever will usually last for 10 to 14 days but your temperature will decrease for the last week of this period.

Fatigue is the most persistent symptom, and can last for several weeks. However, about 1 in 10 people feel fatigue that lasts for up to six months. Most people will be able to resume their normal activities within one to two months.

When to seek medical advice

You should contact your GP if you suspect that you or your child has developed glandular fever.

While there is little that your GP can do in terms of treatment (other than provide advice and support) blood tests may need to be carried out to rule out less common, but more serious, causes of the symptoms listed above, such as hepatitis (a viral infection that can cause liver disease) and HIV.

See Glandular fever - diagnosis for more information. 

Aches
An ache is a constant dull pain in a part of the body.
Antibiotics
Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. Amoxicillin, streptomycin and erythromycin are types of antibiotic.
Depressed
Depression is when you have feelings of extreme sadness, despair or inadequacy that last for a long time.
Fever
A high temperature, also known as a fever, is when someone's body temperature goes above the normal 37°C (98.6°F).
Immune system
The immune system is the body's defence system. It helps protect the body from disease, bacteria and viruses. 
Jaundice
Jaundice is a condition that causes yellowing of the skin and the whites of the eyes, brought on by liver problems.
Liver
The liver is the largest organ in the body. Its main jobs are to secrete bile (to help digestion), detoxify the blood and change food into energy.
Loss of appetite
Loss of appetite is when you don't feel hungry or want to eat.
Lymph nodes
Lymph nodes are small oval tissues that remove unwanted bacteria and particles from the body. They are part of the immune system.
Rupture
A rupture is a break or tear in an organ or tissue.
Swelling
Inflammation is the body's response to infection, irritation or injury. It causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Glandular fever in older adults

In rare cases, glandular fever can affect older adults who are 40 years old and over. In such cases, the pattern of symptoms is often different.

Around half of older adults with glandular fever will not have a sore throat or swollen glands; they will only have a high temperature. Jaundice is also much more common in this group of people, affecting 1 in 5 older adults.

The Epstein-Barr virus

Most cases of glandular fever are caused by the Epstein-Barr virus (EBV). If you come into close contact with infected saliva and you are not immune (resistant) to glandular fever, EBV will infect the cells on the lining inside of your throat.

The infection is then passed to near-by white blood cells called B lymphocytes before spreading through the lymphatic system. This is a series of glands (nodes) that spread throughout your body in a similar way to your blood circulation system. The glands produce many of the specialised cells that are needed by your immune system.

The spleen is an organ that is located just beneath the ribs on the left side of the abdomen. It is an important part of the lymphatic system because it helps to produce the infection-fighting antibodies that your immune system uses to fight infection. If your spleen is infected, it will become inflamed (swollen). This occurs in around half of all cases of glandular fever.

HIV

An early HIV infection can also cause symptoms of glandular fever. Inform your GP if you think you may have been exposed to HIV infection in the previous two months.

Your GP will be able to carry out a blood test to check for HIV infection. If you have HIV, it is very important that it is diagnosed at an early stage because excellent treatments for the condition are now available, which may be of benefit during the early stages of the infection.

See the Health A-Z topic about HIV for more information about the condition.

Other causes

A few cases of glandular fever are caused by viruses other than EBV, such as:

Toxoplasmosis is a parasitic infection that can also cause similar symptoms to glandular fever.

Other causes of glandular fever are usually only a matter of concern for pregnant women. This is because, unlike EBV, other viruses can harm unborn babies. Additional treatment with anti-viral medication (special antibodies) and antibiotics may be required to reduce the risk to your unborn baby.

Age

It is unclear exactly why some people develop the symptoms of glandular fever after coming into contact with EBV, while others do not. Age appears to be the most important factor because most cases affect older teenagers and young adults.

There is also evidence that some people may be born with certain genes that make them more susceptible to developing glandular fever.

Antibodies
Antibodies and immunoglobins are proteins in the blood. They are produced by the immune system to fight against bacteria, viruses and disease.
Fever
A high temperature, also known as a fever, is when someone's body temperature goes above the normal 37°C (98.6°F).
Lymph glands
Lymph nodes are small oval tissues that remove unwanted bacteria and particles from the body. They are part of the immune system.
Sneezes
Sneezing is an involuntary expulsion of air and bacteria from the nose and mouth.
White blood cells
White blood cells are the part of blood that fights infection and disease.

Physical examination

In diagnosing glandular fever, your GP will ask you about your symptoms before carrying out a physical examination. They will look for the characteristic signs of glandular fever, such as swollen lymph nodes, tonsils, liver and spleen.

Blood tests

To help confirm the diagnosis, your GP may recommend that you have blood tests. Two types of blood tests can usually help to diagnose glandular fever. These are:

  • an antibody test - the Epstein-Barr virus causes your immune system to release certain antibodies that can be detected through testing
  • white blood cell test - a high number of white blood cells usually indicate the presence of an infection

If you are pregnant, you may be tested for other possible causes of your symptoms, such as rubella or toxoplasmosis, to make sure that there is no risk to your unborn baby.

Antibodies
Antibodies and immunoglobins are proteins in the blood. They are produced by the immune system to fight against bacteria, viruses and disease.
Blood test
During a blood test a sample of blood is taken from a vein using a needle, so it can be examined in a laboratory.
Fever
A high temperature, also known as a fever, is when someone's body temperature goes above the normal 37°C (98.6°F).
Lymph nodes
Lymph nodes are small oval tissues that remove unwanted bacteria and particles from the body. They are part of the immune system.

There is currently no cure for glandular fever, but you can use a number of self care techniques to help control your symptoms. These are outlined below.

Rest

It is important that you take plenty of rest for the first two to three weeks after your glandular fever symptoms begin. This will help to speed up your recovery time.

In the past, complete bed rest was recommended for people with glandular fever, but this is no longer the case. Research has found that rather than speeding up recovery time, bed rest can actually make the symptoms of fatigue last longer.

Instead, you should gradually increase your range of activities as your energy levels begin to return. But it is important to avoid activities that you cannot manage comfortably. Your GP can give you more advice about the types of exercise and activity that are suitable for your individual circumstances.

You can return to work, college or school as soon as you feel well enough. There is very little risk of you spreading the infection to others as long as you follow common sense precautions, such as not kissing other people or sharing utensils.

For the first month after your symptoms begin, avoid contact sports or activities that put you at risk of falling. This is because if you have a swollen spleen it is more vulnerable to damage, and a sudden knock could cause it to rupture.

Fluids

If you have glandular fever, it is important to drink plenty of water or unsweetened fruit juice. This will help to relieve your symptoms of fever and sore throat, and stop you becoming dehydrated.

Also avoid alcohol because this could damage your liver, which will already be weakened from the infection.

Painkillers

Painkillers that are available over the counter, such as paracetamol, or non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help relieve symptoms of pain and fever.

Children who are under 16 years old should not take aspirin. There is a small risk that it could trigger a rare but very serious health condition called Reye's syndrome, which affects the liver and brain.

Salt water

Gargling with salt water may help to relieve the symptoms of a sore throat. Mix half a teaspoon of salt (2.5g) with a quarter of a litre (eight ounces) of water.

If you are over 16 years old, you may find that dissolving aspirin in the water provides some additional benefit. Children under 16 should not take aspirin.

Antibiotics and steroids

Antibiotics are not effective in treating glandular fever because they have no effect on viral infection. However, antibiotics may be prescribed if you develop a secondary bacterial infection of the throat.

A short course of steroids may also be prescribed if your tonsils are particularly swollen or they are causing breathing difficulties. Steroids are also sometimes used to treat other complications of glandular fever that are unrelated to swollen tonsils, such as:


Antibiotics
Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. Amoxicillin, streptomycin and erythromycin are all varieties of antibiotic.
Antibodies
Antibodies and immunoglobins are proteins in the blood. They are produced by the immune system to fight against bacteria, viruses and disease.
Brain
The brain controls thought, memory and emotion. It also sends messages to the body controlling movement, speech and senses.
Corticosteroid
Corticosteroid is a naturally occurring hormone produced by the adrenal gland, or a synthetic hormone having similar properties. It is used to reduce inflammation, so reducing swelling and pain.
Fever
A high temperature, also known as a fever, is when someone's body temperature goes above the normal 37°C (98.6°F).
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Spine
The spine supports the skeleton, and surrounds and protects the delicate spinal cord and nerves. It is made up of 33 bones called the vertebrae.
Swelling
Inflammation is the body's response to infection, irritation or injury. It causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Preventing the spread of infection

If you develop glandular fever, you should avoid kissing and sharing eating and drinking utensils for at least two months after your symptoms begin. It is also important to wash your hands regularly, particularly after coughing or sneezing.

There is no need for a person with glandular fever to be isolated from others because most people will already be immune to the Epstein-Barr virus.

Blood cells

In 25-50% of cases, glandular fever reduces the production of the three types of blood cells. It can reduce levels of:

  • red blood cells, which can make you feel tired and out of breath
  • white blood cells, which can make you more prone to developing a secondary infection (see below)
  • platelets, which can make you bruise and bleed more easily

In most cases, the reduction in the amount of blood cells is minimal and only causes mild symptoms.

Neurological complications

In an estimated 1 in 100 cases, the Epstein Barr virus (EBV) can affect a person's nervous system and trigger a range of neurological complications, including:

  • Guillain-Barré syndrome - the nerves become inflamed, causing symptoms such as numbness and temporary paralysis
  • Bell's palsy - causes temporary weakness or paralysis of the muscles in one side of the face
  • viral meningitis - an infection of the protective membranes that surround the brain and spinal cord; viral meningitis, although unpleasant, is much less serious than bacterial meningitis which is life-threatening encephalitis
  •  - an infection of the brain

These complications will usually pass once the underlying infection has resolved. Around four out of five people will make a full recovery.

Ruptured spleen

Around half of people who develop glandular fever will have a swollen spleen. A swollen spleen does not present any immediate health problems, but it increases the risk of the spleen rupturing (splitting). The main sign of a ruptured spleen is the sudden onset of a sharp abdominal (tummy) pain.

Dial 999 for an ambulance if you have glandular fever and you suddenly experience abdominal pain. If you have a ruptured spleen, emergency surgery may be required to repair it.

The risk of the spleen rupturing is small, occurring in just 1 in every 1,000 cases, but it can be life-threatening because it causes severe internal bleeding.

A ruptured spleen usually occurs as a result of damage caused by vigorous physical activities, such as contact sports. It is therefore very important to avoid these activities for at least a month after the symptoms of glandular fever begin.

Be particularly careful during the second and third week of your illness as this is when the spleen is most vulnerable. Your GP can advise you about when it is safe to start doing vigorous physical activities again.

Secondary infection

In a small number of glandular fever cases, the initial infection spreads to other parts of the body, leading to a more serious secondary infection. Possible secondary infections arising from glandular fever include:

Secondary infections usually only occur in people who have a weakened immune system (those who are immunocompromised), such as people with HIV or AIDS or those undergoing high-dose chemotherapy.

If you have a weakened immune system and you develop glandular fever, as a precaution you may be referred to hospital for specialist treatment. This will enable your health to be carefully monitored and any secondary infection to be treated.

Prolonged fatigue

Around 1 in 10 of people with glandular fever will experience prolonged fatigue which lasts for six months or more after the initial infection. It is not known why some people experience prolonged fatigue after having glandular fever.

Some experts think that it may be a form of chronic fatigue syndrome (CFS). This is a poorly understood condition that causes fatigue and flu-like symptoms, such as headache and joint pain.

Recent research in Australia suggests that particularly severe glandular fever infections may affect the nervous system at the genetic level, leading to prolonged fatigue. However, further research is required to explore this more fully.

From the evidence that is available, it seems that adopting a gradual exercise plan to rebuild your strength and energy levels is the best way to prevent prolonged fatigue.

Multiple sclerosis

Research has found that people who have had glandular fever are twice as likely to develop multiple sclerosis in later life compared with the population at large. However, it is important to put this increase in context. Multiple sclerosis is an uncommon condition, with 1 to 5 people in every 1,000 being affected at some point in their life. Therefore, the risk of someone who has had glandular fever developing multiple sclerosis later in life is very low.

There are two main theories to explain why there is an increase in risk of developing multiple sclerosis.

These are:

  • glandular fever may affect some people's immune system in a way that causes it to malfunction many years after the original infection
  • there may be certain genes that make some people more vulnerable to glandular fever and multiple sclerosis 
Brain
The brain controls thought, memory and emotion. It also sends messages to the body controlling movement, speech and the senses.
Fever
A high temperature, also known as a fever, is when someone's body temperature goes above the normal 37°C (98.6°F).
Inflammation
Inflammation is the body's response to infection, irritation or injury. It causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Lymph node
Lymph nodes are small oval tissues that remove unwanted bacteria and particles from the body. They are part of the immune system.
Ruptured
A rupture is a break or tear in an organ or tissue.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.