By Dr Ananya Mandal, MD
Glandular fever is most commonly caused by the Epstein-Barr virus (EBV). EBV commonly affects children and once infected the child develops a lifelong immunity against the disease. However if the infection occurs during early adulthood, glandular fever can occur. (1-5)
How is glandular fever caught?
Adults who have not been exposed to the virus before are at risk if they come in contact with infected saliva and are not immune or resistant to the infection.
How does EBV cause glandular fever?
EBV infects the cells on the lining inside of the throat and salivary glands. From there the infection passed to near-by white blood cells called B lymphocytes.
Then the infection spreads via the lymphatic channels. They thus encounter the small bean shaped lymph nodes that act as filters along the channels. These glands produce many of the cells of the immune system to fight infections.
The spleen is another organ that receives infected cells and helps fight infections.
The infected B cells go on to the lymph nodes present on the sides of the neck, back of the head and behind the ears. These become swollen and painful.
The lymph nodes are also called glands and this characteristic feature of lymph node swelling or lymphadenopathy gives the name glandular fever to this infection.
If the spleen is infected, it will become inflamed and enlarged. Nearly half of the patients with glandular fever have enlargement of spleen.
Who is at risk of glandular fever?
People who have suppressed immunity due to HIV infection, diabetes or long term intake of steroids and drugs that supress the immunity like cancer chemotherapeutic drugs, are at risk of glandular fever.
Other causes of glandular fever
Glandular fever may also be caused by other viral infections. An early HIV infection can manifest as glandular fever.
On presentation the physician will exclude HIV infection before beginning therapy. This may sometimes yield an early diagnosis of HIV and improve the outcome of the infection.
Other viruses that may cause glandular fever include Cytomegalovirus and Rubella virus.
Toxoplasmosis is a parasitic infection that may lead to similar symptoms as glandular fever.
These conditions are particularly dangerous for pregnant women as they raise the risk of congenital defects and deformities and still birth in the unborn foetus.
How is glandular fever transmitted?
Glandular fever is transmitted by close contact with the infected person. Since virus is shed in saliva it may spread in two different ways :
- If the infected person sneezes or coughs with his or her mouth and nose open the virus is released in the saliva droplets in the air. These have the potential for infecting people in the vicinity.
- Infection may spread by direct contact with the infected saliva. This may be due to kissing.
Glandular fever is termed “kissing disease” due to this mode of transmission. It is common among high school and university students. Virus may also pass through sharing eating utensils and drinking containers with the infected person.
Young children get infects by saliva on toys, shared cups or the hands of caregivers.
Edited by April Cashin-Garbutt, BA Hons (Cantab)
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