By Dr Ananya Mandal, MD
Glandular fever is a type of viral infection. It is also called “infectious mononucleosis”.
It commonly manifests as high fever, sore throat, swollen lymph nodes at the neck and extreme tiredness or fatigue. Jaundice can also occur in a small number of people.
Usually glandular fever does not run a severe course but it may last for several weeks, incapacitating the person. This is a disease commonly affecting young adults. (1-5)
Cause of glandular fever
Glandular fever is caused by the Epstein-Barr virus (EBV). EBV is the most common viruses to affect humans.
Infections with EBV commonly occur during childhood and leads to very mild symptoms. However, if a person develops an EBV infection during youth or young adulthood, symptoms of glandular fever may be seen.
EBV attacks two types of cell in the body including cells in the salivary glands and white blood cells known as B lymphocytes (B-cells).
Initial infection is at the salivary glands from which large amounts of the virus is released into the saliva.
The infection spreads to the B lymphocytes and leads to their multiplication and causes the lymph glands to swell and become painful.
Frequency of glandular fever
Glandular fever rarely affects the population. Per year 1 in every 200 people gets the infection.
The largest affected population includes those between 15 and 24 years of age. Men and women are equally affected.
In young children the disease is mild or asymptomatic and duration is from one to a few weeks.
How is glandular fever spread?
Glandular fever is spread through saliva. It is commonly spread through kissing and is thus called “kissing disease”.
The disease may also spread when an infected person coughs or sneezes with his or her mouth open. This releases droplets of saliva containing the virus into the air. This may be inhaled.
Sharing eating and drinking cups, glasses forks and spoons and plates with an infected person also raises the risk of glandular fever transmission.
Risk of transmission persists for at least two months after initially being infected with EBV.
The infectious nature of the disease may persist in an individual for up to 18 months or years after having the infection. One bout of infection usually provides the body with an immune mechanism against the disease. Glandular fever thus usually does not occur twice.
Studies have shown that 15 – 20% healthy adults who have had EBV infection before carry the virus in their saliva over a long time.
Treatment for glandular fever
Glandular fever has no specific cure. A full blood examination and Paul Bunnell test confirm diagnosis.
Treatment is aimed at relieving symptoms of fever, aches and pains etc. symptoms usually subside within two to three weeks without treatment.
Fatigue however may last longer and in most may last up to three months. At least 10% individuals experience fatigue for up to six months.
Home remedies include plenty of rest, isolation and clear drinking fluids.
Contact sports should be avoided for 6-8 weeks as the spleen may be enlarged and be more delicate than normal. There is a risk of the spleen rupturing due to a blow to the abdomen.
Complication with glandular fever
Complications with glandular fever are rare but may be severe. These include a secondary bacterial infection of the brain or nervous system.
Excessive swelling of the tonsils may lead to breathing difficulties.
The spleen may rupture. This is an emergency. The spleen normally plays an important role in fighting off infection. It may be enlarged in glandular fever. In very rare emergencies the spleen may rupture.
Vaccine against glandular fever
A vaccine against the Epstein-Barr virus is under development.
Until then prevention includes isolation and maintenance of good hygiene measures.
The infection is most contagious during the fever stage and isolation during this period is important.
Edited by April Cashin-Garbutt, BA Hons (Cantab)
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