What is glandular fever?
Glandular fever, also known as infectious mononucleosis, is caused by the Epstein-Barr virus (EBV). Glandular fever is an infectious disease of children, young people, and occasionally adults. In children the infection may pass unrecognised or with only a few days trivial illness with sore throat, fever, swollen tonsils and glands in the neck. In young adults the infection is often more severe. About half of teenagers and young adults who become infected develop glandular fever. This causes profound tiredness, aching muscles, fever, very swollen tonsils and enlarged neck glands. Sometimes glands may be swollen in the groin (crotch). The tiredness may continue for days or weeks and may cause depression (low moods). It is very unusual for symptoms to last for more than 4 months.
How is glandular fever caught?
The virus persists within the patient for life, even after the illness has got better, but usually does not cause problems forever. Small amounts of the virus are present in the saliva in the mouth. This virus is caught by close contact between children or young people who have not been infected and adults who carry the virus. Persons with glandular fever are most likely to spread the infection for a period of weeks. In the United Kingdom, 50% of children have been infected by the age of 5 years, and most adults have been infected. Most people in the United Kingdom become infected at some time in their lives. Only people who haven’t already had it as a child can get glandular fever as an older child or young adult. In Western society in young adults it is known as 'kissing disease' in that it is very common in teenagers and young adults, when it can spread between young people of similar ages. The virus may be spread in children attending kindergartens, playgroups and crèches.
The incubation period, or the time from infection to appearance of symptoms, ranges from 4 to 6 weeks.
Can infection with EBV (glandular fever) be prevented?
No special precautions are recommended, since the virus is also found frequently in the saliva of healthy people. In fact, many healthy people can carry and spread the virus intermittently for life. These people are usually the reason for spread. For this reason, spread of the virus is almost impossible to prevent. The Health Protection Agency advises that young children don’t need to be taken out of school or nursery when they have glandular fever. This is because the infection is usually mild in young children, and the incubation period is so long that it is hard to work out the source (who it was caught from).
How do you diagnose this illness?
The appearance of a sore throat, swollen tonsils and neck glands in teenagers and young adults who are feeling very unwell is very often the first indication of this illness. The hospital laboratory can diagnose glandular fever by testing a blood sample from a patient. Antibiotic treatment, occasionally given by the general practitioner in the mistaken belief that the sore throat is a bacterial infection, often causes a widespread rash.
Is there any treatment?
There are no medicines which work against the virus. The best advice, is to ensure the person drinks plenty of fluids and has enough rest during the period that they are actually ill. Paracetamol or ibuprofen (or child equivalents) can be used to reduce pain and fever. Stress may extend the period of illness, and for those working for exams this may present a real problem. On rare occasions, a patient may require admission to hospital if the tonsils become excessively swollen. Antibiotics are not given because glandular fever is caused by a virus
Heavy physical activity and contact sports (such as boxing and rugby) should be avoided for 8 weeks following initial infection in those with glandular fever. This is because the spleen (an organ inside the tummy) is often also swollen, and is at risk of being damaged.
Is the infection a problem in pregnancy?
There are no known problems in pregnancy from EBV, such as miscarriages or birth defects. It should be noted that a different virus cytomegalovirus (CMV) can cause a glandular fever like illness. CMV infection in pregnant women can sometimes cause damage to the foetus. Therefore if glandular fever-like illness occurs in a pregnant woman, she must report this promptly to the midwifery team or GP. The local laboratory should be able to distinguish between EBV and CMV infection, by testing blood. |
