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Glandular fever

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. 

Glandular fever (also known as infectious mononucleosis) is an infection caused by the Epstein-Barr virus (EBV). This virus belongs to the herpes group, and like other varieties of herpes, it can infect a person without causing any symptoms. It is very common and by the age of 40, most adults carry EBV in their blood, showing they have been infected at some time.

When symptoms do occur, most people recover from glandular fever within a few weeks. In a very small number of cases, however, it can lead to serious complications.

The symptoms are most likely to develop if the infection takes place during adolescence or young adulthood. The virus is contagious - it is passed from one person to another in saliva (hence its popular name the kissing disease). However, kissing is not the only means of spreading the infection. Coughing and sneezing can leave droplets of infected mucus or saliva suspended in the air to be inhaled by other people. Sharing food or drink from the same container as an infected person can also spread the virus. In rare cases, blood transfusions have been known to spread the infection.

Once a person has been infected, the symptoms take about 4-6 weeks to appear. They generally include one or more of the following:

  • A sore throat
  • Swollen tonsils
  • Swollen lymph nodes (glands) in the neck or - less commonly - in the armpits and groin
  • Fever
  • Flu-like symptoms with a temperature, aches and pains, headaches and loss of appetite
  • Fatigue, which may be intense
  • A rash, which is usually not itchy
  • Swollen eyes

Most of these symptoms disappear after 2-4 weeks although the fatigue can last for several weeks or months, and may cause the person affected to feel low or dispirited. Once recovered, however, people do not usually get glandular fever again.

These are very rare but include swelling and possible rupture of the spleen, hepatitis (inflammation of the liver) causing jaundice and anaemia (a deficiency of red blood cells)

If the symptoms suggest you, or your child has glandular fever, consult your GP. Glandular fever can usually be diagnosed with a blood test, known as a Paul Bunnell or Monospot test. If for any reason this test is inconclusive, additional blood tests, such as EBV antibody tests, can be done. In addition, a throat swab (a sample of saliva and mucus taken from the throat) can rule out other throat infections.

There is no specific medical treatment for glandular fever - see advice on home treatment, below. As glandular fever is a viral illness, antibiotics have no effect. The body's own immune system produces antibodies to fight viruses. GP sometimes mistake the symptoms of glandular fever for a bacterial infection and prescribe antibiotics, which can result in a widespread rash.

Occasionally, if the tonsils become enlarged enough to interfere with swallowing or breathing, a stay in hospital and treatment with steroids may be necessary. Surgery is extremely rare and only necessary if the spleen ruptures and has to be removed.

Home treatment:

  • rest at home and drink plenty of fluids, especially water and fruit juices.
  • avoid stress and vigorous exercise, which can delay recovery (for this reason, glandular fever can present a real problem to students at examination time).
  • avoid contact sports for 6-8 weeks as the spleen may be enlarged.

Adults can take paracetamol, ibuprofen or aspirin for fever and headaches, and gargle with aspirin to help reduce the discomfort of a sore throat. Children under 12 must not be given aspirin and recent advice suggests it should be avoided for teenagers too. Paracetamol or ibuprofen formulations are preferable and liquid formulations (eg Panadol or Nurofen) are available for children.

The virus is present in the throat during infection and for up to a year afterwards. Once the infection has passed it tends to remain dormant for a long period although it can reactivate.

There is currently no vaccine to prevent glandular fever. To prevent spreading the virus:

  • Avoid kissing and any close contact with someone who is currently or has recently been infected.
  • Do not share crockery, clothing or towels with someone who is known to have glandular fever.

1. 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.

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.

2. 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.

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.

3. 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.

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
  • Depression. The Royal College of Psychiatrists. www.rcpsych.ac.uk, accessed 26 October 2009

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