Glandular fever - Infectious Mononucleosis
Common symptoms include:
- a
high temperature (fever)
- a
severely sore throat
- swollen glands in the neck
- fatigue
(extreme tiredness).
While the symptoms of glandular fever can be very
unpleasant, most of them should pass within two to three weeks. Fatigue,
however, can occasionally last several months.
When to seek medical advice
You should contact your doctor if you suspect that you
or your child has glandular fever. While there is little your family doctor can do in terms of treatment,
they can provide advice and support to help you control your symptoms and
reduce the risk of passing the infection on to others.
You should go to your local accident and emergency (A&E) department or
dial 999 for an ambulance if you have glandular fever and you:
- develop
a rasping breath (stridor) or have any breathing difficulties
- find
swallowing fluids difficult
- develop
intense abdominal pain.
These symptoms can be a sign of a complication of
glandular fever that may need to be treated in hospital.
What causes glandular fever?
Glandular fever is caused by the Epstein-Barr virus
(EBV). This virus is found in the saliva of infected people and can be spread
through:
- kissing –
glandular fever is often referred to as the "kissing disease"
- exposure
to coughs and sneezes
- sharing
eating and drinking utensils, such as cups, glasses and unwashed cutlery.
EBV may be found in the saliva of someone who has
had glandular fever for several months after their symptoms pass, and some
people may continue to have the virus in their saliva on and off for
years.
If you have EBV, it is a good idea to take steps to
avoid infecting others while you are ill, such as not kissing other
people, but there's no need no need to avoid all contact with
others as the chances of passing on the infection are generally low.
Who is affected?
Glandular fever can affect people of all ages, but
most cases affect teenagers and young adults. Most EBV infections are thought to occur during
childhood and cause only mild symptoms, or no symptoms at all.
However, if a person develops an EBV infection
during early adulthood, they can develop glandular fever. Once you have had glandular fever, it is unlikely
you will develop it again. This is because people develop lifelong immunity
after the initial infection.
How glandular fever is diagnosed
To diagnose glandular fever, your doctor will
first ask about your symptoms before carrying out a physical examination.
They will look for characteristic signs of glandular fever, such as swollen
glands, tonsils, liver and spleen.
Your doctor may also recommend a blood testto help confirm the diagnosis and
rule out infections that can cause similar symptoms, such as cytomegalovirus (CMV), rubella, mumps and toxoplasmosis.
How glandular fever is treated
There is no cure for glandular fever, but there are
a number of simple treatments and measures that can help reduce the symptoms
while you wait for your body to control the infection.
These include:
- drinking
plenty of fluids
- taking
over-the-counter painkillers, such as paracetamol or ibuprofen
- getting
plenty of rest and gradually increasing your activity as your energy
levels improve.
Occasionally, antibiotics or corticosteroids may be used if you
develop complications of glandular fever. Some people with particularly severe symptoms may
need to be looked after in hospital for a few days.
Possible complications
Complications associated with glandular fever are
uncommon, but when they do occur they can be serious. They can include:
- further
infections of other areas of the body, including the brain, liver and
lungs
- severe
anaemia (a lack of oxygen-carrying red blood cells)
- breathing
difficulties as a result of the tonsils becoming significantly
swollen
- a
ruptured (burst) spleen, which may need to be treated with surgery.
Causes of glandular fever
Glandular fever is caused by the Epstein-Barr
virus (EBV). EBV is most often spread through the saliva of someone who carries
the infection. For example, it can be spread through:
- kissing –
glandular fever is sometimes referred to as the "kissing
disease"
- sharing
food and drinks
- sharing
toothbrushes
- exposure
to coughs and sneezes.
Small children may be infected by chewing toys that
have been contaminated with the virus. When you come into contact with infected saliva,
the virus can infect the cells on the lining of your throat.
The infection is then passed into your white blood
cells before spreading through the lymphatic system. This is a series of glands (nodes) found throughout
your body that allows many of the cells that your immune system needs to travel
around the body. After the infection has passed, people develop
lifelong immunity to the virus and most won't develop symptoms again.
Many people are first exposed to EBV during
childhood, when the infection causes few symptoms and often goes unrecognised
before it eventually passes. Young adults may be most at risk of glandular fever
because they might not have been exposed to the virus when they were younger,
and the infection tends to produce more severe symptoms when you're older.
EBV carriers
Not everyone who can pass on EBV will have symptoms
themselves. These are known as asymptomatic carriers. Some people can have the virus in their saliva for
a few months after recovering from glandular fever, and may continue to have
the virus in their saliva on and off for years.
This is because the virus remains inactive in the
body for the rest of your life after you have been exposed to it. For most
people, the inactive virus won't cause any symptoms. However, there is a chance of the virus
periodically becoming reactivated, which may mean it re-enters the saliva. This
reactivation may be without any symptoms, or it may cause symptoms to
recur for a short time.
Symptoms of glandular fever
Symptoms of glandular fever are thought to take
around one to two months to develop after infection with the Epstein-Barr virus
(EBV).
Main symptoms
The most common symptoms of the condition
are:
- a
high temperature (fever)
- a sore throat – this is
usually more painful than any you may have had before
- swollen glands in your neck and
possibly in other parts of your body, such as under your armpits
- fatigue
(extreme tiredness).
Other symptoms
Glandular fever can also cause:
- a
general sense of feeling unwell
- aching
muscles
- chills
- sweats
- loss
of appetite
- pain
around or behind your eyes
- swollen
tonsils and adenoids (small lumps of tissue at the back of the nose),
which may affect your breathing
- the
inside of your throat to become very red and ooze fluid
- small
red or purple spots on the roof of your mouth
- a
rash
- swelling
or "puffiness" around your eyes
- a tender
or swollen tummy
- jaundice (yellowing of the skin
and whites of the eyes).
Some of these symptoms may develop a few days
before the main symptoms mentioned above.
How the condition progresses
Most symptoms of glandular fever will usually
resolve within two or three weeks. Your throat will normally feel
most sore for three to five days after symptoms start before
gradually improving, and your fever will usually last 10 to 14 days.
Fatigue is the most persistent symptom
and often lasts a few weeks, although some people may feel persistently
fatigued for several months after the other symptoms have passed.
When to seek medical advice
You should contact your doctor if you suspect that you
or your child has glandular fever. While there is little your doctor can do in terms of
treatment other than provide advice and support, blood tests may be needed to rule out
less common but more serious causes of your symptoms, such as hepatitis (a viral infection that
affects the liver).
You should go to your local accident and emergency (A&E) department or
dial 999 for an ambulance if you have glandular fever and you:
- develop
a rasping breath (stridor) or have any breathing difficulties
- find
swallowing fluids difficult
- develop intense
abdominal pain.
If you have these symptoms, you may need to be
looked after in hospital for a few days.
Treating glandular fever
There is currently no cure for glandular fever,
but the symptoms should pass within a few weeks. There
are things you can do to help control your symptoms.
Fluids
It is important to drink plenty of
fluids (preferably water or unsweetened fruit juice) to avoid dehydration. Avoid alcohol, as this could harm your liver,
which may already be weakened from the infection.
Painkillers
Painkillers available over the counter, such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) such
as ibuprofen, can help reduce pain and fever.
Children under 16 years old should not take aspirin
because there is a small risk it could trigger a rare but serious health
condition called Reye's syndrome. Regularly gargling with a solution of warm, salty
water may also help relieve your sore throat.
Rest
It is important you take plenty of rest while
you recover from glandular fever, although complete bed rest is no longer
recommended because it may make the fatigue last longer. You should gradually increase your activities as
your energy levels return, but avoid activities you cannot manage comfortably.
For the first month after your symptoms begin,
avoid contact sports or activities that put you at risk of falling. This is
because you may have a swollen spleen that it is more vulnerable to
damage, and a sudden knock could cause it to burst (rupture).
Preventing the spread of infection
There is no need to be isolated from others if you
have glandular fever as most people will already be immune to the
Epstein-Barr virus (EBV). You can return to work, college or school as soon
as you feel well enough. There is little risk of spreading the infection to
others as long as you follow commonsense precautions while you are ill, such as
not kissing other people or sharing utensils.
It is also important to thoroughly clean
anything that may have been contaminated by saliva until you have recovered.
Antibiotics and steroids
Antibiotics are not effective in
treating glandular fever because they have no effect on viruses, but they may
be prescribed if you also develop a bacterial infection of your throat or
lungs (pneumonia). A short course of corticosteroids may also be helpful
if:
- your
tonsils are particularly swollen and are causing breathing
difficulties
- you
have severe anaemia (a lack of oxygen-carrying red blood cells)
- you
have problems affecting your heart, such as pericarditis(inflammation of the sac
that surrounds the heart)
- you
have problems affecting your brain or nerves, such as encephalitis.
Hospital treatment
Most people are able to recover from glandular
fever at home, but hospital treatment may be necessary for a few days if
you or your child:
- develop
a rasping breath (stridor) or have any breathing difficulties
- find
swallowing fluids difficult
- develop
intense abdominal pain.
Treatment in hospital may involve receiving fluids
or antibiotics directly into a vein (intravenously), corticosteroid injections
and pain relief. In a small number of cases, emergency
surgery to remove the spleen(splenectomy) may be needed if it
ruptures.
Complications of glandular fever
Most people with glandular fever will recover in
two or three weeks and won't experience any further problems. However, complications can develop in a few cases.
Some of the main complications associated with the condition are described
below.
Prolonged fatigue
More than 1 in every 10 people with glandular
fever will experience prolonged fatigue, which lasts for six months or more
after the initial infection. It is not known why fatigue lasts longer in some
people.
Some experts think it may be a form of chronic fatigue syndrome (CFS). This is a
poorly understood condition that causes persistent fatigue and a range of other
symptoms, such as headaches and joint pain.
Adopting a gradual exercise plan to rebuild your
strength and energy levels may help prevent and reduce prolonged fatigue.
Reduction in blood cells
In a few cases, glandular fever can lead to a
reduction in some blood cells. It can reduce levels of:
- red
blood cells (anaemia) – this can make you
feel tired and out of breath
- white
blood cells (neutropenia) – this can
make you more prone to developing a secondary infection
- platelets –
this can make you bruise and bleed more easily.
In most cases, the reduction in the number of
blood cells is small and only causes mild symptoms. These problems should get
better by themselves within a few weeks or months.
Ruptured spleen
Around half of people who develop glandular fever
will have a swollen spleen. This does not present any immediate health
problems, but there is a small risk of it rupturing (bursting). The main sign of a ruptured spleen is sharp
pain in the left of the tummy (abdomen).
Go to your local accident and emergency (A&E) department or
dial 999 for an ambulance if you have glandular fever and you develop intense
abdominal pain. The risk of the spleen rupturing is small,
occurring in just 1 in every 500 to 1,000 cases of glandular fever, but it
can be life threatening because it may cause severe internal bleeding.
In some cases, emergency surgery may be
required to remove an enlarged or ruptured spleen (splenectomy). 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.
Neurological complications
In less than 1 in every 100 cases, the Epstein-Barr
virus (EBV) can affect the nervous system and trigger a range of neurological
complications, including:
- Guillain-Barré syndrome –
where the nerves become inflamed, causing symptoms such as numbness,
weakness and temporary paralysis
- Bell's palsy – where the
muscles on one side of the face become temporarily weak or paralysed
- viral meningitis – an infection of
the protective membranes that surround the brain and spinal cord; although
unpleasant, viral meningitis is much less serious than bacterial
meningitis, which is life threatening
- encephalitis – an infection
of the brain.
These complications will often need specific treatment,
but more than four out of every five people with them will make a full
recovery.
Secondary infection
In a small number of cases, the initial infection
weakens your immune system and allows bacteria to infect parts of the body.
This is called a secondary bacterial infection. Possible secondary infections that can develop
during glandular fever include serious conditions such as pneumonia (infection of the lung)
and pericarditis (infection of the sac
that surrounds the heart).
Secondary infections usually occur in people who
have a very weak immune system, such as people with HIV or AIDS, or those having 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 allow for your health to be carefully
monitored and any secondary infections to be treated.
Source: NHS Choices.
Source: NHS Choices.