What Is Glandular Fever? What Causes Glandular Fever? What Is Infectious Mononucleosis?

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Main Category: Infectious Diseases / Bacteria / Viruses
Also Included In: Ear, Nose and Throat
Article Date: 14 Oct 2009 - 8:00 PDT

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Glandular fever is a type of viral infection. It is also known as infectious mononucleosis. It can cause fever, sore throat, fatigue, swollen lymph nodes and glands.

It is caused by the Epstein-Barr virus (EBV). It is one of the most common viruses that can affect humans. Most EBV infections occur during early childhood. They usually produce few or no symptoms. Afterwards, the virus will remain in the body for life, lying dormant in a number of throat and blood cells.

According to Medilexicon's medical dictionary, infectious mononucleosis is: "an acute febrile illness of young adults caused by the Epstein-Barr virus, a member of the Herpesviridae family; frequently spread by saliva transfer; characterized by fever, sore throat, enlargement of lymph nodes and spleen…"

When an EBV infection occurs during the teenage years, or early adulthood, it will lead to the development of glandular fever. This is why the majority of glandular fever cases occur in teenagers and young people aged between 15 and 25. Nonetheless, the condition can affect people of any age group.

During the infection, the immune system fabricates antibodies to fight the virus. This then provides lifelong immunity. Therefore, it is rare to have more than one bout of glandular fever.

The virus is contagious. It can be passed on by coming into contact with the saliva of someone who is currently infected with the condition. Contagion can occur when:

Kissing. It is often referred to as "the kissing disease"
Exposure to coughs and sneezes
Sharing eating and drinking utensils (cups, glasses, unwashed forks, spoons, towels..)

A person remains contagious for at least two months after initial infection with EBV. Some people can have EBV in their saliva for up to 18 months after infection.

There is no cure for glandular fever. In most cases, the majority of the symptoms should pass within four to six weeks without treatment. Fatigue can sometimes persist for longer. In most people, fatigue will end after three months. Full recovery is usual.

Complications of glandular fever are uncommon, but can be serious. They include a ruptured spleen, which would require emergency surgery, or a secondary infection of the lungs such as pneumonia.

What are the signs and symptoms of glandular fever?

A symptom is something the patient feels or reports, while a sign is something other people, including a doctor, may detect. For example, a headache may be a symptom, while a rash may be a sign.

The symptoms of glandular fever usually begin between four and seven weeks after a person contracts the initial infection. In younger children, symptoms may appear earlier. They include the following:

• Flu-like symptoms. As is the case with many virus infections, glandular fever often causes fever and temperature, aches, headaches, and feeling sick.


• A skin rash can appear in some individuals. Widespread, red, non-itchy.


• Loss of appetite.


• Nausea.


• Malaise. A feeling of intense tiredness and weakness often develops.


• Sore throat. The tenderness may be mild, but commonly the throat is very sore, red, and swollen. It resembles a bad bout of tonsillitis. Glandular fever is typically suspected when 'tonsillitis' is severe and lasts longer than usual. Swallowing is often painful.


• Spleen. This organ is under the ribs on the left side of the abdomen and part of the immune system. Like the lymph glands, it swells and can sometimes be felt below the ribs. Occasionally, it causes mild pain in the upper left section of the abdomen.


• Swelling around eyes. About 1 in 5 people with glandular fever become quite puffy and swollen around the eyes. This disappears rapidly.


• Swollen glands. As the body's immune system fights off the virus the lymph glands swell. Any lymph nodes in the body can be affected, but the glands in the neck and the armpits are usually the most prominent. They can become swollen and tender.


• No symptoms. This is called a sub-clinical infection. Many people become infected with this virus but do not develop symptoms.


• The liver can be affected. In some cases, the infection can affect the liver. This can cause jaundice (yellowing of the skin and the eyes). It is more common in people who are over 30 years of age.
  
  Many people with glandular fever will also experience mild inflammation of the liver or hepatitis with symptoms such as:
  
  
  • Intolerance to alcohol
  • Loss of appetite
  • Nausea

The symptoms of jaundice and hepatitis should clear up as the patient recovers from glandular fever.

The symptoms of a sore throat and fever improve usually after two weeks. Fatigue and swollen lymph nodes may persist for longer, occasionally for several months.

What are the causes of glandular fever?

Most cases of glandular fever are caused by the Epstein-Barr virus (EBV).

If a person does not have immunity to glandular fever and comes into close contact with infected saliva, EBV will first infect the cells on the lining of the inside of the throat. Then, the infection is passed to nearby white blood cells, known as B lymphocytes. The lymphocytes spread the infection to nearby lymph nodes, the spleen and the liver.

A few other causes of glandular fever

A small number of cases of glandular fever are caused by viruses other than EBV. These viruses include:

• Cytomegalovirurs (CMV)
• Rubella (German measles)

Toxoplasmosis is a parasitic infection that can cause symptoms that are comparable to glandular fever.

For pregnant women, other causes of glandular fever are usually a matter of concern. Unlike EBV, they can harm unborn babies. To reduce the risk to the embryo/fetus, additional treatment with anti-viral medication, special antibodies and antibiotics may be required.

Diagnosis of glandular fever

Physical examination. Medical evaluation will include a description of the symptoms and a physical examination in order to detect swollen lymph nodes, tonsils, liver and spleen.

Blood tests. Blood tests may be recommended in order to confirm the diagnosis. There are two blood tests that can usually help to diagnose glandular fever:

• Antibody test. The Epstein-Barr virus (EBV) causes your immune system to release certain antibodies that can be detected through testing.


• White blood cell test. An elevated number of white blood cells usually indicates the presence of infection.

Pregnant women may be tested for other possible causes of the symptoms, such as rubella or toxoplasmosis. The aim here is to protect the health of the unborn baby.

What is the treatment for glandular fever?

Currently, there is no cure for glandular fever. However the symptoms can be controlled following:

• Rest. It is essential to take plenty of rest for the first four weeks after the symptoms of glandular fever begin. This will help speed up recovery time. Until symptoms improve the patient will find it hard to carry out usual daily activities, such as attending school, college or work.
  
  Once energy level begins to return to normal, it is important to start a program of gradual exercise in order to rebuild strength.


• Fluids. It is tempting not to drink very much if swallowing is painful. However, the patient needs to drink plenty of water, or unsweetened fruit juices to help relieve the symptoms of fever and sore throat and prevent dehydration. Mild dehydration can exacerbate the symptoms of headache and tiredness. Avoid alcohol to protect the liver already weakened by the infection.


• Over-the-counter painkillers. Over-the-counter (OTC) painkillers, such as ibuprofen can also help relieve symptoms of pain and fever.
  
  Children under 16 years of age should not take aspirin because there is a small risk that it could trigger an uncommon but extremely serious health condition called Reye's syndrome that affects the liver and the brain.


• Salt water. Gargling with salt water may help to relieve the symptoms of a sore throat. Mix half a teaspoon of salt (2.5g) with quarter of a liter (8oz) of water.
  
  Dissolving aspirin in the water provides some additional benefit for patients aged over 16 years.


• Antibiotics and steroids. Antibiotics are not effective in treating glandular fever because they have no effect on viral infection. However, they may be used if there is a secondary bacterial infection of the throat.
  
  A short course of steroids might be prescribed if there is particularly severe swelling of the tonsils, and to reduce inflammation in the throat.

What are the complications of glandular fever?

• Ruptured spleen
  
  Most people who develop glandular fever will experience swelling of the spleen. Although it does not present any immediate health problems, it does increase the risk of rupture. The risk of rupturing the spleen is small. If it does happen it can be life-threatening because it causes severe internal bleeding.
  
  The main symptom of a ruptured spleen is the sudden development of a sharp abdominal pain.
  
  If you experience a sudden abdominal pain, and you have glandular fever, immediately seek medical attention. Emergency surgery will be required to repair it the ruptured spleen.
  
  A ruptured spleen usually occurs as a result of damage caused by a violent fall and vigorous physical activities, such as contact sports. These activities should be avoided for at least two months after the symptoms of glandular fever begin.


• Secondary infection
  
  In some uncommon cases, the initial infection spreads to other parts of the body, leading to a more serious secondary infection.
  
  Possible secondary infections are:
  
  
  • Pneumonia (infection of the lung)
  • Meningitis (infection of the membranes of the brain and spinal cord)
  • Inflammation of the heart
  
  Secondary infections usually only occur in people who have a weakened immune system, for example those with HIV or AIDS, or those undergoing high-dose chemotherapy.


• Prolonged fatigue
  
  It is estimated that about 10% of people with glandular fever will experience prolonged fatigue lasting for six months or more, after the initial infection.
  
  There are indications that this may be a form of chronic fatigue syndrome (CFS). It is a poorly understood condition that causes fatigue and flu-like symptoms, such as headache and joint pain.
  
  There is little explanation on why some people experience prolonged fatigue after having glandular fever. Latest research carried out in Australia seems to suggest that particularly severe glandular fever infections may alter the nervous system at a genetic level. This can lead to prolonged fatigue.
  
  Experts say that adopting a gradually progressing exercise plan in order to recover strength and energy levels is currently the best way to prevent prolonged fatigue.

Preventing glandular fever

It is important to prevent the spread of infection.

If ill, avoid kissing, sharing eating and drinking utensils and towels for at least two months after symptoms begin. Wash hands regularly, particularly after coughing or sneezing. Do not play rough or contact sports for eight weeks.

A person with glandular fever does not need to be isolated from others because most people will already be immune to the Epstein-Barr virus.

Seek medical advice if any unusual, severe, or unexplained symptoms develop.

The majority of people with glandular fever can expect a full recovery. It is very rare to have it again.

Written by Stephanie Brunner (B.A.)
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today