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Glandular fever, or infectious mononucleosis, is common among teenagers, young adults, and college students. Some symptoms include a fever, a sore throat, fatigue, and swollen lymph nodes.
Glandular fever usually stems from an infection with the Epstein-Barr virus (EBV), a highly contagious herpes virus.
Experts believe that more than 90% of people worldwide have EBV infections. However, it does not always cause symptoms or lead to glandular fever.
There is no cure for glandular fever, which usually passes without treatment. However, the fatigue can be long-lasting.
Cytomegalovirus infection and rubella, known as German measles, can also cause glandular fever, while toxoplasmosis, a parasitic infection, can cause similar symptoms.
When a person develops glandular fever, the symptoms usually appear 4–6 weeks after the initial infection.
A person may experience:
- flu-like symptoms, including body aches and a headache
- a temperature of 100.4°F (38°C) or higher
- a widespread rash that is not itchy
- nausea and a loss of appetite
- malaise, fatigue, tiredness, and weakness
- swelling and puffiness around the eyes
- a sore throat
- swelling of the lymph nodes
- pain in the upper abdomen, due to a swollen spleen
- liver pain and jaundice
The symptoms tend to resolve within 2–4 weeks, though the fatigue may last for a few more weeks. Some people experience symptoms for 6 months or longer.
Some people have EBV infections but no symptoms. This is more common in younger children and people over 40 years old.
The throat
The soreness can be mild, but it is often severe and occurs with redness and swelling, similar to tonsilitis. Swallowing is often painful.
If what seems like severe tonsillitis lasts longer than usual, the person may have glandular fever.
The lymph nodes and spleen
As the immune system fights the virus, the lymph nodes swell. The swelling can occur in any lymph node, but those in the neck and armpits are usually the most prominent. They may be tender.
The spleen is part of the immune system, and it sits under the ribs on the left side of the abdomen.
The spleen may also swell as the body combats the virus, and the person may be able to feel it beneath their ribs. The swelling may cause mild pain in the upper left part of the abdomen.
The liver
In rare cases, the EBV can cause mild inflammation of the liver, known as hepatitis. It is more common in people over 30 years of age.
Symptoms of hepatitis include:
- jaundice, a yellowing of the skin and eyes
- intolerance to alcohol
- a loss of appetite
- nausea
The jaundice and hepatitis should disappear as the person recovers from glandular fever.
There is no cure for glandular fever, and some people experience symptoms for 6 months or longer.
However, even without treatment, most people find that their symptoms go away within 2–4 weeks, though fatigue can last longer. In fact, studies have found that 9–22% of people continue to experience fatigue for 6 months after developing the infection.
A person can take the following steps to help the body heal:
Rest
A person with glandular fever often feels too tired and unwell to continue with their regular routine, but complete rest is key, especially in the first month after symptoms have appeared.
As the person recovers, light exercise may help them regain muscle strength.
Drink plenty of fluids
This will help prevent dehydration, especially if there is a fever.
A sore throat can make it hard to swallow, but it is important to consume enough fluids.
Pain relief medication
Pain relief medication, such as ibuprofen (Advil) and acetaminophen (Tylenol) are available over-the-counter and online. They may help keep any fever and pain at bay.
Aspirin is not suitable as it can increase the risk of bleeding. Children under 16 should also not use it due to the risk of developing Reye’s syndrome.
Gargling
Gargling with salt water or a solution from a pharmacy may help relieve a sore throat.
Steroids
If the tonsils are very inflamed or breathing is otherwise difficult, a doctor may prescribe a short course of corticosteroids.
Most EBV infections occur during early childhood. When it happens, the immune system produces antibodies to fight the virus.
The virus remains in the body for life, lying dormant in throat and blood cells. The antibodies provide lifelong immunity, and glandular fever rarely comes back a second time.
Sometimes, however, the virus becomes active again. This can occasionally cause symptoms, especially in a person with a weakened immune system.
However, an EBV infection does not always lead to glandular fever or any symptoms.
A person who contracts the infection as a teenager or young adult is more likely to develop glandular fever. It mainly appears in those aged 15–24 years.
At least 1 in 4 young adults with EBV infections develop glandular fever. Less commonly, the illness affects people in other age groups.
How does it spread?
A person who has an EBV infection can pass it on through bodily fluids, such as saliva. It is possible to spread the infection through coughing, sneezing, or sharing items such as utensils and cups, for example.
It is also possible to pass on glandular fever, or infectious mononucleosis, through kissing. It is sometimes called the “kissing disease.”
The Centers for Disease Control and Prevention (CDC) note that the virus can also spread through contact with semen or blood and through an organ transplant.
However, stringent testing of transfused blood and transplanted organs means that the risk of developing glandular fever through these ways is very low.
When the EBV enters the body, it first infects the lining of the throat. Then, white blood cells called B lymphocytes can spread the infection to other parts of the body, including the liver and spleen.
The virus remains in the body even after symptoms have gone, and it can reactivate at a later date.
Other causes of glandular fever
Beyond the EBV, cytomegalovirus and rubella, sometimes called German measles, can also cause glandular fever.
Also, a person may develop similar symptoms if they have toxoplasmosis, a parasitic infection.
Cytomegalovirus, rubella, and toxoplasmosis can affect a fetus. If a pregnant woman develops any of these infections, treatment with antibiotics and antibodies may be necessary.
The doctor will perform a physical examination to detect swollen lymph nodes and assess the tonsils, liver, and spleen.
If they suspect glandular fever, they also may order some tests. An antibody test can detect antibodies developed specifically to combat EBV.
During pregnancy, tests can show whether rubella or toxoplasmosis are present. The EBV does not harm a fetus or an embryo.
Complications of glandular fever are rare, but they can be serious.
They include:
- damage to the spleen
- a secondary infection, such as pneumonia, meningitis, or one that causes heart inflammation
- anemia
- a neurological condition, such as Guillain-Barre syndrome or Bell’s palsy
- upper airway obstruction
Secondary infections are rare, but there is a risk for patients with weakened immune systems.
Also, due to the possibility of spleen damage, it might be a good idea to avoid contact sports, such as football, for 8 weeks after having glandular fever.