Glandular fever

Glandular fever is an infectious illness caused by the Epstein-Barr virus (EBV). It tends to affect teenagers and young adults, especially college and university students.

Although the Epstein-Barr virus is not very catching, it spreads from person to person in saliva, which is why it is sometimes called the kissing disease. It also spreads through coughing and sneezing and also probably in tiny droplets in the air when people talk. The incubation period is over four weeks.

The Epstein Barr-virus is part of the herpes group of viruses, like the herpes simplex virus (which causes cold sores) and herpes zoster (which causes chickenpox and shingles). Although glandular fever is very different from these conditions, the Epstein Barr virus does have some similarities with other herpes group viruses, for instance:

• infection does not always cause symptoms (for example, many people have been infected as children with the Epstein Barr virus without becoming ill)
• the virus can persist in the body
• the virus can be reactivated from time to time without necessarily bringing on symptoms.

Most patients have some combination of the following syptoms:

• Fever
• Sore throat and enlarged tonsils
• Painful lymph gland enlargement (usually in the neck but it can be elsewhere too)

However the condition can cause a wide range of symptoms, including:

• Rash (small but widespread red patches or bumps, especially if the patient has recently taken certain types of penicillin)
• Abdominal discomfort from an enlarged spleen
• Liver enlargement and occasionally jaundice
• Joint pains
• Extreme tiredness or sleepiness, especially in the first week or two
• Anaemia
• Swelling around the eyes

Tiredness is the main possible complication. Rupture of the spleen can occur if there is an injury while it is enlarged which is why it is important to avoid contact sports and any other risk of abdominal injury when suffering from glandular fever, especially if the spleen is swollen.

Very occasionally, the tonsils may become so massive that they block the airway. This is potentially very serious and needs urgent hospital treatment.

Other complications, such as encephalitis (inflammation of the brain), are extremely rare.

While it is possible to strongly suspect glandular fever in someone with a typical combination of symptoms, tests may be needed to confirm the diagnosis. It can, for instance, be difficult to distinguish glandular fever from acute tonsilitis because in both conditions the tonsils can be very large, painful and covered in pus.

Glandular fever gets better without specific treatment and it is usually enough just to ease the symptoms by:

• Taking plenty of fluids and paracetamol to control any fever
• Using mild throat lozenges and soothing drinks for sore throat
• Resting, just as one would for an illness such as flu or tonsilitis. However, strict or prolonged bed-rest is unnecessary and can do more harm than good
• Avoiding abdominal injury for at least three weeks

Research is going on into more specific treatments for the Epstein Barr virus, but most people recover perfectly well with simple measures. Some experts have shown that drugs like acyclovir (sometimes used for shingles) can stop the Epstein Barr virus multiplying, but these treatments do not always relieve or prevent the symptoms of glandular fever.

Occasionally, some people with glandular fever feel unwell for many weeks, which has given the condition a reputation for being persistent and very unpleasant. It usually is not, and most people recover completely from glandular fever within three weeks.

The question of whether glandular fever can reoccur is difficult. Most experts believe it does not, but a few people who have the disease may find that for a year or more they may get symptoms similar to those of glandular fever whenever they happen to get a different illness, such as flu.

A person with glandular fever need not keep away from others because the Epstein Barr virus is very common (but not highly contagious) and does not always cause any trouble. In practice, the most infectious phase is early on, often before the diagnosis is made, so there is little point in isolating a patient. All the same, it makes sense to keep glandular fever sufferers away from those who might be particularly susceptible to infection, like premature or sick babies and the very old.

References

1. COZAD, J. Infectious mononucleosis, Nurse Practice, 21
2. LINDE, A. Diagnosis of Epstein-Barr virus related diseases, Scandinavian Journal of Infectious Diseases Supplement
3. OKANO, M. (1997) Therapeutic approaches for severe Epstein-Barr virus infection, Pediatric Hematological Oncology
4. GRIFFITHS, P.D. (1996) Herpesvirus infections, Medicine Series