Glandular fever

Glandular fever is a type of viral infection that mostly affects young adults. Common symptoms include fever, a sore throat and extreme tiredness (fatigue).

Information written and reviewed by Certified Doctors.

Contents

Key Information

What should I do?

If you think you have this condition you should see a doctor within 2 weeks.

How is it diagnosed?

Your doctor might suspect glandular fever based on your symptoms and physical examination findings. A small sample may need to be taken from your throat using a swab in order to diagnose the condition.

What is the treatment?

If you are diagnosed with glandular fever, you can expect it to get better on its own.

It is important that you drink plenty of fluids, and you can take non-prescription painkillers for any pain you might be experiencing.

When to worry?

If you develop any of the following symptoms, please see a doctor immediately:

  • difficulty breathing
  • unable to drink fluids
  • severe abdominal pain.

Introduction

Glandular fever is a type of viral infection that mostly affects young adults.

Common symptoms of glandular fever include:

  • a high temperature (fever) of 38ºC (100.4ºF) or above
  • sore throat
  • swollen nodes (glands) in the neck
  • fatigue (extreme tiredness)

Read more about the symptoms of glandular fever.

Glandular fever is not usually a serious threat to a person's health, but can be unpleasant and last several weeks.

Diagnosing glandular fever

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 lymph nodes, tonsils, liver and spleen.

To help confirm the diagnosis, your doctor may recommend that you have a blood test known as an antibody test.

If you are pregnant, you may be tested for other possible causes of your symptoms, such as rubella or toxoplasmosis, to make sure there is no risk to your unborn baby.

Causes of glandular fever

Most cases of glandular fever are caused by the Epstein-Barr virus (EBV), one of the most common viruses to affect humans.

Most EBV infections are thought to take place during childhood and cause mild symptoms. However, if a person develops an EBV infection during early adulthood, they can develop symptoms of glandular fever.

Glandular fever is spread through saliva. It can be spread through:

  • kissing (it is often referred to as the "kissing disease")
  • exposure to coughs and sneezes
  • sharing eating and drinking utensils, such as cups, glasses and unwashed forks and spoons

Someone with glandular fever is contagious for at least two months after initially being infected with EBV. However, some people can have EBV in their saliva for up to 18 months after having the infection. A few may continue to have the virus in their saliva on and off for years.

Once you have had glandular fever, it is highly unlikely you will develop a second bout of the infection. This is because almost everyone develops a life-long immunity to glandular fever after the initial infection.

Read more about the causes of glandular fever.

Treating glandular fever

There is no cure for glandular fever. Treatment focuses on relieving the symptoms, such as using painkillers to ease pain and reduce fever.

Most symptoms of glandular fever should pass within two to three weeks without treatment. However, fatigue can last longer, sometimes up to six months.

Read more about how glandular fever is treated.

Complications associated with glandular fever are uncommon, but when they occur they can be serious. They can include:

  • secondary infection of the brain or nervous system
  • breathing difficulties as a result of the tonsils becoming massively swollen
  • ruptured (burst) spleen, which is a life-threatening emergency – the spleen is an organ that plays an important role in fighting off infection (this complication is very rare, occurring in just one in 1,000 cases)

Dial 999 for an ambulance if you have glandular fever and you experience sudden, intense abdominal pain.

Read more about the complications of glandular fever.

Who is affected?

Glandular fever is an uncommon type of infection. It is estimated that one in every 200 people will develop glandular fever in any given year.

Most cases affect young adults between the ages of 15 to 24, although cases have been reported in people of all ages. Both sexes are equally affected.

Due to the improving standards of hygiene in Western countries, the number of cases of glandular fever is expected to rise. This is because fewer children are being exposed to EBV, which means they are more likely to develop the infection in early adulthood.

Symptoms

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Symptoms of glandular fever take around one to two months to develop after infection with the Epstein-Barr virus. This is known as the incubation period.

Common symptoms

The most common symptoms of glandular fever are:

  • a high temperature (fever) of 38ºC (100.4ºF) or above
  • a sore throat – usually more painful than any previous throat infection you may have had
  • swollen glands (nodes) in your neck and possibly in other parts of your body, such as under your armpits

In addition to throat pain, you may also have:

  • swollen tonsils
  • the inside of your throat may be very red and ooze fluid
  • swollen adenoids, which are two lumps of tissue at the back of your nose
  • small purple spots on the roof of your mouth

Other symptoms

Other symptoms of glandular fever include:

  • fatigue (extreme tiredness)
  • a general sense of feeling unwell
  • a headache
  • chills
  • sweats
  • loss of appetite
  • pain behind your eyes
  • swelling of your spleen – this may cause a noticeable and tender swelling or lump in the left side of your abdomen (tummy)
  • swelling or "puffiness" around your eyes
  • swelling of your liver – this usually causes mild pain and tenderness in the lower right side of your abdomen
  • jaundice – yellowing of the whites of your eyes and skin

The course of the infection

In most cases of glandular fever, the symptoms will resolve within two to three weeks of the initial infection. Your sore throat will be at its worst 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 can last for several weeks. However, in about one in 10 people fatigue lasts for up to six months. Most people will be able to resume normal activities within one to two months.

When to seek medical advice

You should contact your doctor if you suspect that you or your child has developed glandular fever.

While there is little that 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 can cause liver disease) and HIV.

Seek urgent medical help if you or your child experience any sudden, intense lower abdominal pain.

Causes

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

The Epstein-Barr virus

If you come into close contact with infected saliva and are not immune (resistant) to glandular fever, EBV will infect cells on the lining inside your throat.

It can be caught by close personal contact, especially kissing (it's sometimes referred to as the "kissing disease"). It may also be possible to catch it from sharing toothbrushes and drinking utensils.

The infection is then passed to white blood cells before spreading through the lymphatic system. This is a series of glands (nodes) that spread throughout your body in a similar way to your blood circulation system. The glands produce many of the cells that are needed by your immune system.

The spleen is an important part of the lymphatic system, because it helps produce the infection-fighting antibodies your immune system uses to fight infection. If your spleen is infected, it will become inflamed (swollen). This occurs in around half of all cases of glandular fever.

Age

It is unclear exactly why some people develop the symptoms of glandular fever after coming into contact with EBV, while others do not. Age appears to be the most important factor, as most cases affect older teenagers and young adults.

There is also evidence that some people may be born with certain genes that make them more susceptible to developing glandular fever.

Other causes

A few cases of glandular fever are caused by viruses other than EBV, such as:

Toxoplasmosis is a parasitic infection that can also cause similar symptoms to glandular fever.

Other causes of glandular fever are usually only a matter of concern for pregnant women. This is because unlike EBV, other viruses can harm unborn babies. Additional treatment with antiviral medication (special antibodies) and antibiotics may be required to reduce the risk to your unborn baby.

HIV

An early HIV infection can also cause symptoms of glandular fever. Inform your doctor if you think you may have been exposed to HIV infection in the previous two months.

Your doctor will be able to carry out a blood test to check for HIV infection. If you have HIV, it is very important it is diagnosed at an early stage, as excellent treatments for the condition are now available which may be of benefit during the early stages of the infection.

Treatment

There is currently no cure for glandular fever, but the symptoms should pass within a few weeks. However, 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 becoming dehydrated. This will also help to relieve your symptoms of fever and sore throat.

Avoid alcohol, as this could damage your liver, which will 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 relieve symptoms of pain and fever.

Children under 16 years old should not take aspirin. There is a small risk it could trigger a rare but serious health condition called Reye's syndrome, which affects the liver and brain.

Rest

It is important you take plenty of rest for the first two to three weeks after your glandular fever symptoms begin. However, complete bed rest is no longer recommended, as it can make the symptoms of fatigue last longer.

You should gradually increase your activities as your energy levels return, but it is important to avoid activities you cannot manage comfortably.

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, such as not kissing other people or sharing utensils.

For the first month after your symptoms begin, avoid contact sports or activities that put you at risk of falling. This is because if you have a swollen spleen, it is more vulnerable to damage and a sudden knock could cause it to rupture.

Salt water

Gargling with salt water may help relieve the symptoms of a sore throat. Mix half a teaspoon of salt (2.5g) with a quarter of a litre (eight ounces) of water.

If you are over 16 years old, you may find dissolving aspirin in water provides some additional benefit. Children under 16 should not take aspirin.

Antibiotics and steroids

Antibiotics are not effective in treating glandular fever because they have no effect on viral infection. However, antibiotics may be prescribed if you develop a secondary bacterial infection of the throat.

A short course of steroids may also be prescribed if your tonsils are particularly swollen or causing breathing difficulties. Steroids are also sometimes used to treat other complications of glandular fever unrelated to swollen tonsils, such as:

  • severe anaemia – a lack of oxygen-carrying red blood cells
  • hepatitis – inflammation of the liver
  • low platelet count – a lack of blood-clotting cells
  • neurological complications – such as encephalitis

Complications

Complications of glandular fever can include a swollen spleen or secondary infection. In rarer cases there can be more serious complications, such as a ruptured spleen.

Blood cells

In 25 to 50% of cases, glandular fever reduces the production of the three types of blood cells. It can reduce levels of:

  • red blood cells, which can make you feel tired and out of breath
  • white blood cells, which can make you more prone to developing a secondary infection (see below)
  • platelets, which can make you bruise and bleed more easily

In most cases, the reduction in the amount of blood cells is minimal and only causes mild symptoms.

Swollen or ruptured spleen

Around half of people who develop glandular fever will have a swollen spleen. A swollen spleen does not present any immediate health problems, but is at risk of rupturing (bursting). The main sign of a ruptured spleen is sudden sharp abdominal (tummy) pain.

Dial for an ambulance if you have glandular fever and you suddenly experience abdominal pain. If you have a ruptured spleen, emergency surgery may be required to repair it.

The risk of the spleen rupturing is small, occurring in just one in every 1,000 cases, but it can be life-threatening because it causes severe internal bleeding.

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. Your doctor can advise you about when it is safe to start doing vigorous physical activities again.

Neurological complications

In an estimated one in 100 cases, the Epstein-Barr virus (EBV) can affect a person's nervous system and trigger a range of neurological complications, including:

  • Guillain-Barré syndrome – the nerves become inflamed, causing symptoms such as numbness and temporary paralysis
  • Bell's palsy – causes temporary weakness or paralysis of the muscles on one side of the face
  • 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 usually pass once the underlying infection has resolved. Around four out of five people will make a full recovery.

Secondary infection

In a small number of glandular fever cases, the initial infection spreads to other parts of the body, leading to a more serious secondary infection. Possible secondary infections arising from glandular fever include:

Secondary infections usually only occur in people who have a weakened immune system, such as people with HIV or AIDS or those undergoing high-dose 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 enable your health to be carefully monitored and any secondary infection to be treated.

Prolonged fatigue

Around one in 10 of 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 that it may be a form of chronic fatigue syndrome (CFS). This is a poorly understood condition that causes fatigue and flu-like symptoms, such as headache and joint pain.

Recent research in Australia suggests that particularly severe glandular fever infections may affect the nervous system at the genetic level, leading to prolonged fatigue. However, further research is required to explore this more fully.

From the evidence that is available, it seems that adopting a gradual exercise plan to rebuild your strength and energy levels is the best way to prevent prolonged fatigue.

Multiple sclerosis

Research has found that people who have had glandular fever are twice as likely to develop multiple sclerosis in later life compared with the population at large. However, it is important to put this increase in context. Multiple sclerosis is an uncommon condition, with one to five people in every 1,000 being affected at some point in their life. Therefore, the risk of someone who has had glandular fever developing multiple sclerosis later in life is very low.

There are two main theories to explain why there is an increase in the risk of developing multiple sclerosis.

These are:

  • glandular fever may affect some people's immune system in a way that causes it to malfunction many years after the original infection
  • there may be certain genes that make some people more vulnerable to glandular fever and multiple sclerosis
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