Glandular fever (mononucleosis) is an infectious disease which is caused by the Epstein Barr virus (EBV). It is characterised by fatigue, fever, inflammation in the throat and swelling of the lymph nodes. Glandular fever usually heals within 2 – 3 weeks without any complications. However, it can sometimes also last longer and be connected with chronic tiredness and loss of performance.

Pfeifferisches Drüsenfieber Symptome & Behandlung

Overview of glandular fever

Glandular fever, also known as ‘kissing disease’, is caused by the Epstein-Barr virus (EBV). The widespread virus remains in the body permanently after initial infection and in some cases can cause fever, sore throat, tiredness and swelling of the lymph nodes. Adolescents and young adults are particularly affected.

Transmission of the virus occurs mainly through contact with saliva, with susceptibility to the illness depending on various factors such as age and immunity. It is diagnosed based on symptoms and blood tests, and treatment is aimed at alleviating the symptoms. Despite the possibility of ongoing fatigue, most people recover fully and develop a permanent immunity to glandular fever.

Causes and risk factors

Cause and trigger

Glandular fever is caused by Epstein-Barr virus (EBV), a member of the herpes virus family. EBV is one of the most widespread viruses in the world and has the unique ability to establish long-term infection of B lymphocytes in the immune system. After initial infection, the virus remains in the body for life, usually in a latent (inactive) state. Although many people become infected with EBV in their childhood or adolescence, not all people end up with glandular fever. The illness typically develops when the immune system responds to the infection in a certain way.

Transmission and infection

Epstein-Barr virus is transmitted mainly through the exchange of body fluids, especially saliva. This can happen by kissing, sharing drinks, food, cutlery or toothbrushes, as well as coughing and sneezing. EBV can also be transmitted through blood transfusions and organ transplants, although this is less common. The fact that the virus is easily transmitted through saliva has earned the it the nickname ‘kissing disease’. It is important to know that EBV can also be transmitted by people who do not show symptoms or who have already recovered from the illness, as the virus can be excreted temporarily in saliva.

Risk factors and groups at risk

Although Epstein-Barr virus is widespread and many people become infected at some point in their lives, there are certain factors and groups that have an increased risk of developing glandular fever after an EBV infection:

Age

Adolescents and young adults between the ages of 15 and 24 are most likely to be affected. Children can also become infected with EBV, but rarely show severe symptoms.

Immune status

People with a weakened immune system, either due to a disease (such as HIV/AIDS or certain cancers) or due to taking immunosuppressive medication, are more susceptible to EBV infection and may have a more severe course of glandular fever.

Lifestyle and social factors

Close contact in communal settings such as schools, universities and military barracks can increase the risk of EBV transmission.

Symptoms 

Glandular fever presents with a range of symptoms that can range from mild to severe, vary according to the age of the infected person and are easy to confuse with those of other viral infections.

Early symptoms and first signs

The incubation period of Epstein-Barr virus is usually 4 to 6 weeks. The first signs of infection are often similar to those of the flu or a severe cold and include:

  • Tiredness and generally feeling unwell
  • Fever
  • Sore throat
  • Headaches
  • Loss of appetite

These early symptoms are easily be overlooked or confused with other, less specific viral infections.

Typical symptoms of glandular fever

After the first signs, more specific symptoms develop that are characteristic of glandular fever:

  • Severe sore throat, often with white spots on the tonsils
  • Persistent high fever
  • Swollen lymph nodes, particularly in the neck and under the jaw
  • Enlargement of the spleen and sometimes the liver
  • Fatigue that can last for weeks to months

Different symptoms in children, adolescents and adults

  • Children often have milder symptoms. They may have a fever and sore throat, but the characteristic tiredness and swelling of the lymph nodes are often absent.
  • Adolescents and young adults usually experience the full range of symptoms with severe fatigue and pronounced swelling of the lymph nodes.
  • Adults may have a more severe course of illness with more intense symptoms and a higher risk of complications.

Progression of glandular fever

Most people recover from the acute symptoms of glandular fever within 2 to 4 weeks, although the fatigue can last longer, sometimes several months. Full recovery depends on the severity of the symptoms and the general state of health of the person concerned.

While most cases of glandular fever subside without long-term problems, some people may experience complications such as:

  • Ruptured spleen, a rare but serious complication
  • Hepatitis or jaundice
  • Anaemia, thrombocytopenia (decrease in blood platelets) or neutropenia (decrease in neutrophils)
  • Neurological complications such as meningitis or encephalitis
  • Secondary infections such as streptococcal tonsillitis

After an EBV infection, the body usually develops a lifelong immunity to glandular fever. However, the virus remains latent in the body and can be reactivated under certain circumstances, especially in people with weakened immune systems. Recurrence of glandular fever is rare, though.

Diagnosis

The diagnosis of glandular fever is based on a combination of clinical symptoms and specific blood tests. The main diagnostic tests are:

Monospot test (heterophile antibody test)

This test can typically be done one week after the onset of symptoms and detects antibodies associated with EBV infection. It is quick and easy, but not always reliable for children under 4 years of age.

EBV-specific antibody tests

These tests measure antibodies against specific EBV antigens and can detect current or previous infection. They are more accurate than the monospot test and can also be used to determine the stage of infection.

Blood count

A complete blood count may show abnormalities such as an increased number of white blood cells (leukocytosis) or the presence of atypical lymphocytes indicative of EBV infection.

Due to similar symptoms, glandular fever must be distinguished from other diseases:

  • Strep throat: a bacterial infection that can also cause a sore throat and fever.
  • Cytomegalovirus (CMV) infection: another herpes virus that can cause symptoms similar to EBV.
  • HIV infection: early symptoms of HIV may be similar to those of glandular fever.
  • Influenza and other viral respiratory infections: these may cause similar general symptoms.

Treating glandular fever

The treatment of glandular fever is primarily supportive and aims to alleviate the symptoms:

  • Rest: adequate rest is important for recovery.
  • Fluid intake: drink plenty to relieve fever and sore throat.
  • Pain relief: antipyretic and pain-relieving medications such as paracetamol or ibuprofen can help relieve fever, headache and sore throat.
  • Medicinal treatment options
  • There are no specific antiviral drugs routinely used to treat glandular fever. However, in severe cases or complications, treatment with corticosteroids may be considered to reduce swelling or treat airway obstructions.

The following things should also be taken into account while sick with glandular fever:

  • Nutrition: a balanced diet rich in vitamins and minerals can help the body recover.
  • Avoidance of alcohol: as EBV can damage the liver, alcohol should be avoided.
  • Physical rest: activities that may increase the risk of a ruptured spleen should be avoided until the spleen has returned to normal size.

Prevention

As there is currently no vaccination against Epstein-Barr virus, prevention focuses on minimising the risk of transmission:

  • Personal hygiene: regular hand washing and avoiding sharing drinks, food or personal items can reduce the risk of transmission.
  • Education: awareness of the ways in which the virus is transmitted can help reduce the risk of infection, particularly in communal settings or where there is close physical contact.
  • Protecting the immune system: a healthy lifestyle with a balanced diet, regular exercise and adequate sleep can strengthen the immune system and increase resistance to infections.

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