December 28, 2018
Glandular fever, otherwise known as infectious mononucleosis or “mono”, is an illness
caused by an infection by the Epstein-Barr (EB) virus – a member of the herpesvirus
It is spread by person-to-person contact through saliva hence its informal name of the
‘kissing disease’. It can also be transmitted by coughing, sneezing & sharing food
utensils etc, especially whilst the patient is unwell. There is no vaccine against EB virus.
Most people are infected by the virus when they are young and develop a lifelong
Infection usually occurs in the teenage group who often have no or only mild flu like
symptoms. Some, however, develop glandular fever.
The clinical features of glandular fever.
The first symptoms of glandular fever are loss of appetite, chills, tiredness and muscle
Within a day or two the patient experiences a painful throat, headache and temperature.
Swollen glands appear in the neck & armpits, and possibly the groin.
Examination of the throat shows inflamed enlarged tonsils, a few patients have a
blotchy red rash on the chest. Some patients have short lived jaundice or may develop
an enlarged spleen.
Patients usually feel better within two or three weeks although some feel tired for
Diagnosis is based on symptoms and examination. Sometimes a blood tests can be
used both assist the diagnosis and exclude other causes.
These blood tests are divided into three groups.
a)Diagnosis of Epstein-Barr virus infection.
Patients with glandular fever commonly (85-90%) have heterophile antibodies which
can be detected by the Paul-Bunnell test. This test uses sheep red blood cells that are
specially prepared. These clump when they are put in blood samples of patients with
heterophile antibodies. A similar test is a Monospot® test, in this test horse red blood
cells clump when exposed to heterophile antibodies.
The results may be falsely negative in 25% cases in the first week, 5-10% cases in
second week and 5% cases in the third week of illness. The results may be falsely
negative in children less than 12 years of age and in the elderly. The levels of these
heterophile antibodies may remain in the body for up to one year.
Other tests include the ELISA method of detecting antibodies against viral capsid
antigens (VCAs) and the EB nuclear antigen (EBNA).
b)Specific blood tests to diagnose alternative infections and diseases such as
cytomegalovirus, rubella, cytomegalovirus, toxoplasmosis and hepatitis which produce
similar symptoms and physical signs.
c)Blood test to see the impact of the EB virus on other bodily systems such as the blood
Most people require no specific treatment and antibiotics are of no benefit because it is
a viral infection.
Patients require rest, plenty of fluids, paracetamol and/or ibuprofen for the throat pain
and avoidance of alcohol (because of possible impaired liver function).
Patients are advised not to engage in contact sports for at least three months as an
enlarged spleen can be damaged in contact sports.
Complications are rare but can be very serious and some require immediate medical
Examples include tonsil enlargement to the extent of impairing the breathing where the
role of steroids in shrinking their size.
Glandular fever can also cause inflammation of the lungs, liver, the heart muscle, the
membranes that surround the heart and brain.
The virus can also damage red blood cells leading to a lack of haemoglobin, damage
the platelets which makes people more prone to bruising and bleeding and damage to
the white blood cells which increase the risk of infection.
Recurrent Glandular Fever
Although very rare glandular fever may also form a persistent form called Chronic Active
Epstein-Barr Virus infection (CAEBV) in which patients have persistent or recurring
glandular fever. Blood tests show EBV DNA at high levels. CAEBV can lead to serious