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 family.
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Glandular fever 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 immunity.
Infection usually occurs in the teenage group who often have no or only mild flu like symptoms. Some, however, develop glandular fever.
The first symptoms of glandular fever are loss of appetite, chills, tiredness and muscle ache.
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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.
- 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. T
his 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).
- Specific blood tests to diagnose alternative infections and diseases such as cytomegalovirus, rubella, cytomegalovirus, toxoplasmosis and hepatitis which produce similar symptoms and physical signs.
- Blood test to see the impact of the EB virus on other bodily systems such as the blood and liver.
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 attention.
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.
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