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Glandular fever

Alternative Names
Epstein-Barr virus, EBV, mono, mononucleosis Definition
Glandular fever is an infection marked by a sore throat, swollen lymph nodes, fever and fatigue.

What is going on in the body?
Often called "the kissing disease," glandular fever is spread from one person to another, most likely through saliva. A herpes virus called the Epstein-Barr virus (EBV) causes it.

Most people get EBV during childhood. Like other herpes viruses, it stays quiet in the body long after symptoms go away and can be reactivated later in life. Often this happens when the immune system has been weakened by disease, cancer treatment or an organ or bone marrow transplant.

EBV may not cause symptoms, especially in young children. When teens or young adults get EBV, though, glandular fever can occur.

What are the signs and symptoms of the infection?
Common symptoms of glandular fever are:
  • sore throat
  • fever
  • swollen lymph nodes
  • enlarged spleen
  • fatigue
Occasionally a rash occurs, especially if a person is taking amoxycillin.

What are the causes and risks of the infection?
The disease is caused by EVB, which may stay quiet in the body long after it is acquired. People with weakened immune systems are at risk for severe disease. EVB has been associated with certain types of lymphoma and nasopharengeal carcinoma.

What can be done to prevent the infection?
EBV is spread primarily via saliva, hence the name "the kissing disease". Less commonly, it can be spread via blood transfusion. Because it is not spread through the air, isolation is not required. EBV replicates and lives in the mouth and throat for years after initial infection. Shedding of EBV by healthy individuals, through contact with salvia, accounts for most of the spread to uninfected people. Little can be done to prevent the disease apart from avoiding contact with saliva of infected persons.

How is the infection diagnosed?
A blood test can identify antibodies, or chemicals produced by the body to fight the Epstein-Barr virus. Many people, though, have such antibodies without any symptoms. Diagnosis is usually based on a combination of medical history, physical examination, and the blood test.

What are the long-term effects of the infection?
EBV is associated with certain cancers, such as Burkitt's lymphoma, oral cancer, and throat cancers, in certain ethnic groups. Very rarely, other complications of EBV include:
  • central nervous system infection, or an infection of the brain or spinal cord
  • a ruptured spleen
  • very low blood counts
  • heart infection
  • lymph nodes so swollen they cause breathing problems
  • severe infection in people with weakened immune systems
What are the risks to others?
EBV is contagious.

What are the treatments for the infection?
Otherwise healthy people are not treated for the disease unless complications occur and are encouraged to rest during the early stages. Strenuous exercise or contact sports should also be avoided during this time.

Oral corticosteroids, such as prednisone, are sometimes used to treat very large lymph nodes or tonsils that may obstruct the airway in the throat.

Paracetamol is frequently used to help reduce fever and relieve pain.

What are the side effects of the treatments?
Side effects vary according to the medication used.

What happens after treatment for the infection?
Symptoms of glandular fever can last for weeks, but usually resolve. However, EBV is sometimes fatal in people with very weakened immune systems.

How is the infection monitored?
Most cases resolve by themselves. Complicated cases will require assessment of the underlying condition.

Author: Danielle Zerr, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

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