Glandular fever

Glandular fever (also known as infectious mononucleosis) is a common illness of childhood that presents with headache, fever, sore throat, fatigue, & enlarged lymph nodes. It is caused by infection with Epstein-barr virus.

EBV (Epstein-Barr virus) is a virus that is part of the herpesvirus family of viruses and which causes a number of different types of diseases (including infectious mononucleosis) but also linked with other diseases including cancers.Between 90-95% of adults show evidence of previous infection with EBV which demonstrates how common this condition is.

Symptoms

Most patients have mild symptoms with sore throat, tonsillitis and fever.  Some patients develop fever with enlarged lymph nodes but without a sore throat.  Fatigue usually settles within 1 month but can persist for 6 months in 13% of patients.

An enlarged spleen is found in over half of patients and this gradually settles after 3 weeks from the onset of symptoms. Very rarely the spleen can rupture, this is a serious complication but only occurs in 0.1-0.2% of patients and this is usually in the second week after onset of symptoms.

A rash that disappears on pressing (the glass test) or with fine spots can sometimes be seen. It is important to consider more serious infections such as sepsis in this situation. Sometimes a rash appears after the administration of a penicillin such as ampicillin or amoxicillin. This can occur in 70-90% of patients.

Complications

Neurological problems can occur and if they do it is usually 2 – 4 weeks after the initial infection. Other organs (eg liver, heart, chest and kidneys) can also be involved.

Prognosis

Most patients have an uneventful course with most symptoms settling within 2 weeks. The risk of splenic rupture falls significantly after the fourth week from the onset of symptoms but fatigue can be a an ongoing problem in 11% of patients at 6 months. Very rarely EBV infection is associated with the development of malignancies such as lymphoma (and others).