Glandular fever

Symptoms of glandular fever 

Glandular fever is caused by the Epstein-Barr virus (EBV).

Symptoms take about one to two months to develop after infection with the virus.

The most common symptoms of the condition include:

• a high temperature (fever)
• a sore throat – this is usually severe, but in an older adult, or very young child, the infection may be present without a sore throat
• swollen glands (lymph nodes) in your neck and possibly in other parts of your body, such as under your armpits
• fatigue (extreme tiredness)

Glandular fever can also cause:

• a general sense of feeling unwell
• aching muscles
• chills
• sweats
• loss of appetite
• pain around or behind your eyes
• swollen tonsils and adenoids (small lumps of tissue at the back of the nose), which may affect your breathing
• the inside of your throat to become very red and there may be a whitish coating
• small red or purple spots on the roof of your mouth
• a rash
• swelling or ’puffiness’ around your eyes
• a tender or swollen tummy
• jaundice (yellowing of the skin and whites of the eyes)

Some of these symptoms may develop a few days before the main symptoms.

While the symptoms of glandular fever can be unpleasant, most of them should pass within two to three weeks.

Fatigue, however, can occasionally last several months.

When to seek medical advice

You should contact your GP if you think you or your child has glandular fever, or has a sore throat that is not improving.

They can provide advice and support to help you control your symptoms and reduce the risk of passing the infection on to others.

Go to your nearest emergency department, or call 999 for an ambulance if you have glandular fever and you:

• develop a rasping breath (stridor)
• have any difficulty breathing
• develop a severe abdominal pain

You should see your GP or call the GP out of hours service if:

• trouble swallowing fluids is making you dehydrated
• you have abdominal pain (though this can occur with other viral infections that cause a sore throat)
• you become very unwell

These symptoms can be a sign of a complication of glandular fever that may need to be treated in hospital.

Treating glandular fever 

There is no cure for glandular fever. However, there are simple treatments and measures that can help reduce the symptoms. These include:

• drinking plenty of fluids
• taking over-the-counter painkillers, such as paracetamol or ibuprofen
• getting plenty of rest and gradually increasing your activity as your energy levels improve

Occasionally, if your GP thinks this is necessary, other treatments may be needed if you develop complications of glandular fever.

Some people with particularly severe symptoms may need to be looked after in hospital for a few days.

How glandular fever is diagnosed 

To diagnose glandular fever, your GP will first ask about your symptoms and examine you.

Your GP may also recommend a blood test to confirm the diagnosis.

It can also help rule out infections that can cause similar symptoms, such as:

• cytomegalovirus (CMV)
• rubella
• mumps
• toxoplasmosis

Causes of glandular fever

Glandular fever is caused by the Epstein-Barr virus (EBV).

This virus is found in the saliva of infected people and can be spread through:

• kissing – glandular fever is often called the "kissing disease"
• exposure to coughs and sneezes
• sharing eating and drinking utensils, such as cups, glasses and unwashed cutlery

If you have EBV, it's a good idea to take steps to avoid infecting others while you are ill, such as not kissing other people.

How the condition progresses

In most people, the disease usually lasts two to three weeks.

The sore throat is usually severe for three to five days and then gets better over the next seven to 10 days.

Most symptoms tend to get better in two to four weeks. However, 20 per cent of people have a persistent sore throat at four weeks.

Fatigue is common and usually lasts for a few weeks

Up to 10 per cent have persistent fatigue that may last several months (most people with persistent fatigue recover within two years).

Possible complications 

Complications with glandular fever are not common. However, when they do occur they can be serious.

They can include:

• further infections of other areas of the body, including the brain, liver and lungs
• severe anaemia (a lack of oxygen-carrying red blood cells)
• difficulty breathing as a result of the tonsils becoming significantly swollen
• a ruptured (burst) spleen, which may need to be treated with surgery

More useful links

• Glandular fever
• How to use your health services