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Glandular fever

Glandular; fever; young; person; kissing; disease; infectious; mononucleosis; glandular fever; infectious mononucleosis; kissing disease; Epstein-Barr; virus; Epstein-Barr; EB; tired; mono ;

The virus (germ) causing Glandular Fever (which is also called Infectious Mononucleosis or 'Mono') is very common, and almost everyone will have been infected by the time they are adults

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The virus (germ) causing Glandular Fever (which is also called Infectious Mononucleosis or 'Mono') is very common, and almost everyone will have been infected by the time they are adults. In developing countries most children get the infection before they are 3 years old. In developed countries like Australia, between 20% and 40% of people may not catch it until they are teenagers or young adults.

What causes glandular fever?

  • Glandular fever is caused by a virus called the Epstein-Barr (EB) virus.

How is it spread?

  • The EB virus is found in saliva, especially when the person is unwell, but also sometimes when they have recovered.
  • Glandular fever is spread through close contact with saliva, such as kissing, and possibly through sharing cups, toothbrushes, etc.
  • Glandular fever is not very contagious (it does not spread easily). Also many people will already have had the infection, and will not catch it from someone who is ill with glandular fever.
  • There is no need to keep someone with glandular fever away from others, they can return to school etc as soon as they feel well enough.
  • Good hygiene (including handwashing) is advised, and avoid sharing cups or glasses.
  • There is no vaccine to protect people against glandular fever.

Time it takes to develop

  • It takes about 4 to 6 weeks to develop.

Signs and symptoms

  • Usually young children, under 2 or 3 years, do not have any clear signs or symptoms of glandular fever, so you may not know they have been infected.
    • They may not be ill at all, or they may have a mild, short lasting illness which is like many of the other mild illnesses that young children have.
  • Up to 50% of older children, teenagers and adults have a typical illness, which may last several weeks (about 50% do not become unwell).
    • Usually the first symptoms are vague, and develop slowly. These may include feeling unwell, tiredness, headache, feeling sick, loss of appetite or abdominal (stomach) pain.
    • After 1 to 2 weeks the throat becomes very sore, and usually there is a fever (up to 39º ). The throat can look very red, and the tonsils become large and red and they may have white spots. They look like very bad tonsillitis.
    • Many glands swell up, in the neck, and often in other parts of the body too (eg in the armpit and groin).
    • Usually the spleen swells, and it may be tender and cause pain at the bottom of the ribs on the left side of the body. While the spleen is swollen there is a small chance of it tearing if it is hit (eg during sport).
    • Hepatitis is a usual part of the illness. Usually there is no jaundice (yellow skin and eyes), but there are changes in the liver. The hepatitis is probably why people with glandular fever feel sick, lose their appetite, and cannot drink as much alcohol as usual. Having this form of hepatitis does not protect a person from other types of hepatitis.
    • Some people with glandular fever have a red itchy rash, especially if their tonsillitis is treated with some antibiotics.
  • Most people recover fully within a couple of weeks, but they may feel tired for several weeks and sometimes for several months.
  • The illness sometimes comes back for a week or so during the first year after getting glandular fever. Although the virus remains in the body, it rarely causes illness later.
  • If a person becomes unwell again with an illness that seems like Glandular Fever, check with your doctor, because it probably is caused by something else.

Treatment

  • There is no specific treatment other than rest.
  • Drink lots of fluids. Do not worry if the child or young person does not want to eat much. Appetite will return (usually after the sore throat settles).
  • Paracetamol or ibuprofen can be given for fever or sore throat. Do not give aspirin while the child or young teenager is unwell with glandular fever.
  • Bed rest is not usually needed except if the person feels really unwell, however normal activities may need to be cut back for several weeks (especially sport, exercise and late nights).
  • Because of the possibility of a ruptured spleen, sport should be avoided while the spleen is swollen (about 2-3 weeks). Check with your doctor.
  • Slowly build back up to normal exercise levels.
  • It is very important to 'listen to your body', and rest when needed.
  • If older teenagers or adults drink alcohol when they are unwell with glandular fever, they can feel much worse than usual because of the effect of glandular fever on the liver. (The liver breaks down alcohol - glandular fever may slow this down).

What you can do

  • See a doctor early on. Blood tests are needed to be sure it is glandular fever.
  • If the person is at school or university, and may miss assignments or exams, it is important to get a medical certificate early so you can ask for special consideration.
  • Encourage the young person to rest and 'take notice of his or her body'.

Unusual complications

  • Unusual complications include meningitis and encephalitis (affecting the brain), myocarditis (affecting the heart), haemolytic anaemia (destroying red blood cells) and Reye's syndrome (a rare but very serious illness that seems caused by children using aspirin during some viral illnesses such as glandular fever).  
  • In other countries, other malignancies (cancers) have been linked with the EB virus. EB virus does not appear to be linked to these cancers in Australia.

References and further reading

Department of Health, South Australia 'Glandular fever'

Mayo Clinic (USA)
http://www.mayoclinic.com

MedlinePlus (National Library of Medicine, USA)
http://www.medlineplus.gov

National Center for Infectious Diseases (USA) 
http://www.cdc.gov/ 

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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