Glandular Fever - Illnesses & Conditions - NHS Inform

01/09/2023, 20:11 Glandular fever - Illnesses & conditions | NHS inform
Glandular fever
About glandular fever
Glandular fever is a type of viral infection that mostly affects
young adults.
It is also known as infectious mononucleosis, or "mono".

Common symptoms include:
a high temperature (fever)

a severely sore throat (/illnesses-and-conditions/ears-nose-and-
throat/sore-throat/)
swollen glands (/illnesses-and-conditions/glands/swollen-glands/) in
the neck
fatigue (extreme tiredness)
While the symptoms of glandular fever can be very

unpleasant, most of them should pass within two to three
weeks. Fatigue, however, can occasionally last several
months.
Read more about the symptoms of glandular fever (/illnesses-
and-conditions/infections-and-poisoning/glandular-fever#symptoms-of-
glandular-fever) .
When to seek medical advice

You should contact your GP if you suspect that you or your
child has glandular fever.
https://www.nhsinform.scot/illnesses-and-conditions/infections-and-poisoning/glandular-fever 1/16
While there is little your GP can do in terms of treatment,

they can provide advice and support to help you control
your symptoms and reduce the risk of passing the infection
on to others.
You should go to your local accident and emergency (A&E)

department or dial 999 for an ambulance if you have
glandular fever and you:
develop a rasping breath (stridor) or have any breathing
difficulties
find swallowing fluids difficult
develop intense abdominal pain
These symptoms can be a sign of a complication of
glandular fever that may need to be treated in hospital.
Fever in adults self-help guide

Complete this guide to assess your symptoms and find out
if you should visit A&E, your GP, pharmacist or treat your
condition at home.
Self-help guide: Fever in adults


What causes 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 referred to as the "kissing
disease"
exposure to coughs and sneezes

sharing eating and drinking utensils, such as cups, glasses
and unwashed cutlery
EBV may be found in the saliva of someone who has had
glandular fever for several months after their symptoms
pass, and some people may continue to have the virus in
their saliva on and off for years.
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, but there's no need no need to avoid all contact
with others as the chances of passing on the infection are
generally low.
Read more about the causes of glandular fever (/illnesses-and-

conditions/infections-and-poisoning/glandular-fever#causes-of-glandular-
fever) .
Who is affected?
Glandular fever can affect people of all ages, but most
cases affect teenagers and young adults.
Most EBV infections are thought to occur during childhood

and cause only mild symptoms, or no symptoms at all.
However, if a person develops an EBV infection during early

adulthood, they can develop glandular fever.
Once you have had glandular fever, it is unlikely you will
develop it again. This is because people develop lifelong
immunity after the initial infection.
How glandular fever is

diagnosed
To diagnose glandular fever, your GP will first ask about
your symptoms before carrying out a physical examination.
They will look for characteristic signs of glandular fever,
such as swollen glands, tonsils, liver and spleen.
Your GP may also recommend a blood test (/tests-and-
treatments/blood-tests/) to help confirm the diagnosis and rule
out infections that can cause similar symptoms, such as
cytomegalovirus (CMV), rubella, mumps and toxoplasmosis.
How glandular fever is treated

There is no cure for glandular fever, but there are a number
of simple treatments and measures that can help reduce
the symptoms while you wait for your body to control the
infection.
These include:
drinking plenty of fluids

taking over-the-counter painkillers, such as paracetamol
(/tests-and-treatments/medicines-and-medical-aids/types-of-
medicine/paracetamol/) or ibuprofen (/tests-and-
treatments/medicines-and-medical-aids/types-of-medicine/ibuprofen/)
getting plenty of rest and gradually increasing your activity
as your energy levels improve
Occasionally, antibiotics (/tests-and-treatments/medicines-and-
medical-aids/types-of-medicine/antibiotics/) or corticosteroids (/tests-
and-treatments/medicines-and-medical-aids/types-of-
medicine/corticosteroids/) may
be used 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.
Read more about treating glandular fever (/illnesses-and-

conditions/infections-and-poisoning/glandular-fever#treating-glandular-
fever) .
Possible complications
Complications associated with glandular fever are
uncommon, but 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)
breathing difficulties as a result of the tonsils
becoming significantly swollen
a ruptured (burst) spleen, which may need to be treated
with surgery
Read more about the complications of glandular fever

(/illnesses-and-conditions/infections-and-poisoning/glandular-
fever#complications-of-glandular-fever) .
Symptoms of glandular fever

Symptoms of glandular fever are thought to take around
one to two months to develop after infection with the
Epstein-Barr virus (EBV).
Main symptoms
The most common symptoms of the condition are:
a high temperature (fever)
a sore throat (/illnesses-and-conditions/ears-nose-and-throat/sore-
throat/) – this is usually more painful than any you may have
had before
swollen glands (/illnesses-and-conditions/glands/swollen-glands/) in
your neck and possibly in other parts of your body, such as
under your armpits
fatigue (extreme tiredness)
Other symptoms
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 ooze fluid
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 mentioned above.
How the condition progresses

Most symptoms of glandular fever will usually resolve within
two or three weeks. Your throat will normally feel
most sore for three to five days after symptoms start before
gradually improving, and your fever will usually last 10 to 14
days.
Fatigue is the most persistent symptom and often lasts a

few weeks, although some people may feel persistently
fatigued for several months after the other symptoms have
passed.
When to seek medical advice

You should contact your GP if you suspect that you or your
child has glandular fever.
While there is little your GP can do in terms of treatment
other than provide advice and support, blood tests (/tests-
and-treatments/blood-tests/) may be needed to rule out less
common but more serious causes of your symptoms, such
as hepatitis (a viral infection that affects the liver).
You should go to your local accident and emergency (A&E)

glandular fever and you:

difficulties
If you have these symptoms, you may need to be looked

after in hospital for a few days.
Read more about treating glandular fever (/illnesses-and-

conditions/infections-and-poisoning/glandular-fever#treating-glandular-
fever) .
Causes of glandular fever

Glandular fever is caused by the Epstein-Barr virus (EBV).
EBV is most often spread through the saliva of someone
who carries the infection.
For example, it can be spread through:
kissing – glandular fever is sometimes referred to as the

"kissing disease"
sharing food and drinks
sharing toothbrushes
exposure to coughs and sneezes
Small children may be infected by chewing toys that have
been contaminated with the virus.
When you come into contact with infected saliva, the virus
can infect the cells on the lining of your throat.
The infection is then passed into your white blood cells
before spreading through the lymphatic system.
This is a series of glands (nodes) found throughout your

body that allows many of the cells that your immune system
needs to travel around the body.
After the infection has passed, people develop lifelong
immunity to the virus and most won't develop symptoms
again.
Many people are first exposed to EBV during childhood,

when the infection causes few symptoms and often goes
unrecognised before it eventually passes.
Young adults may be most at risk of glandular fever
because they might not have been exposed to the virus
when they were younger, and the infection tends to
produce more severe symptoms when you're older.
EBV carriers
Not everyone who can pass on EBV will have symptoms
themselves. These are known as asymptomatic carriers.
Some people can have the virus in their saliva for a few
months after recovering from glandular fever, and may
continue to have the virus in their saliva on and off for
years.
This is because the virus remains inactive in the body for

the rest of your life after you have been exposed to it. For
most people, the inactive virus won't cause any symptoms.
However, there is a chance of the virus periodically

becoming reactivated, which may mean it re-enters the
saliva. This reactivation may be without any symptoms, or
it may cause symptoms to recur for a short time.
Treating glandular fever

There is currently no cure for glandular fever, but the
symptoms should pass within a few weeks. There are things
you can do to help control your symptoms.
Fluids
It is important to drink plenty of fluids (preferably water or
unsweetened fruit juice) to avoid dehydration (/illnesses-and-
conditions/nutritional/dehydration/) .
Avoid alcohol, as this could harm your liver, which may

already be weakened from the infection.
Painkillers
Painkillers available over the counter, such as paracetamol
(/tests-and-treatments/medicines-and-medical-aids/types-of-
medicine/paracetamol/) or non-steroidal anti-inflammatory
drugs (NSAIDs) (/tests-and-treatments/medicines-and-medical-
aids/types-of-medicine/nsaids/) such as ibuprofen (/tests-and-
treatments/medicines-and-medical-aids/types-of-medicine/ibuprofen/) ,
can help reduce pain and fever.
Children under 16 years old should not take aspirin
because there is a small risk it could trigger a rare but
serious health condition called Reye's syndrome.
Regularly gargling with a solution of warm, salty water may
also help relieve your sore throat (/illnesses-and-conditions/ears-
nose-and-throat/sore-throat/) .
Rest
It is important you take plenty of rest while you recover

from glandular fever, although complete bed rest is no
longer recommended because it may make the fatigue last
longer.
You should gradually increase your activities as your energy

levels return, but avoid activities you cannot manage
comfortably.
For the first month after your symptoms begin, avoid
contact sports or activities that put you at risk of falling.
This is because you may have a swollen spleen that it is
more vulnerable to damage, and a sudden knock could
cause it to burst (rupture).
Preventing the spread of

infection
There is no need to be isolated from others if you have
glandular fever as most people will already be immune to
the Epstein-Barr virus (EBV).
You can return to work, college or school as soon as you
feel well enough. There is little risk of spreading the
infection to others as long as you follow commonsense
precautions while you are ill, such as not kissing other
people or sharing utensils.
It is also important to thoroughly clean anything that may

have been contaminated by saliva until you have recovered.
Antibiotics and steroids

Antibiotics (/tests-and-treatments/medicines-and-medical-aids/types-
of-medicine/antibiotics/) are not effective in treating glandular
fever because they have no effect on viruses, but they may

be prescribed if you also develop a bacterial infection
of your throat or lungs (pneumonia) (/illnesses-and-
conditions/lungs-and-airways/pneumonia/) .
A short course of corticosteroids (/tests-and-

treatments/medicines-and-medical-aids/types-of-
medicine/corticosteroids/) may also be helpful if:
your tonsils are particularly swollen and are causing
breathing difficulties
you have severe anaemia (a lack of oxygen-carrying red
blood cells)
you have problems affecting your heart, such as pericarditis
(inflammation of the sac that surrounds the heart)
you have problems affecting your brain or nerves, such as
encephalitis
Read more about the complications of glandular fever
(/illnesses-and-conditions/infections-and-poisoning/glandular-
fever#complications-of-glandular-fever) .
Hospital treatment
Most people are able to recover from glandular fever at
home, but hospital treatment may be necessary for a few
days if you or your child:
difficulties
Treatment in hospital may involve receiving fluids or

antibiotics directly into a vein (intravenously), corticosteroid
injections and pain relief.
In a small number of cases, emergency surgery to
remove the spleen (splenectomy) may be needed if it
ruptures.
Complications of glandular fever
Most people with glandular fever will recover in two or
three weeks and won't experience any further problems.
However, complications can develop in a few cases. Some

of the main complications associated with the condition are
described below.
Prolonged fatigue
More than 1 in every 10 people with glandular fever will
experience prolonged fatigue, which lasts for six months or
more after the initial infection. It is not known why fatigue
lasts longer in some people.
Some experts think it may be a form of chronic fatigue
syndrome (CFS) (#) . This is a poorly understood condition
that causes persistent fatigue and a range of other
symptoms, such as headaches (#) and joint pain.
Adopting a gradual exercise plan to rebuild your strength
and energy levels may help prevent and reduce prolonged
fatigue.
Reduction in blood cells
In a few cases, glandular fever can lead to a reduction in

some blood cells. It can reduce levels of:
red blood cells (anaemia) – this can make you feel tired and
out of breath
white blood cells (neutropenia) – this can make you more
prone to developing a secondary infection
platelets – this can make you bruise and bleed more easily
In most cases, the reduction in the number of blood cells is
small and only causes mild symptoms. These problems
should get better by themselves within a few weeks or
months.
Ruptured spleen
Around half of people who develop glandular fever will
have a swollen spleen. This does not present any
immediate health problems, but there is a small risk of it
rupturing (bursting).
The main sign of a ruptured spleen is sharp pain in the left

of the tummy (abdomen).
Go to your local accident and emergency (A&E)

glandular fever and you develop intense abdominal pain.
The risk of the spleen rupturing is small, occurring in just 1
in every 500 to 1,000 cases of glandular fever, but it can be
life threatening because it may cause severe internal
bleeding.
In some cases, emergency surgery may be required to

remove an enlarged or ruptured spleen (splenectomy).
A ruptured spleen usually occurs as a result of damage

caused by vigorous physical activities, such as contact
sports.
It is therefore very important to avoid these activities for at
least a month after the symptoms of glandular fever begin.
Be particularly careful during the second and third week of
your illness, as this is when the spleen is most vulnerable.
Neurological complications
In less than 1 in every 100 cases, the Epstein-Barr virus (EBV)
can affect the nervous system and trigger a range of
neurological complications, including:
Guillain-Barré syndrome – where the nerves become
inflamed, causing symptoms such as numbness,
weakness and temporary paralysis
Bell's palsy – where the muscles on one side of the face
become temporarily weak or paralysed
viral meningitis (/illnesses-and-conditions/infections-and-
poisoning/meningitis/) – an infection of the protective
membranes that surround the brain and spinal cord;
although unpleasant, viral meningitis is much less serious
than bacterial meningitis, which is life threatening
encephalitis – an infection of the brain
These complications will often need specific treatment, but
more than four out of every five people with them will make
a full recovery.
Secondary infection
In a small number of cases, the initial infection weakens

your immune system and allows bacteria to infect parts of
the body. This is called a secondary bacterial infection.
Possible secondary infections that can develop during
glandular fever include serious conditions such as
pneumonia (/illnesses-and-conditions/lungs-and-airways/pneumonia/)
(infection of the lung) and pericarditis (infection of the sac
that surrounds the heart).
Secondary infections usually occur in people who have a

very weak immune system, such as people with HIV or AIDS
(/illnesses-and-conditions/immune-system/hiv/) , or those
having chemotherapy (/tests-and-treatments/non-surgical-
procedures/chemotherapy/) .
If you have a weakened immune system and you develop

glandular fever, as a precaution you may be referred to
hospital for specialist treatment. This will allow for your
health to be carefully monitored and any secondary
infections to be treated.
Source: NHS 24
Last updated:
29 May 2023

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01/09/2023, 20:11 Glandular fever - Illnesses & conditions | NHS inform

It is also known as infectious mononucleosis, or "mono".

a high temperature (fever)

While the symptoms of glandular fever can be very

When to seek medical advice

While there is little your GP can do in terms of treatment,

You should go to your local accident and emergency (A&E)

Fever in adults self-help guide

Self-help guide: Fever in adults

What causes glandular fever?

exposure to coughs and sneezes

Read more about the causes of glandular fever (/illnesses-and-

Most EBV infections are thought to occur during childhood

However, if a person develops an EBV infection during early

How glandular fever is

How glandular fever is treated

drinking plenty of fluids

Some people with particularly severe symptoms may need

Read more about treating glandular fever (/illnesses-and-

Read more about the complications of glandular fever

Symptoms of glandular fever

a general sense of feeling unwell

a tender or swollen tummy

Some of these symptoms may develop a few days before

How the condition progresses

Fatigue is the most persistent symptom and often lasts a

When to seek medical advice

You should go to your local accident and emergency (A&E)

develop a rasping breath (stridor) or have any breathing

If you have these symptoms, you may need to be looked

Read more about treating glandular fever (/illnesses-and-

Causes of glandular fever

kissing – glandular fever is sometimes referred to as the

This is a series of glands (nodes) found throughout your

Many people are first exposed to EBV during childhood,

This is because the virus remains inactive in the body for

However, there is a chance of the virus periodically

Treating glandular fever

Avoid alcohol, as this could harm your liver, which may

It is important you take plenty of rest while you recover

You should gradually increase your activities as your energy

Preventing the spread of

It is also important to thoroughly clean anything that may

Antibiotics and steroids

fever because they have no effect on viruses, but they may

A short course of corticosteroids (/tests-and-

Treatment in hospital may involve receiving fluids or

However, complications can develop in a few cases. Some

Reduction in blood cells

In a few cases, glandular fever can lead to a reduction in

The main sign of a ruptured spleen is sharp pain in the left

Go to your local accident and emergency (A&E)

In some cases, emergency surgery may be required to

A ruptured spleen usually occurs as a result of damage

In a small number of cases, the initial infection weakens

Secondary infections usually occur in people who have a

If you have a weakened immune system and you develop

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