Glandular Fever
Glandular fever, also known as infectious mononucleosis or simply mono, is a viral illness most commonly caused by the Epstein-Barr virus (EBV). Glandular fever typically affects teenagers and young adults, although it can occur at any age. It spreads primarily through saliva, earning it the informal name “the kissing disease,” though transmission can also happen through coughing, sneezing, or sharing utensils.
The condition is usually mild but can be prolonged and exhausting, with symptoms lasting for several weeks. In rare cases, complications can occur, especially if rest and proper care are not observed. Understanding glandular fever helps individuals manage the illness appropriately and avoid spreading the virus to others.
What Is Glandular Fever?
Glandular fever is a viral infection that triggers a strong immune response, resulting in:
Fever
Sore throat
Swollen lymph nodes
Severe fatigue
The illness is caused by the Epstein-Barr virus, a member of the herpesvirus family. Once a person contracts EBV, the virus remains in their body for life in a dormant state. In most cases, it does not reactivate or cause further illness.
How It Spreads
The virus spreads through bodily fluids, particularly saliva. Common ways people catch glandular fever include:
Kissing someone infected
Sharing drinks, food, straws, or cutlery
Being exposed to droplets from coughs or sneezes
Contact with contaminated objects (e.g. toothbrushes, lip balm)
EBV is highly contagious during the active phase of infection, especially when symptoms are present. However, the virus can be transmitted even before symptoms begin and for months afterward.
Who Is at Risk?
Glandular fever most commonly affects:
Teenagers and young adults aged 15–25
University students or young professionals in close living or social environments
People with weakened immune systems, who may experience more severe illness
In children under five, infection with EBV usually causes mild or no symptoms, which is why many adults test positive for past exposure without remembering being ill.
Common Symptoms
The hallmark symptoms of glandular fever usually appear four to six weeks after exposure and include:
Fever, often mild to moderate but occasionally high
Severe sore throat, sometimes mistaken for bacterial tonsillitis
Swollen lymph nodes, especially in the neck and armpits
Profound fatigue that can last for weeks
Headache
Muscle aches
Loss of appetite
Swollen tonsils, sometimes with white or grey coating
Mild rash, especially if the person has taken antibiotics such as ampicillin or amoxicillin
Some individuals also experience:
Enlarged spleen or liver
Abdominal discomfort
Nausea or jaundice
Fatigue can be debilitating, lingering for several weeks or months even after the main symptoms have resolved.
Incubation and Duration
After infection, there is an incubation period of approximately 4 to 6 weeks. The acute illness phase typically lasts 2 to 3 weeks, but fatigue and reduced stamina can persist for:
Up to two months in most people
Three months or more in a small percentage
Proper rest and recovery are key to minimising prolonged symptoms.
Diagnosis
Doctors often suspect glandular fever based on:
A combination of clinical symptoms
The patient’s age and lifestyle
Physical examination findings such as swollen glands and enlarged tonsils
Confirmation may include:
Monospot test, which detects heterophile antibodies (most useful after the first week of illness)
Full blood count, showing atypical lymphocytes
Liver function tests, often mildly abnormal in active infection
EBV serology, which can determine whether the infection is recent or past
Diagnosis is typically clinical, and additional testing is only necessary if symptoms are unclear or prolonged.
How It Differs from Other Illnesses
Glandular fever is frequently mistaken for:
Streptococcal tonsillitis
Flu or COVID-19
Cytomegalovirus (CMV) infection
Toxoplasmosis
HIV (in early seroconversion)
The distinguishing feature of glandular fever is its combination of sore throat, swollen glands, and extreme fatigue that lasts well beyond the usual viral illness duration.
Is Glandular Fever Serious?
In most cases, glandular fever resolves on its own with proper rest and hydration. However, it can become serious if complications develop, such as:
Ruptured spleen (rare but life-threatening)
Airway obstruction due to severe tonsil swelling
Hepatitis or elevated liver enzymes
Prolonged fatigue resembling chronic fatigue syndrome
Anaemia or thrombocytopaenia
For this reason, individuals are advised to avoid contact sports or heavy lifting for at least four weeks after diagnosis to reduce the risk of spleen rupture.
Long-Term Outlook
Most people recover fully from glandular fever and do not experience further problems. The body develops lifelong immunity to EBV, so reinfection is extremely rare.
However, EBV remains in the body for life in a dormant form. In very rare cases, reactivation can occur, especially in people with compromised immune systems.
Understanding glandular fever helps individuals manage the condition safely and prevent unnecessary complications. With rest, fluids, and time, most people return to full health.
