Symptoms of Glandular Fever
The symptoms of glandular fever vary widely between individuals, depending on their age, immune response, and overall health. Glandular fever, also known as infectious mononucleosis, most commonly affects teenagers and young adults, though people of any age can contract the virus. While some individuals may experience only mild symptoms or none at all, others endure a more severe and prolonged illness that interferes with daily life.
The disease is caused primarily by the Epstein-Barr virus (EBV) and triggers an intense immune reaction. This reaction is responsible for many of the hallmark signs, which include fatigue, swollen glands, and a sore throat. Recognising the full spectrum of symptoms allows for early diagnosis, appropriate care, and the prevention of complications.
Typical Onset
The incubation period for EBV is approximately four to six weeks. During this time, the virus replicates and spreads within the body, often without producing any symptoms. Once the immune system begins to respond, symptoms emerge rapidly and may persist for several weeks.
In many cases, the illness begins with general malaise, including:
Mild fever
Muscle aches
Loss of appetite
Headache
Low energy or sleepiness
These early signs can mimic other common viral infections, making initial diagnosis difficult.
Core Symptoms
Once fully developed, glandular fever typically presents with a characteristic trio of symptoms:
1. Sore Throat
The sore throat associated with glandular fever is usually severe and can:
Last for more than a week
Resemble bacterial tonsillitis
Include red, inflamed tonsils with white or grey patches
Make swallowing difficult and painful
In some cases, the tonsils become so enlarged that they obstruct the airway or cause voice changes.
2. Swollen Lymph Nodes
Enlargement of lymph nodes is a key sign and occurs particularly in:
The neck
The armpits
Occasionally the groin
These glands may feel tender and firm, and they can persist for several weeks even after other symptoms subside.
3. Fatigue
Profound fatigue is perhaps the most debilitating symptom. It can:
Begin suddenly and worsen quickly
Persist for weeks or even months
Be accompanied by sleep disturbances, mental fog, or difficulty concentrating
Even after other symptoms improve, fatigue may linger and affect academic performance, work productivity, and overall quality of life.
Additional Symptoms
In addition to the classic triad, individuals may also experience:
Fever: Typically low to moderate, but occasionally higher than 38.5°C
Chills and night sweats
Muscle and joint pain
Headaches
Loss of appetite
Nausea or mild abdominal pain
In some cases, the liver and spleen become inflamed, leading to:
Tenderness in the upper abdomen
Mild jaundice (yellowing of the skin or eyes)
Enlarged spleen (splenomegaly), increasing the risk of rupture
The presence of liver and spleen involvement makes it crucial to avoid contact sports or heavy lifting for at least four weeks.
Skin Rash and Antibiotic Reactions
Some individuals develop a maculopapular rash, which is:
Flat or slightly raised
Pink or red in appearance
Usually non-itchy
This is more likely to occur if the person has taken certain antibiotics, particularly amoxicillin or ampicillin, which can trigger an allergic-looking rash in people with EBV.
The rash is not harmful and usually disappears within a few days, but its appearance can be alarming if unexpected.
In Children
Children infected with EBV often display:
Very mild symptoms
Brief fever or irritability
Mild throat inflammation
In many cases, the infection goes unnoticed, and the child develops lifelong immunity without ever being diagnosed.
In Older Adults
Glandular fever is less common in older adults, but when it occurs, symptoms may be:
Atypical or less pronounced
Mistaken for flu, hepatitis, or other infections
Associated with jaundice and liver enzyme abnormalities
Fatigue and weakness may persist longer in older individuals, especially if underlying conditions are present.
Timeline of Symptoms
| Timeframe | Common Symptoms |
| Week 1 | Fatigue, sore throat, mild fever |
| Week 2 | Enlarged lymph nodes, severe sore throat |
| Weeks 3–4 | Fatigue, lingering fever, swollen glands |
| Weeks 5+ | Residual fatigue, occasional mild symptoms |
When to Seek Medical Advice
Medical attention is advised if:
Breathing or swallowing becomes difficult
Abdominal pain or fullness is felt under the ribs (may suggest spleen enlargement)
Symptoms last longer than four weeks without improvement
There is concern about jaundice or rash after antibiotics
Severe fatigue interferes with daily life
Symptoms of Glandular Fever
Most cases of glandular fever resolve on their own with time and rest. However, severe or persistent symptoms may indicate complications or require further investigation.
Understanding the symptoms of glandular fever helps with early identification, proper care, and safe recovery. While most people recover fully, patience is often required to cope with the extended fatigue phase.
