Why glandular fever - "the kissing disease" - is no joke

Photo: Shutterstock
Photo: Shutterstock 

My poor son has been diagnosed with glandular fever this week, so I have been able to see up close exactly how awful this infection can make you feel.

He is absolutely exhausted, finding it very hard to swallow anything and, other than keeping him supplied with a range of ice blocks, smoothies and soups, there doesn't seem to be much I can do to help.

Glandular fever (GF) is predominantly an issue for adolescents and young adults, though young children and older adults can be affected as well. The majority of cases are a result of infection with the Ebstein Barr virus (or EBV), but other viruses, such as toxoplasmosis and cytomegalovirus, can also cause it.

Interestingly, it is thought that around 90 per cent of adults have been exposed to EBV at some point in their life, probably during early childhood, and develop lifelong antibodies to it – but most of these adults will have never had any symptoms; it seems to be the unlucky ones such as my son who get exposed to it for the first time during adolescence that go on to get the illness known as glandular fever.

EBV is spread in saliva droplets, hence it used to be called the "kissing disease" (something I remember relentlessly teasing my cousin about when he got glandular fever at 16 years of age). Although kissing certainly can be a way of passing it on, anything that brings you into contact with infected saliva can also lead to infection, so coughing or sharing drink bottles and food are not a great plan if you know someone who has GF.

The symptoms and severity of GF vary and, as mentioned, many people exposed to the virus won't get any at all – but the classic ones include:

A very sore throat, with difficulty swallowing due to pain – on examination, the tonsils and the area at the back of the throat often look incredibly red, swollen and covered with white gunk, similar to the appearance of tonsillitis.

Swollen glands – typically the neck glands can get very enlarged with GF (hence the name) and may be noticeable around the side of the neck and under the jawline; other glands can be affected too, causing swelling and aching in the groin and armpits

Fevers, sweats and shivers

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Fatigue

Headaches

Muscle aches

A rash – if present, this is usually over all the body and tends to disappear quickly, within a day or less

Less commonly, GF can lead to an inflammation of the liver and spleen – this can cause abdominal pain and occasionally jaundice (a yellowing of the skin) which can last a few days, or even weeks.

As GF can mimic tonsillitis very closely, it is important to see your doctor if you are suffering from the symptoms above – if they are concerned, they will be able to do a simple blood test that will tell you if GF is the culprit.

Although it can make you feel really dreadful, the good news is that for nearly everyone GF is self-limiting, which means it goes away on its own and doesn't need any specific treatment. For an unlucky few though, it can lead to post-viral fatigue, where an overwhelming tiredness can last for many weeks, or even months, after the original infection. Once you have had GF, you shouldn't get it again – if your body develops good antibodies against EBV or one of the other viruses, it is very unlikely you will ever develop a second infection.

As it is caused by a virus, and not a bacteria, antibiotics are of no use in the treatment of GF. There isn't unfortunately any medication available at present that can remove the infection from your body (and reduce the amount of time you are going to be unwell), but that doesn't mean there aren't things that can help improve the symptoms, if you are unlucky enough to get this:

Most importantly, remain really well-hydrated – this can be difficult as swallowing is often very painful, but pushing any form of fluid is the key: ice blocks, ice cream, juices, smoothies, soups and so on, can all feel easier to get down than a big glass of water

Ensure you have adequate pain relief – this will help with the muscle aches, headache and fevers, but will also reduce the pain and swelling in the throat making drinking much easier; regular paracetamol and ibuprofen are usually sufficient, and can be prescribed in liquid form if swallowing tablets isn't possible

Rest up – as with any illness or infection, if you feel exhausted and achey, listen to your body and take some time off. Staying home on the couch for a few days is entirely justified and will reduce the risk of you passing this onto someone else at work or school

Avoid alcohol – as the liver is often inflamed in GF, staying away from any alcohol until you are completely better is a really good idea

Avoid contact sports – as well as affecting the liver, GF can cause enlargement of the spleen, which sits at the upper left side of the abdomen, close to the bottom of the ribcage; when it is enlarged, the spleen can be easily damaged by rough contact or a fall, leading to serious internal bleeding. If you have GF and normally play contact sports, I'd recommend at least three weeks off, even longer if your doctor is concerned your spleen isn't reducing back to its normal size quickly enough.

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