Not "wedding fever," but glandular fever!

On a normally busy day, a 16-year-old boy named Ruwan came to my clinic with his mother. Although usually a very mischievous and active boy, Ruwan was very pale that day, looking completely lifeless. He sat down in the chair very slowly, rubbing his neck with great fatigue.

"Dr. Priya, Ruwan has been feeling extremely tired and fatigued for the past two or three weeks. He also has frequent fevers. He has been complaining of a sore throat for the past two days, and his lymph nodes on both sides of his neck are swollen," Ruwan's mother explained with great concern. "We thought it was just a normal viral fever, but it doesn't seem to be getting better, Doctor."

I listened to Ruwan calmly, examined his throat and neck. Then I said, "Mom, Ruwan's symptoms don't match a normal fever. This is Glandular Fever , or what is medically known as Infectious Mononucleosis . This is a viral infection."

What is Glandular Fever?

This condition is caused by the Epstein-Barr virus (EBV) . It is also known as the "Kissing Disease" in Western countries because it is most commonly spread through saliva.

"But it's not just kissing that spreads this," I explained with a laugh. "This virus can also be spread very easily by drinking from the same glass, sharing eating utensils, or by droplets of saliva that get into the air when an infected person coughs or sneezes."

Glandular fever is most common in teenagers and young adults. 95% of adults worldwide have been infected with EBV by the age of 40, but not all of them develop glandular fever.

🚨 Red Flags that require immediate medical attention

Since glandular fever can rarely cause serious health complications, you should seek immediate hospitalization if you experience the following symptoms:

• Sudden, severe pain in the upper left part of the abdomen: This is a fatal symptom of a ruptured spleen .
• Difficulty Breathing/Swallowing: This occurs when the throat and tonsils become excessively swollen, blocking the airway.
• Yellowing of the skin or whites of the eyes: The virus causes inflammation of the liver, resulting in jaundice .
• High fever that lasts for several days.

Symptoms of glandular fever

It usually takes between 4 and 6 weeks for the virus to enter the body and for symptoms to appear. Here are the main symptoms:

• Extreme fatigue and lethargy:This is the main symptom of this disease, and it can turn into Chronic Fatigue Syndrome, which can last for weeks or months even after the disease has healed.
• Persistent fever: Usually lasts for 1-2 weeks.
• Severe sore throat: The tonsils become red and swollen, and white spots may appear on them (a condition similar to tonsillitis).
• Swollen lymph nodes: The glands in the neck, armpits, and groin become swollen and painful.
• Headache, body aches, and loss of appetite.

Diagnosis and treatment methods

1. Diagnosis

In addition to checking symptoms, the doctor will confirm the disease through the following blood tests:

• Monospot Test: Detects antibodies produced in the body against the EBV virus.
• Blood Smear: Checks for the presence of lymphocytes, an abnormal type of white blood cell that is characteristic of the disease.
• Liver Function Tests: Check for damage to the liver's function.

2. Treatment

Since glandular fever is a viral infection, there are no antiviral drugs or antibiotics that can directly kill it. Treatment is aimed at relieving symptoms:

• Complete Bed Rest: Maximum rest is necessary for the body's immune system to suppress the virus.
• Drink plenty of fluids: Drink plenty of water and fruit juices to prevent dehydration.
• Use of painkillers: Paracetamol or ibuprofen can be used to reduce fever and sore throat as directed by a doctor (never give aspirin to children under 16 years of age).

Do's & Don'ts

Scientific sources (References)

• 📚 Glandular fever - NHS
• 📚 Epstein-Barr virus and its association with disease - a review of relevance to general practice - PMC