Not "wedding fever," but glandular fever!

It was a typical day at the clinic. That morning, a 16-year-old boy, Ruwan , came in with his mother. Although usually a mischievous and energetic boy, Ruwan was pale and lifeless that day. He sat up slowly from his chair, rubbing his neck, and letting out a tired sigh.

“ Dr. Priya , Ruwan has been feeling very tired for weeks. He also has frequent fevers. Now he says he has a sore throat and swollen lymph nodes in his neck,” his mother explained. “We thought it was just a high fever, but this one doesn’t look like anything.”

I nodded in agreement with their idea. "Let's check him out and see what's wrong."

After a little testing, I explained that Ruwan's symptoms were consistent with glandular fever, or infectious mononucleosis. This is a viral disease. It is caused by the Epstein-Barr virus ( EBV ). It is also called the " kissing disease " because it is spread through saliva.

“But it doesn't happen from kissing,” I explained with a laugh. “It can also be spread by sharing drinking glasses, eating utensils, or even by being near someone who has the virus and they cough or sneeze.”

Glandular fever mainly affects adolescents and young adults, but most people will contract the virus at some point in their lives.

Research findings: About 95% of adults worldwide have been infected with the EBV virus by the age of 40. However, not everyone develops glandular fever.

What are the symptoms?

Ruwan's mother shook her head as I recounted the main symptoms:

• Fatigue : Often felt very bad. It can last for weeks or months.
• Fever: Usually low-grade, but persistent.
• Sore throat : Tonsils may become swollen and red, and may have white spots, similar to tonsillitis.
• Swollen lymph nodes: The glands in the neck, armpits, and groin may become swollen.
• Nasal congestion and swelling: There may be swelling around the eyes.
• Headache: A common symptom.
• Enlargement of the spleen or liver : This is rare, but can occur in severe cases.

“These symptoms explain why Ruwan is having such a hard time,” I said. “The fatigue is often the hardest thing.”

How is glandular fever diagnosed?

To make sure of this, I asked for a blood test. “We’re looking for abnormal white blood cells and antibodies to EBV,” I explained.

Key diagnostic features:

• Mononucleosis Spot Test: Checks for specific antibodies to EBV.
• Blood Smear: Checks for abnormal lymphocytes that are characteristic of EBV.
• Liver Function Tests: Check for inflammation of the liver.

Research findings: A 2020 study found that the monospot test is about 70-90% accurate. However, it doesn't work as well for young children.

How long does glandular fever last?

Ruwan's mother asked, looking a little scared. "How long will it take for him to get better?"

I reassured him that most symptoms would improve in 2-3 weeks, but the fatigue could last for months. “That’s why we say get plenty of rest and don’t rush to get well,” I said.

Chronic glandular fever is rare, but if symptoms persist, it can sometimes lead to conditions like chronic fatigue syndrome.

Research findings: A study published in the Journal of Infectious Diseases found that about 12% of people with the disease experienced fatigue for more than six months.

How common is this problem?

I explained that glandular fever is a more common illness than most people think. “Most people get the EBV virus at some point, but not everyone gets glandular fever. If they do, it usually happens in adolescence or young adulthood.”

Research findings: According to the Centers for Disease Control and Prevention (CDC), about 25% of adolescents and young adults who are infected with the EBV virus develop symptoms of glandular fever.

Are there any risks?

“Is this dangerous?” Ruwan's mother asked.

“Normally not,” I said. “But if not taken care of properly, complications can occur.”

Possible complications:

• Spleen rupture: Rare, but serious. Occurs when the spleen becomes enlarged.
• Liver inflammation: In severe cases, jaundice may develop.
• Secondary infections: Things like throat infections caused by bacteria.
• Autoimmune reactions: Rare conditions such as hemolytic anemia.

Research findings: About 0.1-0.2% of people with glandular fever develop a ruptured spleen. This usually happens within the first 3 weeks of the illness. A case study published in the British Medical Journal suggests that to reduce this risk, people should avoid strenuous activity until their illness has resolved.

What are the treatments?

“Since it’s a viral disease, there’s no cure,” I explained. “Treatment is to reduce the symptoms and help the body recover quickly.”

Things to do:

• Rest: is the most important thing.
• Drink plenty of water: Drink fluids like water and fruit juice.
• Painkillers: Take things like paracetamol and ibuprofen to reduce fever and sore throat.
• Gargle: Gargle with salt water or dissolved aspirin to relieve sore throat.

Things not to do:

• No alcohol: It can damage the liver.
• Avoid heavy lifting: Avoid doing such activities for at least 4-6 weeks to prevent damage to the spleen.
• Don't work too hard: it will take longer to get better.

Ruwan's mother listened carefully. "We'll take good care of him, we won't let him work," she said.

How can this be prevented?

Because the EBV virus spreads so easily, it can be difficult to prevent. But you can reduce your risk with these tips:

• Do not share items: Do not share eating and drinking utensils, cutlery, etc. with someone who is sick.
• Wash your hands well: Do things like washing your hands and cleaning surfaces regularly.
• Maintain a good immune system: Eat well and sleep well. This will reduce your chances of getting sick.

Research findings: A study published in Clinical Infectious Diseases found that good hygiene practices can reduce the risk of EBV transmission by about 30%. This is especially important in homes with young children.

How Ruwan is recovering

Two weeks later, Ruwan came back for a checkup. He was still tired, but he didn't have a fever, and his sore throat had improved. "I rested well, just like the doctor said," he told me.

“Come on, that’s how it’s supposed to be,” I replied. “If you stay like this for a few more days, you’ll be able to run and jump well again.”