I can still remember Julie having teething trouble as a baby. It was hard to believe all those years had gone by and she was now starting a science course. During her orientation week she came to the surgery looking pale and exhausted.
She had had a sore throat for a few days and felt very sweaty at night. She was not eating much and looked as if she had lost some weight. Her voice sounded quite different and she seemed to be having trouble swallowing her saliva. The whole throat was very reddened and the tonsils were covered with a yellow-white exudate. The glands in her neck were swollen, and she also had tender glands in the armpits and groin.
I explained that she probably had glandular fever and that a blood test would be necessary to confirm the diagnosis. The blood test done the same morning was positive. Her liver function tests were also abnormal, suggesting that she had a mild hepatitis associated with the glandular fever.
Julie was advised to rest and take paracetamol for her sore throat. Although she felt very tired for a couple of weeks, her other symptoms gradually settled. She missed the first week of lectures but was soon back enjoying her course.
Glandular fever is a fairly common viral infection. As the name suggests, it is characterized by fever and enlargement of the lymph glands. It is often seen in adolescents and tends to cause great anguish amongst the parents of VCE students, perhaps more than it should. It is commonly believed that patients with glandular fever are troubled by prolonged tiredness and lack of energy. Whilst this happens occasionally, a full recovery is more often the case.
The proper name for glandular fever is Infectious Mononucleosis, or IMN for short. The mononucleosis part describes the particular white cells that are seen when a sample of blood is looked at under the microscope. A specific virus called the Epstein-Barr virus is responsible for the infection and various antibody tests will confirm the diagnosis. It occurs in all parts of the world and can affect people of all ages, including children. For every confirmed case of glandular fever there are two or three milder cases that go undiagnosed.
Glandular fever used be referred to as the "kissing disease". Although close personal contact like kissing does increase the risk of transferring the infection, it also spreads when saliva is sprayed around by coughing and sneezing. There is an incubation period of a few weeks between coming into contact with the virus and developing the infection. A very sore throat is a common presenting symptom of glandular fever. There may be flecks of white matter on the tonsils and it may be impossible to distinguish from acute tonsillitis. Other symptoms include headaches, muscular aches and pains, sore joints and sometimes a rash. A fever is usually present and there might be enlarged lymph glands in the armpits and groin. At times the spleen is also enlarged.
A rash with glandular fever may be due to the viral infection itself or a reaction to various types of penicillin. Because the throat can look similar to tonsillitis, quite a few patients are initially given antibiotics. Amoxycillin and Ampicillin are two types of penicillin that frequently cause a rash in the presence of glandular fever. For this reason, other antibiotics are usually prescribed for tonsillitis. The rash may not signify a true allergy, just a one-off reaction because the person happened to have glandular fever. However, with any rash, the medication should be stopped and the reaction reported immediately to the treating doctor.
There are several blood tests that can help to confirm the diagnosis of glandular fever. However, the tests are often negative early in the illness and may need to be repeated the following week. Usually glandular fever runs a fairly uncomplicated course, with most people recovering fully after a few weeks. There may be a hepatitis episode related just to the glandular fever. A temporary arthritis with painful joints can also occur. Occasionally the throat may be so inflamed that eating and drinking is not adequate and hospitalization becomes necessary. More serious complications like anaemia and injury to the spleen can occur but are very uncommon. There is no real treatment for glandular fever. Paracetamol and saltwater gargles may provide some relief. Rest also helps, especially early in the illness.
It was once thought that glandular fever was related in some way to chronic fatigue syndrome. No direct association has been established; it is just one of many infections that occasionally goes on to cause symptoms of chronic fatigue. Despite much that has been said to the contrary, glandular fever is not a condition that tends to relapse and recur.