Glandular fever, or infectious mononucleosis, is a common infection among teenagers, young adults, and college students. Symptoms include fever, sore throat, fatigue, and swollen lymph nodes and glands, and sometimes hepatitis.

It is normally caused by the Epstein-Barr virus (EBV) a highly contagious herpes virus. EBV is thought to be present in 90 to 95 percent of people worldwide, but it does not always cause symptoms, and it does not always lead to glandular fever. There is no cure, and glandular fever usually passes without treatment, but the fatigue can last for some time. Cytomegalovirurs (CMV) and rubella, or German measles, can also cause glandular fever, but the cause is not EBV and it is not mononucleosis. Toxoplasmosis can cause similar symptoms

Fast facts on glandular fever:

  • Glandular fever is usually caused by the Epstein-Barr virus (EBV).
  • EBV is a common herpes virus that many people have, often without symptoms.
  • Symptoms include a sore throat, fever, swollen glands, and fatigue.
  • The symptoms may continue for several weeks, and the fatigue may persist for several months.
  • There is no cure, and glandular fever usually passes without treatment.


Glandular fever has an incubation period of 4 to 6 weeks. In other words, symptoms appear 4 to 6 weeks after initial infection. The symptoms, and especially fatigue, may continue for several weeks.

  • flu-like symptoms, including body aches and a headache
  • A temperature of 38 degrees Celsius or above
  • A skin rash that is a widespread, red, and does not itch
  • nausea and loss of appetite
  • malaise, fatigue, tiredness, and weakness
  • swelling and puffiness around the eyes
  • sore throat
  • swelling in the lymph glands
  • swollen spleen, leading to pain in the upper abdomen
  • liver pain and jaundice


  • Most EBV infections occur during early childhood. When infection occurs, the immune system produces antibodies to fight the virus.
  • EBV infection does not always lead to glandular fever, and there may be few or no symptoms.
  • After infection, the virus will remain in the body for life, lying dormant in a number of throat and blood cells. The antibodies provide lifelong immunity, and glandular fever rarely comes back a second time.
  • Sometimes, however the virus becomes active again. This can occasionally cause symptoms, especially in a person with a weakened immune system.
  • A person who is infected with EBV during the teenage years or early adulthood is more likely to develop glandular fever. This is why most cases occur between the ages of 15 and 25 years.

How does it spread?

  • EBV is contagious. It can be passed on through contact with the saliva of a person who has the infection, for example, through coughs and sneezes and when sharing cutlery and crockery, such as cups, plates and spoons.
  • It can also be passed on through kissing, and it is sometimes called the kissing disease.
  • A person remains contagious for at least 2 months after initial infection with EBV. Some people can have EBV in their saliva for up to 18 months after infection. If they do not have symptoms, they may not know that they have the infection.
  • If a person has not been infected with EBV in the past, and they come into contact with infected saliva, they may become sick, even if the other person is not showing symptoms.
  • First, the virus will infect the lining of the inside of the throat. Then, a type of white blood cells known as B lymphocytes can spread the infection to other parts of the body, including the liver and spleen
  • A person can spread EBV if they have the infection, even if they have no symptoms. If the virus reactivates, it can also spread to others, however long it is since the original infection.

Other causes of glandular fever

  • Glandular fever may also be caused by cytomegalovirus (CMV) and rubella, or German measles. Similar symptoms may also appear in cases of toxoplasmosis, a parasitic infection.
  • Non-EBV causes of glandular fever may harm a fetus or embryo. A woman who becomes infected with any of these conditions during pregnancy may need special treatment with antibiotics and antibodies.


The doctor will carry out a physical examination to detect swollen lymph nodes and to assess the tonsils, liver, and spleen.

If the physician suspects glandular fever, they may order some tests.Two blood tests can help confirm a diagnosis:

  • An antibody test can detect specific antibodies to EBV.
  • A white blood cell test can find out whether there are more white blood cells than usual, suggesting an infection, or if white blood cells have an unusual appearance.


There is no cure for glandular fever, and most symptoms normally disappear within 4 to 6 weeks without treatment, although fatigue may persist for up to 6 months in some cases. Most people make a full recovery.

Symptoms can be controlled with:
  • Rest
  • Drinking fluids
  • Painkillers
  • Gargling
  • Steroids


Complications of glandular fever are rare, but they can be serious.They include:

  • damage to the spleen
  • A secondary infection, such as pneumonia, meningitis, or heart inflammation
  • Anemia, or a low level of red blood cells
  • A neurological condition, such as Guillan-Barre syndrome or Bell's Palsy
  • upper airway obstruction

A person with a damaged spleen should avoid contact sports such as football for 8 weeks after having glandular fever.

Secondary infections are rare, but they are a risk for patients with weakened immune systems

Studies have found that between 9 and 22 percent of patients continue to experience fatigue 6 months after infection.