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Glandular fever (infectious mononucleosis) – Causes, Symptoms, Diagnosis and Treatment

Glandular fever (infectious mononucleosis) is an acute infectious disease characterized by high temperature and lymphodenopathy. It is caused by Epstein-Barr virus (HHV-4) and is transmitted in humans through saliva by close contact and is often referred to as ‘Kissing disease’.

Glandular fever (infectious mononucleosis) is of worldwide distribution involving mainly young adults. The incubation period of it is 5-12 days. Onset is sudden with high temperature, chills, headache, malaise and sore throat. Mild conjunctivitis and stiffness of the neck may occur. Lymph glands usually in the cervical region swell rapidly and by the second or third day the glands attain a considerable size. They may be tender.

Although glandular enlargement to start with is unilateral but soon glands on the other side of neck enlarge followed by enlargement of glands in axillary and inguinal regions. There is sharp rise in temperature which is irregular. Mediastinal glands involvement may lead to paroxysmal cough, dysphagia and even pulmonary collapse. Mesenteric glands involvement leads to vomiting and pain in abdomen.

grandular fever

Throat may show congestion, exudate and local edema along with petechiae. Spleen enlarges slightly and so does liver. A transient non-itchy rash (macular, papular, petechial) may develop in some.

Complications include splenic rupture, myocarditis, benign hemorrhagic nephritis, atypical pneumonia, thrombocytopenia, auto immune haemolytic anemia mediated by 1gM antibodies (cold agglutinin disease) nerve palsies and meningitis which is benign. A few patients may remain depressed for a long time even after recovery.

Laboratory investigations

There is presence of atypical nuclear cells in the peripheral blood. Paul Bunnell test is positive. It shows the presence of Heterophile antibodies in the blood serum. Hepatic enzymes are elevated. Specific EBV 1gM antibodies are present in recent infection. The Mono spot test is a sensitive test and is diagnostic. It is performed by a commercially available kit.

Course of the disease – The course of it generally lasts for 10 days and recovery takes place. But in some it may be prolonged even up to 1 month accompanied by fresh glandular enlargement.

Exacerbations of glandular enlargement subside slowly. Very rarely petechial eruptions may accompany the clinical picture. There is fall in platelets and thrombocytes. This constitutes a rare form of Purpuric type of infectious mononucleosis.

Treatment Glandular fever (infectious mononucleosis)

Majority of cases recover without any treatment since it is a self limiting illness.

Patients who develop neurological features (encephalitis, Meningitis, Guillain barre syndrome) or with other complications should be put on corticosteroids (60 mg/day in divided doses). Prevention of it is important by ensuring hygienic measures and proper personal hygiene.

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