Glandular fever

Also called Infectious mononucleosis, Epstein-Barr virus, Mono

A viral infection whose fatigue outlasts everything else. And there are two things you must not do while you have it.

What it is

Glandular fever is caused by the Epstein-Barr virus, which most people catch at some point. Caught in childhood it usually passes as a mild illness; caught in adolescence or early adulthood it causes the full syndrome.

The acute illness lasts two to four weeks. The fatigue commonly lasts two to three months and sometimes longer, and a minority go on to develop ME/CFS.

Two practical rules matter more than anything else in this entry.

Do not take amoxicillin or ampicillin. Given during glandular fever they cause a widespread rash in the large majority of people, which is frightening and gets wrongly recorded as a penicillin allergy for life.

And do not play contact sport or lift heavily for at least a month. The spleen enlarges and can rupture, which is a life-threatening emergency.

Signs you might notice

Severe sore throat, often with enlarged tonsils covered in white exudate.

Swollen glands in the neck, armpits and groin.

High fever, headache, and profound fatigue.

An enlarged spleen, causing discomfort in the upper left abdomen.

Sometimes jaundice, or a rash.

Sudden severe pain in the upper left abdomen or the left shoulder tip may be splenic rupture. That is a 999 call.

How it can affect day-to-day life

The fatigue is the part that disrupts life, and it is chronically underestimated by schools, universities and employers who expect a return after a fortnight.

Students in particular are affected during exam periods and need formal adjustments rather than sympathy.

Pushing through the fatigue is the commonest mistake and it prolongs recovery. Graded, patient return works; heroics do not.

Supporting someone well

Avoid contact sport and heavy lifting for at least four weeks, and longer if advised. Splenic rupture is rare and catastrophic.

Never take amoxicillin or ampicillin during it, and make sure any rash from those is recorded accurately rather than as an allergy.

Rest properly in the acute phase, and return to activity gradually rather than all at once.

Keep fluids up; the sore throat makes drinking difficult and dehydration is common.

Get formal adjustments at school, university or work, and be realistic about a two to three month recovery.

If fatigue persists beyond six months with post-exertional malaise, ask about ME/CFS.

Where to get help

A GP can diagnose with a blood test.

Difficulty breathing or swallowing because of swollen tonsils needs urgent assessment.

Severe abdominal or left shoulder pain is a 999 call.