Glandular Fever (Infectious Mononucleosis)

By Dr Megan Yap - PaediatricianGeneral13 May 2019


This is a common infection and one that has a pretty bad reputation.  The offending microbe is the Epstein Barr Virus (or “EBV”) and it is spread by contact with infected saliva (hence it has been known historically as the “kissing disease”).  Interestingly, the vast majority of people will be infected with this virus during their lifetime, but only about HALF of them will actually develop symptoms that is recognisable as glandular fever (or its other name, “infectious mononucleosis” – this is the name that doctors use when they are trying to make themselves sound smarter ;D ).  When the infection occurs in young children (often by contact with saliva on toys or on the hands of shared carers) the symptoms are often mild or absent. Most people who develop symptoms are older children, adolescents or adults.

Symptoms and Diagnosis

So how do we know if someone has glandular fever?  Well, your doctor (usually your GP) will take a history and do an examination. If there is suspicion of glandular fever, the infection can be proven with a blood test.  The symptoms that might indicate EBV infection are:

  • Sore throat with exudate (deposits of fluid) around the tonsils and back of the throat
  • Feeling unwell and tired
  • Fever
  • Enlarged lymph nodes (lymphadenopathy)
  • Enlargement of the spleen (splenomegaly) – this occurs in about half of cases
  • Jaundice (yellow discolouration of the skin and eyes) – this affects approximately four per cent of people with glandular fever.

Incubation and infectious period

It takes 4-6 weeks for symptoms to develop in an individual after they have been exposed.  The time that a person remains infectious to others is actually unknown. The virus can be shed in the saliva for a whole YEAR after a person has been infected and then again, intermittently thereafter.  Exclusion from day care/kindy or school is sensible whilst the child is feeling unwell, but not necessary thereafter.


Like most viruses, there is no specific treatment or medication to treat EBV.  The management of the condition is to alleviate symptoms like sore throat, fever and headache (eg with medications like paracetamol). It is important to rest during the active phase of this illness, and sometimes some children will have a somewhat protracted course of feeling tired and fatigues for some weeks afterwards.  In some children, where the sore throat is particularly troublesome, sometimes it is necessary for a short admission to hospital to achieve adequate pain relief and hydration – especially with those children who are unable to drink due to throat pain.


Unfortunately you cannot be immunised or vaccinated against EBV.  If you have been exposed to it earlier in life, your body will have some immunity to further infection. This doesn’t necessarily mean you won’t still get sick if you kiss someone who has it, but it does mean you might have a slightly less severe disease, or your immune system will be more able to fight it off.  Otherwise:

  • Don’t allow children to share drinking and eating utensils
  • Disinfect items that are soiled with nasal secretions or saliva (eg hankerchiefs, toys, clothing)


So moral of the story is (as in many infectious situations):  WASH YOUR HANDS, don’t share drink bottles/cups/eating utensils with other people and try to minimise your tendency to pash random strangers or drink their saliva  ;D.  Ha ha ha ha!!!  I know. Too gross.


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Until next time!

Stay well!!


xxDr Megs

For more articles from Dr Megan Yap visit her blog – “Dr Megs – Paeds & Feeds” at


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