Glandular fever (infectious mononucleosis)

Glandular fever (GF), also known as infectious mononucleosis, is a viral throat infection, which may present with creamy throat exudates.    

Caused by the Epstein-Barr virus, GF can leave a patient debilitated for months afterwards and is associated with chronic fatigue syndrome (myalgic encephalomyelitis, ME).

Glandular fever is characterised by a sore throat that grumbles on with swollen lymph glands and often also causes general malaise, fatigue, muscle aches, chills, sweats, loss of appetite and headache. The most common age group affected is between 15 and 25 years.

A severe sore throat may follow one or two weeks of general malaise. The throat may become very inflamed with creamy exudates present. There may be difficulty swallowing because of the painful throat. Glands (lymph nodes) in the neck and axillae (armpits) may be enlarged and tender.

The diagnosis can be confirmed with a blood test, although this may not become positive until the second week of the illness. If the test is negative and there is a strong suspicion of GF, it should be repeated after a further week. 

Antibiotics are of no value; in fact if ampicillin or amoxicillin is given during the infection, a measles-type rash is likely to develop in 80 per cent of those with GF. Treatment is aimed at symptomatic relief.