Mononucleosis – Causes, Symptoms & Treatment

Glandular fever

Mononucleosis , or infectious mononucleosis , is an infectious disease that is very common. The main symptoms caused by the Epstein-Barr virus (EBV) are swelling of the lymph nodes and fever .

What is glandular fever?

As a rule, glandular fever is a very common, harmless viral disease. It is caused by the Epstein-Barr virus. The infection can easily be detected via the blood count. According to estimates, over 90% of the population is infected by the age of 30 with glandular fever.

At least in children up to the end of the 10th year, glandular fever runs its course without any major symptoms. Older people have flu-like symptoms, which are rarely accompanied by complications. Typical symptoms of glandular fever can include: swollen lymph nodes , sore throat or tonsillitis , dizziness and disorientation. The viruses therefore attack the organs of the lymphatic pharyngeal ring. The liver, heart and spleen can also be affected.


The transmission of the causative agent of glandular fever occurs primarily via the saliva. Other transmission routes can be the so-called contact, droplet or smear infection. Since the main transmission is therefore from mouth to mouth, glandular fever is also known as “kissing disease”, “student disease”.Once you have been infected with the pathogen, it remains in the body for life, as with other herpes infections. Even after an outbreak of glandular fever or after the disease has ended, the virus can still be transmitted to non-immune people via saliva. Even after the disease has completely healed, the infected person can always have symptoms again. This renewed outbreak of the disease can be detected at any time by a corresponding blood count.

Symptoms, Ailments & Signs

Since the period from infection to the onset of the disease in glandular fever is very long, the typical symptoms only appear late. There is a difference between the symptoms in adults and those in children. Since children’s immune systems are not yet fully developed and therefore do not react so strongly to the virus, they often remain completely symptom-free.

In contrast, adults are much more affected by the effects. You suffer from tiredness and a general feeling of illness , feel weak and exhausted. This weakness can last for a long time before it is recognized as a sign of illness. Unpleasant sore throat , accompanied by redness of the throat and difficulty swallowing are possible.

Sometimes the lymph nodes swell and the patient becomes feverish . In the further course, additional, but individually completely different, symptoms can occur. There are patients in whom the disease causes hepatitis ; recognizable by the yellowing of the skin and the sclera of the eyes.

The spleen can also be affected and become swollen as a result . In isolated cases, a nodular rash appears that is raised and spreads in patches on the skin. Rare complications in the form of paralysis and inflammation of the meninges only occur when the virus affects the nervous system.

course of the disease

The incubation period for glandular fever in children is seven to thirty days. In adults, this time can be anywhere from four to seven weeks.

Glandular fever usually begins with fever , body aches and tiredness , i.e. with relatively “normal” cold symptoms . The lymph nodes swell (possibly also under the armpits and groin) and the tonsils become inflamed.

Typical of glandular fever is the dirty gray coating on the tonsils, which causes a putrid bad breath . In addition, some sufferers also have hoarseness and speech disorders.

The illness usually lasts a few weeks, in the rarest of cases this can also extend to 1-2 months. If the disease is asymptomatic, fatigue and persistent weakness can occur over a period of a few months to two years .


The complications that can occur with mononucleosis are diverse but rare. They can also be treated for the most part, but may necessitate hospitalization. This is different for people with a weakened immune system (especially children). Here the disease can take a severe or fatal course.For example, swelling of the liver or spleen can occur. Both are painful when touched and limit the function of the affected organs. Excessive exertion and dislocations should be avoided if the spleen is swollen, as they can lead to a rupture of the spleen. Jaundice can also occur.

Inflammation of the lungs, heart muscles or kidneys can occur and usually require treatment. Inflammation of the kidneys and heart in particular harbors a risk of destroying vital tissue and can accordingly cause consequential damage.

Anemia or a reduced blood platelet count is possible. This exacerbates the debilitating phase of the disease and bleeding (nosebleeds, bleeding from injury, etc.) can be harder to control. The aim here is to avoid exertion and injuries.

Inflammation of the brain can also occur. It requires special medical attention because it can affect the nerves – and thus the motor and cognitive abilities of the person affected.

When should you go to the doctor?

If the child has swollen lymph nodes, a sore throat, or a high fever, a doctor should be consulted. The doctor can make a diagnosis based on the number of white blood cells and, if necessary, start treatment immediately. Medical advice is particularly important in the case of increasing symptoms that cannot be alleviated by home remedies and bed rest. If glandular fever does not go away on its own, the pathogen must be treated with medication. The doctor can also prescribe fever suppositories and other aids.

The glandular fever is treated by the family doctor or pediatrician or a specialist in internal medicine. If the Epstein-Barr virus has spread to the respiratory tract, the ear, nose and throat specialist must be involved in the treatment. Depending on whether complications occur, inpatient treatment may also be necessary. With appropriate drug treatment, the symptoms should subside within a few days to weeks. If this is not the case, the doctor must be informed. Parents should consult a doctor simply because of the risk of infection.

Treatment & Therapy

Unfortunately, there is no specific medication for the treatment of glandular fever . In any case, it is necessary to drink a lot of fluids, as is generally recommended for fever illnesses. Antipyretics and, in any case, plenty of time to rest are also helpful.

In some cases, a bacterial infection can also occur, which must be treated with antibiotics . In general, it is important to contact a doctor who decides on the intake. In general, care should be taken to ensure that the doctor does not prescribe any broad-spectrum antibiotics such as amoxicillin or ampicillin . These can cause widespread skin rashes with itching all over the body. This rash can also develop up to three days after taking the antibiotic. The rash can take up to two weeks to clear up and is sometimes very painful. This is not an allergy, but “only” an overreaction.


Mononucleosis is a protracted disease. Follow-up care includes rest and regular check-ups by the doctor. Patients should recover for at least four to six weeks. If the course is positive, the doctor should be consulted weekly. The responsible internist or general practitioner takes care of the aftercare.

The doctor will draw blood from the patient and perform a physical exam. Follow-up care also includes an anamnesis to clarify open questions and to assess the current state of health of the patient. After glandular fever has been cured, no further follow-up examinations are usually necessary.

If complications arise, medical advice is required. The doctor will first check typical symptoms such as yellow skin and increased body temperature in order to determine or rule out involvement of the internal organs. Hospitalization may be required afterwards. If the course is complicated, further follow-up examinations by the responsible specialists are necessary.

The doctor must examine the internal organs to rule out organ damage and concomitant diseases. Depending on the cause of glandular fever, further doctor’s appointments must be made after the aftercare. The cause of the condition must be identified and resolved before treatment can be completed.

Outlook & Forecast

The prospects of a complete cure are very good for glandular fever. As a rule, the disease heals within two to three weeks without any complications or consequential damage. In people whose immune system is weakened, e.g. B. by an HIV infection or after an organ transplant, but there is an increased risk of a course with complications.

Possible consequential damage is inflammation of the heart, liver, kidneys or brain. There is a risk of additional infections with bacteria or viruses, which worsen the prognosis. In very rare cases, the enlarged spleen may rupture. This is an emergency that requires immediate surgery. Lymphomas develop in some cases in immunocompromised individuals. These are tumors that develop from altered white blood cells and that can later become malignant.

After a previous infection with glandular fever, antibodies against the Epstein-Barr virus form. As a rule, there is lifelong immunity after the first infection. However, reinfection in immunocompromised people is quite possible. In order to avoid reinfection, contact with sick people should be avoided. Since the infection only occurs through direct contact, the risk of reinfection can be reduced.

You can do that yourself

The primary supportive therapy for mononucleosis is bed rest when the fever flares occur. Physical rest gives the body the strength it needs to fight off viruses. Good results in reducing fever can be achieved by using calf wraps .

In the case of sick people in general, and children in particular, it is important to ensure that they drink enough fluids and eat easily digestible food during the infection. In addition to the fever episodes, patients often experience severe sore throats. These can be relieved by gargling with sage tea or warm salt water.

Furthermore, inhaling chamomile flower tea can have a positive effect on sore throats. If bacterial angina develops from the sore throat, a doctor must be consulted, since antibiotics are then indicated. Severe headaches and body aches can be counteracted with commercially available painkillers. However, patients must ensure that the painkiller used is not based on acetylsalicylic acid. Bleeding could occur here.

After the symptoms of the disease have subsided, patients should rest physically for four to eight weeks. Lifting heavy loads during this time is particularly dangerous because it can easily rupture the spleen. In general, there is a risk of injury to the spleen if physical exertion occurs too early.

Lisa Newlon
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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.