’Kissing disease’ is not much fun to have but we have to live with it

HUMANS have at least 600 lymph nodes throughout the body and about a third of these are in the neck. When they swell up therefore, we tend to know about it.

Swollen “glands”, as we often call them, are a common symptom of viruses affecting our upper respiratory tract.

With a cold, this may be relatively mild whereas, with a bad tonsillitis, it is likely to be more significant.

However, the condition I’m featuring this week actually uses this swelling in its name. I’m talking about glandular fever, of course.

Believe it or not, there is a
90 per cent chance that anyone reading this has had glandular fever at some point.

Glandular fever is also known as “mono”, which is short for infectious mononucleosis.

This was a bit more of a technical definition based on the effect the condition has on immune cells in blood tests.

It is caused by a virus called the Epstein-Barr virus, discovered by its namesakes in 1964. (At least 90 per cent of the time this is the case anyway but there are a handful of other viruses that can produce the same “disease”. This virus can be picked up during early childhood, at which point symptoms (if there are any at all) are likely to be mild.

Once it is in your system it never leaves but instead remains dormant, a bit like chicken pox. Both chicken pox and EBV are members of the herpes virus family so that’s probably no coincidence.

For those that have managed to avoid it during childhood, when encountered later in adolescence their immune systems are caught off guard and that is when it starts producing symptoms.

One can expect fever, fatigue, swelling of the glands around the neck and sometimes a sore throat.

The classic presentation therefore occurs when someone between the ages of 15 and 25 begins to experience these symptoms, perhaps after having just started university or college.

While it is often thought of as very contagious, it is not quite as contagious as, for example, cold viruses, which can spread via the airborne route.

EBV’s mode of spread is relatively limited, through contact with an infected person’s saliva, hence the reason it is colloquially known as the “kissing disease”.

Of course, it can also spread through sharing cups and cutlery.

One of the problems in controlling this spread is the fact that it has an enormous incubation period before symptoms occur.

From the time of infection, it may take several weeks for the classic features of glandular fever to develop. Once the symptoms have settled, typically after two to four weeks, you can remain contagious for up to 18 months. No wonder most of us have had it.

As I say, many of us will remain asymptomatic (as much as 50 per cent of infections) but for those that do develop the typical features, it is not much fun.

It can often be mistaken for a bacterial tonsillitis, meaning antibiotics are prescribed. These will obviously have no effect on the condition as antibiotics don’t work on viruses but in glandular fever this combination often causes a whole-body rash to develop.

This doesn’t mean one is allergic to the antibiotic, although this is frequently assumed to be the case.

The best way definitively to find out if the condition is caused by EBV is by carrying out a blood test. This may be done if the swelling and fatigue is going on a bit longer than the average upper respiratory tract illness. If confirmed, this doesn’t make any difference to treatment as such.

The best way to manage a glandular fever is via a combination of rest, fluids, paracetamol and ibuprofen.

But sometimes the advice may need to be extended beyond that. For example, glandular fever can sometimes cause swelling in the liver, something that can be measured via testing liver enzymes in a blood sample. It is therefore not advisable to drink alcohol.

More significantly, glandular fever can cause swelling of the spleen, an organ which is essentially the headquarters of all lymph nodes, sitting in the left side of the abdomen.

Here it is quite vulnerable to trauma and during a bout of glandular fever can be prone to rupturing. That would be serious but only happens in less than one per cent of cases.

It is unlikely that someone with glandular fever will want to be particularly active but, in light of this risk, it is still worth reminding people that any physical activity or sport should be avoided for a month or so after diagnosis.

There has been a lot of talk about the longer-term effects of covid. But when it comes to the drivers of chronic fatigue, covid is merely the new kid on the block compared to glandular fever, which may be considered as the original market leader.

It is thought that about 10 per cent of those who suffer from glandular fever experience chronic fatigue lasting several months after infection.

This is obviously extremely debilitating and has knock-on effects not only on physical health but also on education, employment and on mental health. Most of those with persistent fatigue, however, are able to recover by the two-year mark.

Those who rush back to normal levels of activity may lengthen their period of fatigue but there is also a delicate balance to be achieved against resting too much. A slow, gradual stepwise approach to increasing activity levels is thought to be the best approach.

Official advice is to ensure handwashing and good hygiene measures. Considering the seemingly inevitable spread of EBV, however, this may be more relevant to hindering the spread of other conditions.

With around 95 per cent of the world population carrying EBV already, for now at least it’s one of those viruses we just have to live with.