Glandular Fever
Consultation guide for UK community pharmacy: clinical features, referral criteria, time frame to resolution and management strategy.
Clinical features
- This is also known as infectious mononucleosis. Typically, the person has a fever, lymphadenopathy and a sore throat that fails to improve or becomes worse (the sore throat can be severe and encompass tonsillar enlargement and exudate. Possibly patients will experience palatal petechiae). Prodromal symptoms include malaise, fatigue, myalgia,
chills, sweats, anorexia, and headache
- Other clinical features include: splenomegaly and, less commonly, hepatomegaly and jaundice, and a non-specific rash (or a maculopapular rash following amoxicillin). It is often seen in adolescents. In those aged 40 years of age and over, it is uncommon and may present with atypical symptoms. Conversely, very young children can be asymptomatic or present with symptoms that are hard to differentiate from other viral illnesses
- A diagnosis usually includes a full blood count or blood tests (the approach may differ depending on whether the patient is an adult or child, and their immune status — see NHS or NICE guidelines for further information) and the ‘Monospot’ test
Referral criteria
- Glandular fever is not initially diagnosed or managed in an OTC context and therefore referral is required if this condition is suspected
- Other throat infections such as streptococcal sore throat can be difficult to differentiate from glandular fever (as can other viral infections including primary HIV infection, cytomegalovirus primary infection, and acute viral hepatitis). These are typically all referred too
- The person should urgently seek medical advice if they develop respiratory distress, swallowing difficulty, or abdominal pain. Also, if they have signs and symptoms of dehydration or are systemically very unwell
Time frame to resolution
- Symptom resolution takes around 2–4 weeks. However, tiredness is common and is often the last symptom to resolve. Some resources mention that it can take several months before the person feels completely well again
Management strategy
Non-pharmacological advice
- Exclusion from work or school is not necessary and to return to normal activities as soon as possible (tailoring such activities if feeling tired). Patients with glandular fever should avoid contact or collision sports or heavy lifting for the first month, to reduce the risk of the spleen rupturing
- Infection control measures are required (such as avoiding kissing, sharing utensils, and cleaning items contaminated by saliva)
- See under the ‘Referral criteria’ heading for reasons to advise the patient to seek urgent medical attention. Patients should maintain adequate hydration to prevent dehydration. This is particularly important if they have a fever
Pharmacological advice
- Following diagnosis, paracetamol or ibuprofen can be useful for symptomatic relief of pain and pyrexia