Glandular fever – patient advice and red flags
See below for an evidence-based overview of information that should be given to patients with glandular fever along with a summary of potential complications and red flags. You can also access our more in-depth course to update your knowledge on glandular fever symptoms and diagnosis.
As glandular fever has an underlying viral cause, medically there is little a clinician can offer. Information should be provided to patients on this so they can self-manage their symptoms as much as possible.
Two separate Cochrane systematic reviews concluded that there was a lack of evidence for the effectiveness of antivirals and oral steroids in the management of glandular fever, therefore neither are recommended.1.2
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Table 1: Glandular fever management summary: information to give to patients.3,4
Explain the expected course of the illness. Although symptoms usually last for 2–3 weeks, tiredness may persist after the other symptoms have resolved, sometimes for months.
Advise patients to seek urgent medical advice if they:3
Although glandular fever is in many cases a self-limiting illness there are complications associated with it. Providing or signposting to patient information leaflets can inform patients of complications to be aware of.
Table 2: Glandular fever complications and red flags.3,5,6
When is secondary care referral indicated in glandular fever?
Glandular fever can be mainly managed in primary care.
However, the Clinical Knowledge Summaries advise, based on SIGN guidance and textbook recommendations that referral into secondary care should be for immediate admission if a patient with suspected or confirmed glandular fever presents with stridor, dehydration or difficulty swallowing fluids, suspected splenic rupture or a suspected potentially serious complication, as outlined above.3
Glandular fever: patient advice and red flags – References
- De Paor M, et al. Antiviral agents for infectious mononucleosis (glandular fever). Cochrane Database of Systematic Reviews, 2016.
- Rezk E, et al. Steroids for symptom control in infectious mononucleosis. Cochrane Database of Systematic Reviews, 2015.
- Glandular fever (infectious mononucleosis). Clinical Knowledge Summaries, 2020
- Glandular fever. NHS website, 2020
- Rogers ME. Acute Infectious Mononucleosis: A Review for Urgent Care Physicians. American Journal of clinical medicine2012, 9(2), 88-91.
- Epstein-Barr Virus and Infectious Mononucleosis. For Healthcare Providers. Centers for Disease Control and Prevention, 2020.