Glandular fever

Borders Ref Help Toolkit
NHS Borders

It is commonly seen in children and young adults and is caused by the Epstein Barr virus(EBV).

History

  • Symmetrical throat pain
  • Fever
  • May have nasal obstruction due to acute adenoiditis
  • May have abdominal pain due to mesenteric adenitis

Clinical findings

  • Inflamed tonsils
  • White membranous exudate over the tonsils
  • Generalised lymphadenopathy, may be severe in neck and may have splenomegaly

 

Who to refer, who not to refer, how to refer

Send to Emergency Department if unable to take adequate fluid intake despite analgesia and single dose of steroids.

If a patient is felt to require admission for glandular fever they should be sent to ED with an accompanying letter and a brief email sent to ENT@borders.scot.nhs.uk

Primary care management

Tests

  • FBC - Lymphocytosis
  • Atypical lymphocytes in the peripheral blood film
  • Monospot test +ve
    • Do Monospot rather than EBV serology which is slower to get results and more expensive to do           
  • Liver function tests may have abnormalities - normally aspartate aminotransferase (AST) and alanine aminotransferase (ALT)

Management

  • Paracetamol and/or ibuprofen to relieve pain and fever symptoms
  • Hydration
  • Avoid amoxicillin which can cause erythema multiforme and in severe cases- Stevens-Johnson syndrome (SJS)
  • Consider a single dose of prednisolone 40mg for pain
  • Advise to avoid contact sport for one month due to the small risk of splenic rupture
  • Advise against doing anything that could result in the spread of the virus by saliva

Resources and links

Glandular Fever Patient UK Information Leaflet

Infectious mononucleosis (glandular fever) | Health topics A to Z | CKS | NICE

Local service details

ENT@borders.scot.nhs.uk

Editorial Information

Last reviewed: 18/09/2025

Next review date: 18/09/2027

Author(s): Esmond Carr.

Author email(s): Esmond.carr@borders.scot.nhs.uk.