Glandular fever, more commonly known as the kissing disease because it seems directly related to the kiss of an infected partner, is most likely to occur among girls in the 15 to 25 year age group.
It is also most likely to affect those from high-income families and those who have had a strict upbringing.
This is because children who are exposed to a mass of germs in infancy are more likely to contract the virus which causes this disease and gains immunity.
Of course, it is possible to get glandular fever in other ways. But it is established now that the higher the standard of living, the less likely it is for a person to come into contact with the everyday plethora of germs in childhood. And this mightn’t be a good thing, for one child’s immunity can, therefore, be much less than the kid down the road, whose standards of hygiene might not be as high.
Contact with germs – all sorts of germs – in early life will often incite a normal body reaction. This can then give life-long protection against those infecting organisms, whether they be viruses (the popular kind), or bacteria, or whatever.
Kissing disease is the colloquial term given to glandular fever. Doctors term the illness “infectious mononucleosis”.
Initially, the germs abound in the mouth and throat. In an infected person, they are in the saliva in high concentrations. In this way they spread rapidly to another person by direct contact.
The virus quickly attacks the throat lining and produces three characteristic symptoms. These are a high temperature, a sore throat, and swollen, painful glands under the jaw.
It can take from 7 to 49 days from the moment of infection for symptoms to become established.
Often, the person feels off-color, the tongue white and coated, the tonsils (if they are still there) may swell and be coated with pus. There is an unpleasant breath and the mouth feels gluggy.
The general symptoms of any feverish illness soon set in. There is a feeling of general malaise, excessive fatigue, headaches, and probably aches and pains in the large muscles of the back and limbs. The thought of food becomes revolting. There is nausea, sweating, and often tenderness of the tummy region.
Sometimes the spleen and maybe the liver become affected. These can swell, giving general discomfort in the abdominal region, and often these organs can be felt as they protrude below the lower margin of the ribs. Sometimes the liver involvement is considerable and its tubes and canals become blocked causing a yellowing of the skin, called jaundice.
Sometimes there may be a red rash. This is more likely to occur if the patient is given the antibiotic named ampicillin.
Fortunately, serious complications are fairly uncommon, but they can occur. Earlier this year, the New England Journal of Medicine claimed there had been 20 deaths reported due to this virus. But considering the number of cases occurring, this figure is extremely small. Actually, the frequency is between two and six cases for every 10,000 people. Compared to coughs and colds, it is fairly uncommon and serious consequences are unlikely.
Nevertheless, some patients, particularly young women, seem to have nervous problems. Depression is common. Sometimes the germ manages to get to the brain and a viral encephalitis can occur. This may be severe enough to cause partial paralysis of the nerves that supply the face and a dropping eyelid may follow. This has been known to persist for months or even years afterward.
But for the majority, the complaint simply lingers on, causing general misery and discomfort.
Coming when the patient is at school or university, or is becoming accustomed to a new job, is not a very convenient time. But this is when it often occurs.
Treatment is purely symptomatic. Bed rest, analgesics and antipyretics (tablets to reduce fevers and lessen pain) are usually given. Fluids help to remove germs and toxins from the system.
Vitamins probably help and many doctors give these in the hope they will augment the body’s normal healing reaction and immune system. They may or may not help – nobody is certain. Antibiotics are useless and ampicillin recently came under question for producing fiery, red skin rashes in glandular fever patients. Now, it is definitely on the “outer”.
Diagnosis is usually firmly established by a blood test called the Paul Bunnell test and simple variations of this can give a definite diagnosis in a few minutes. Sometimes, the doctor will examine a film of the patient’s blood under the microscope and discover a certain type of blood cell which is typical of the disorder.
Although doctors believed glandular fever was caused by a virus, it was not until that two doctors, Dr. M.A. Epstein and Dr. Y.M. Barr, claimed they had discovered it. It is now known as the Epstein-Barr, or E.B. virus.
Dr. Barr gave an up-to-date report of the virus in “Lancet,” a well known British medical magazine. “Natural primary infection with E.B. virus generally occurs in childhood, but usually does not cause symptoms in this age group,” he stated. “These are always accompanied by permanent, total immunity.”
Dr. Barr also explained the mystery of the kissing business. “The relationship of outbreaks of I.M. (glandular fever) to kissing, among young people has long been recognized. It is explained by the ingestion by previously uninfected individuals, when kissing, of large doses of E.B. virus shed orally by seropositive healthy subjects (that means people with the germ but without symptoms), who have never shown signs of their original primary infection.”
It all sounds a bit ominous in the language of the scientist, but in reality many cases are fairly simple and mild. A person has to be unlucky to get a really serious attack.