Glandular fever diagnosis

[WhisperingAngelisnotbad]

DS is 17 - almost no longer a child! and has had tonsillitis really badly on and off since the beginning of April.

He has had methoxy benzylpenicillin and clavulomycin and then had the return of symptoms again.

He has felt extremely poorly, had enlarged lymph nodes in his neck and had red inflamed tonsils with white patches of pus visible. Low grade pyrexia 37.8.

Last time we saw his GP she thought he might have glandular fever and sent off tests.

Meanwhile, DS, who is supposed to be revising, sneaks off to a teenage beach party, has a drink or two and winds up being taken unconscious to A and E, where he spends the night (nothing like that ever happened before). Eeek.

Also "look mum, strange rash!"

Rash and reduced alcohol tolerance can be features of glandular fever.

His sixth form college are very interested in the possible glandular fever diagnosis and I also want to know whether to demand that he stays teetoal all summer.

However the blood tests are equivocal. They show evidence that he has been infected with EBV but not the marker of very recent infection (presumably IgM).

However, he had been ill for 5 or 6 weeks before the blood tests were taken, and Ig M can dissipate in that time.

I am trying to get the actual figures for the tests, does anyone have any experience or expertise in this sort of situation.

EBV IgM goes down and is replaced by IgG quite rapidly (as little as three weeks). Symptomatically (and age wise) everything would fit with glandular fever. It could also be primary CMV infection (related virus, can cause glandular fever like symptoms in some young adults but much less likely than EBV).

With either virus, they mess up your liver enzymes (which the GP can test) and staying off alcohol for another six weeks is a good plan. Liver enzymes return to normal after roughly 12 weeks from symptom onset, possibly quicker.

On IgM figures - every lab will have its own specific positive and negative cutoff and they aren't portable - there's no international standard (which does exist for PCR).

Many thanks that is really helpful. Poor lad, having to be teetotal for his 18th birthday and the end of A levels and all the parties at the end of term etc

Another six weeks will be end of June - if he's already six weeks in to symptoms. So fine by start of July.

The A level term finishes a bit early. Mind you, he was quite scared by what happened so I think he will tread carefully.

I had glandular fever right at the end of my a-levels and was ill in bed for weeks. I was so unwell that my doctor told me that I mustn’t drink alcohol for 18 months!! My liver and kidney markers hadn’t been great while I was ill so I suspect that’s why. I stuck to it even though the last 6 of those months were my first 6 months at uni. It was hard, but I believe it would have caused me a lot more problems if I’d ignored the advice.

FWIW the 12 week figure for liver enzymes to normalise comes from a scientific paper, and it can vary person to person.

One other thing - has a GP or anyone else checked his spleen? If that's swollen (you can feel for yourself once a healthcare professional shows you how), he would need advice from his GP about contact sports (rugby, martial arts, even gymnastics).