Aetiology

• glandular fever is caused by:
  • Epstein-Barr virus - 80 to 90% of cases
  • in remaining EBV-negative cases, it may be caused by human herpes virus 6 (9%), cytomegalovirus (5% to 7%), herpes simplex virus-1 (6%) (1)
  • however, the aetiology of many EBV-negative IM cases often remains unknown (2)
  • the incubation period is about four to eight weeks (3)

EBV is most commonly transmitted through saliva, hence the name ''kissing'' disease. In one study, all patients with EBV-caused IM shed virus from the oropharynx for 6 months after the disease onset. (4)

References:

1. Gershburg E, Pagano JS. Epstein-Barr virus infections: prospects for treatment. J Antimicrob Chemother. 2005 Aug;56(2):277-81.
2. Naito T, Kudo N, Inui A, et al. Causes of infectious mononucleosis-like syndrome in adult patients. Intern Med. 2006;45(13):833-4.
3. Vouloumanou EK, Rafailidis PI, Falagas ME. Current diagnosis and management of infectious mononucleosis. Curr Opin Hematol. 2012 Jan;19(1):14-20
4. Fafi-Kremer S, Morand P, Brion JP, et al. Long-term shedding of infectious Epstein-Barr virus after infectious mononucleosis. J Infect Dis. 2005 Mar 15;191(6):985-9.