What are the recommended management strategies for a patient with glandular fever experiencing severe fatigue?

Recommended management strategies for a patient with infectious mononucleosis experiencing severe fatigue include:

• Advise the patient to rest as needed and pace activities according to what they can comfortably manage, avoiding bed rest to reduce the risk of deconditioning which may prolong fatigue and recovery time.
• Encourage maintaining adequate hydration and using paracetamol and/or ibuprofen to relieve pain and fever.
• Return to normal activities should be gradual and based on energy levels; patients should avoid heavy lifting and contact or collision sports for at least 3 weeks after symptom onset to reduce the risk of splenic rupture.
• Advise that exclusion from work, school, or nursery is not usually necessary as transmission risk is low once acute symptoms resolve.
• Provide advice on infection control measures such as good hand and respiratory hygiene, avoiding kissing and sharing food or utensils.
• If fatigue persists after acute symptoms resolve, provide ongoing management advice, including pacing and energy management strategies similar to those used in chronic fatigue conditions.
• Advise avoiding excessive alcohol intake during the acute illness.
• Advise urgent medical review if signs of serious complications develop, such as upper airway obstruction, severe dehydration, or acute abdominal pain.

These recommendations are based on UK Health Security Agency guidance and expert opinion in multiple review articles, reflecting best practice in primary care management of infectious mononucleosis and its sequelae including fatigue ¹,².