Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
For a patient with a suspected or confirmed diagnosis of glandular fever, you should consider referring for specialist evaluation in several scenarios, ranging from emergency admissions to urgent reviews for complications or persistent symptoms.
Emergency Hospital Admission:- Arrange emergency hospital admission if the patient has signs of upper airway obstruction, such as stridor and respiratory distress NICE CKS,NICE CKS. This includes suspected upper airway obstruction with symptoms like stridor, signs of superior vena cava obstruction, or dysphagia with aspiration NICE CKS.
- Arrange emergency hospital admission if the patient has signs of severe dehydration that cannot be managed in primary care NICE CKS,NICE CKS. This may include extreme tonsillar hypertrophy and dehydration NICE CKS.
- Arrange emergency hospital admission if there is a suspected serious or life-threatening complication, such as peritonsillar abscess, splenic rupture, or sepsis NICE CKS,NICE CKS.
Advise the patient to seek urgent medical review if they develop clinical features of a potentially serious complication, such as:
- Signs of upper airway obstruction NICE CKS,NICE CKS.
- Difficulty swallowing fluids or signs of severe dehydration NICE CKS,NICE CKS.
- Severe systemic illness NICE CKS,NICE CKS.
- Acute upper abdominal pain, which may indicate acute hepatitis or splenic rupture NICE CKS,NICE CKS.
Consider specialist referral if:
- Lymphadenopathy persists or grows progressively after 7 days, as this may indicate non-infective swelling or abscess formation NICE CKS.
- Lymphadenopathy has not resolved after 2–4 weeks, in which case an urgent referral to an ear, nose, and throat (ENT) surgeon for further investigation may be appropriate NICE CKS.
- There are clinical features of a malignant primary tumour of the head and neck; arrange urgent referral using a 2-week suspected cancer pathway NICE CKS.
- There is unexplained generalised lymphadenopathy in children and young people; offer a very urgent full blood count (within 48 hours) to assess for leukaemia NICE CKS,NICE NG12.
- There is unexplained lymphadenopathy or splenomegaly; consider arranging referral using a 2-week suspected cancer pathway to exclude a diagnosis of lymphoma, particularly for adults aged 25 years or more, or within 48 hours for children and young people up to and including 24 years of age NICE CKS,NICE NG12.
- For children and young people with unexplained lymphadenopathy or splenomegaly accompanied by fever, night sweats, pruritus, or weight loss, consider a very urgent referral (within 48 hours) for specialist assessment for non-Hodgkin's lymphoma or Hodgkin's lymphoma NICE NG12.
- For children and young people with persistent fatigue, unexplained fever, or unexplained persistent infection, offer a very urgent full blood count (within 48 hours) to assess for leukaemia NICE NG12.