Differentiating acute viral nasopharyngitis from other diseases

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

Overview

Acute viral nasopharyngitis should be differentiated from other diseases that cause runny nose, cough and constitutional symptoms.

Differentiating acute viral nasopharyngitis from other diseases

Disease	History	Physical examination	Laboratory or radiological findings
Acute viral nasopharyngitis	Symptoms start with sore throat Nasal congestion and runny nose Cough that may persist after the resolution of the other symptoms Fever is not common	Nasal mucosa is congested and hyperemic Pharynx is typically normal	Diagnosis is usually clinical and lab tests are rarely needed The virus can be cultured on human lung cells but results take time PCR is rapid and accurate test but done only in immunocompromised patients when the virus strain needs to be known
Allergic rhinitis	Characterized by repeated paroxysms of rhinorrhea, sneezing and cough. Symptoms may be related to a specific season of the year, hence the name “seasonal allergies”.	Rhinorrhea fluid is usually clear and watery. Examination of the nose reveals a crease below the nasal bridge from repeated pulling of the nose secondary to irritation. Edema in the area below the eye if associated conjunctivitis is present.	Skin testing using intradermal prick skin tests to determine the specific allergens causing allergic rhinits. Serum immune assays to determine IgE levels in the serum.
Acute sinusitis	Presents with symptoms similar to URTIs (sneezing, cough and runny nose) Symptoms last for a longer time (about 10 days) with the peak of symptoms between 4th and 6th days. Usually, acute sinusitis is not associated with fever	Inspection may show erythema and edema over the involved sinus Palpation of sinuses shows tenderness to palpation Transillumination of the sinuses may show opacity.	X ray and CT may show air fluid level or bubbles in the affected sinus. Culture of the nasal secretions is of limited use in acute sinusitis as nasal secretions may be contaminated by nasal flora.
Infectious mononucleosis	Symptoms of pharyngitis: sore throat and difficult swallowing Fever Fatigue Lymphadenopathy especially in the posterior cervical region	Abdominal examination reveals splenomegaly Maculopapular rash may be present	Positive monospot test Elevated liver enzymes

Differentiating Flu and Common Cold

Symptoms	Flu	Common Cold
Fever	High fever (100-102° F)	Rare
Headache	Common	Rare
Cough	Common, moderate to severe	Mild to moderate
Body aches	Common, may be severe	Slight
Fatigue	Usual, can last up to 2-3 weeks	Sometimes
Nasal congestion	Sometimes	Common
Sneezing	Sometimes	Common
Sore throat	Sometimes	Common
Adapted from the National Institute of Allergy and Infectious Diseases (NIAID)