Pharyngitis differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [2]

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Overview

Pharyngitis should be differentiated from other infectious causes which mimic sore throat that includes oral thrush, infectious mononucleosis, epiglottitis and peritonsilar abscess.

Differentiating Pharyngitis from other Diseases

The major goal of the differentiating patients with sore throat or acute pharyngitis is to exclude potentially dangerous causes (e.g. Group A streptococcus), to identify any treatable causes, and to improve symptoms. Identifying the treatable causes is important because timely treatment with antibiotics helps prevent complications such as acute rheumatic fever, post streptococcal glomerulonephritis.

Thrush	Mononucleosis	Epiglottitis	Peritonsillar abscess
Thrush is caused by candidal infection Dysphagia without odynophagia which will differentiate it from pharyngitis. White plaques that reveal an erythematous base when scraped Usually in immunocompromised patients, including those with advanced HIV/AIDS	Mononucleosisis caused by infection with Epstein-Barr virus The infection is spread by person-to-person contact via oropharyngeal secretions Usually, it presents with a classic triad of severe sore throat accompanied by fever and lymphadenopathy Other symptoms and signs include the following: Fatigue Diffuse lymphadenopathy, particularly bilateral and posterior cervical Splenomegaly in 50% of cases Hepatomegaly in 10% of cases Pharyngeal petechiae Rash: 90% of patients will develop a pruritic, maculopapular rash after the use of ampicillin or amoxicillin	Epiglottitis is an inflammation of the epiglottis and adjacent structures that can be life-threatening In the past, it was an emergency in children, caused by Hemophilus influenzae, but with the use of vaccinations the epidemiology and etiology have changed. In adults, epiglottitis has widely varying presentations and symptoms: Odynophagia (most commonly) Fever, toxicity Dyspnea, respiratory distress Dysphagia Drooling Dysphonia Inspiratory stridor The classic tripod positioning (patient sits or stands leaning forward and supporting the upper body with hands on the knees), is seen only in 5% of cases If epiglottitis is suspected, immediate referral to the emergency department for airway management Diagnosis requires laryngoscopy When the patient has respiratory distress, airway management is required with prompt intubation	Peritonsillar abscess is a collection of pus behind the tonsil in the superior arch of the soft palate May be a complication or progression of another oropharyngeal infection, such as tonsillitis Could be polymicrobial, but the most common bacteria is group A streptococci Symptoms include fever, malaise, dysphagia, drooling, muffled or 'hot potato' voice, and referred ear pain Diagnosis is a combination of physical examination and imaging with computed tomography (CT) or ultrasonography Management requires urgent referral to an ear, nose, and throat specialist or surgeon for surgical drainage, in addition to antibiotic treatment.