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.[1]
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.[2]
Thrush
- 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
Mononucleosis
- 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
- 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
- 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.
References
- ↑ Vincent MT, Celestin N, Hussain AN (2004) Pharyngitis. Am Fam Physician 69 (6):1465-70. PMID: 15053411
- ↑ Del Mar CB, Glasziou PP, Spinks AB (2006) Antibiotics for sore throat. Cochrane Database Syst Rev (4):CD000023. DOI:10.1002/14651858.CD000023.pub3 PMID: 17054126