Pharyngitis differential diagnosis
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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
- 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 byH 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 done by an ear, nose, and throat specialist
- 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
Viral Causes
Viral pharyngitis, the most common cause of sore throat, has a wide differential.[1]
Bacterial Causes
Arcanobacterium haemolyticum is a rarely diagnosed cause of acute pharyngitis and tonsillitis that tends to occur in adolescents and young adults. The symptoms of infection with this organism closely mimic those of acute streptococcal pharyngitis, including a scarlatiniform rash in many patients. A. haemolyticum infection should be suspected in patients with these findings in whom the throat culture is negative for group A streptococci.[3] A. haemolyticum produces a membranous pharyngitis that can be confused with diphtheria.
References
- ↑ 1.0 1.1 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
- ↑ Bisno AL (2001) Acute pharyngitis. N Engl J Med 344 (3):205-11. DOI:10.1056/NEJM200101183440308 PMID: 11172144