Differentiating acute viral nasopharyngitis from other diseases

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, such as influenza, allergic rhinitis, and acute sinusitis.

Differentiating acute viral nasopharyngitis from other diseases

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

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 resolution of the other symptoms. Fever is not common.	Nasal mucosa is congested and hyperemic. Pharynx is typically normal.	Diagnosis is usually clinical; lab tests are rarely needed. The virus can be cultured on human lung cells, but it takes time. PCR is rapid and accurate, but is done only when the infecting virus strain in immunocompromised patients 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 discharge is usually clear and watery. Examination of the nose reveals a crease below the nasal bridge, formed 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 skin prick tests to determine the specific allergens causing allergic rhinitis. 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 a peak between the 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. Transillumination of the sinuses may show opacity.	X-ray and CT may show air fluid level or bubbles in the affected sinuses. Culture of the nasal secretions is of limited use in acute sinusitis, as may be contaminated by nasal flora.
Infectious mononucleosis	Symptoms are like the symptoms of pharyngitis, which include: Sore throat and difficulty 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	Rare, 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)