Some Infectious Causes and Features of Sore Throat

Viral tonsillopharyngitis

Usually rhinorrhea and/or cough

Pharyngeal and tonsillar erythema, sometimes with exudate

Sometimes one or two enlarged cervical lymph nodes

Sometimes no fever and/or only mild or moderate throat pain

History and physical examination alone

Strep throat

Often severe throat pain and fever

Rarely rhinorrhea or cough

Marked pharyngeal and tonsillar erythema with exudate

Usually tender cervical lymphadenopathy

Throat swab rapid antigen detection test (RADT)

Throat culture

Infectious mononucleosis

Often high fever and constant fatigue without other upper respiratory infection symptoms

Usually in adolescents or young adults

Marked pharyngeal and tonsillar erythema with exudate, tonsillar enlargement

Bilateral cervical lymphadenopathy and sometimes splenomegaly

Serology; heterophile antibody test

Sometimes measurement of Epstein-Barr–specific antibodies

Abscess (eg, parapharyngeal)†

Severe throat pain, trismus, odynophagia, and sometimes drooling

Characteristic "hot potato" voice

Pharyngeal and tonsillar erythema

Peritonsillar swelling with uvular deviation

Needle aspiration and culture

Sometimes CT with contrast or another imaging test

Epiglottitis†

Sudden severe throat pain and odynophagia

Usually occurs in children age 2 to 6

Often drooling, tachypnea, stridor

Sometimes tripod position (sitting upright and leaning forward with neck tilted back and jaw thrust forward)

Absence of pharyngeal and tonsillar erythema, exudates, and swelling

Flexible fiberoptic laryngoscopy done in the operating room

Sometimes lateral neck radiographs