Some Infectious Causes and Features of Sore Throat
Cause | Common Features* | Diagnostic Approach† |
|---|---|---|
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 | Clinical 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 | Sometimes a rapid antigen detection test (RADT) Sometimes throat culture |
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 Bilateral cervical lymphadenopathy and sometimes splenomegaly | 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 |
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 x-rays | |
* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present. † Although a doctor's examination is always done, it is mentioned in this column only if the diagnosis can sometimes be made by the doctor's examination alone, without any testing. ‡ These causes are rare. | ||
CT = computed tomography. | ||