Some Infectious Causes and Features of Sore Throat
Cause | Common Features* | Diagnostic Approach† |
|---|---|---|
Viral tonsillopharyngitis (infection of the tonsils and throat caused by a virus) | Usually mild to moderate throat pain and little or no fever Usually a runny nose and/or cough Throat and tonsils that are slightly to very red and that may be coated with a white discharge or pus Sometimes one or two enlarged lymph nodes in the neck | A doctor’s examination alone |
Often severe throat pain and fever Rarely a runny nose or cough Often a very red throat and tonsils that are coated with a white discharge or pus Usually one or two tender, enlarged lymph nodes in the neck | Testing of a sample taken from the throat with a swab | |
Mononucleosis (caused by the Epstein-Barr virus) | Often moderate to severe throat pain, high fever, and constant fatigue but no cold symptoms Usually in adolescents or young adults who have never had mononucleosis Often a very red throat and tonsils, coated with a white discharge or pus Typically many enlarged lymph nodes on both sides of the neck and sometimes an enlarged spleen detected during a doctor's examination | A blood test for antibodies to Epstein-Barr virus |
Severe throat pain, often fever, and no cold symptoms Sometimes a muffled voice that sounds as if a hot object is being held in the mouth ("hot potato" voice) Throat and tonsils that may be slightly to very red Typically substantial swelling on one side of the throat, detected during the examination | Usually removal of pus with a needle (for diagnosis and treatment) Sometimes CT of the neck | |
Epiglottitis‡ (infection of the epiglottis—the small flap of tissue that covers the opening to the voice box, or larynx) | Severe throat pain and difficulty swallowing that begin abruptly In children, often drooling and signs of severe illness (such as little or no eye contact, failure to recognize parents, and irritability) Sometimes (more often in children) respiratory symptoms, including
A throat that typically appears normal seen during the examination with a laryngoscope (however, examination can be dangerous and may not be advisable) | For most children and for adults who appear seriously ill, flexible fiberoptic laryngoscopy (insertion of a thin flexible tube into the throat to directly view the epiglottis), done in operating room Sometimes for people who do not have all the symptoms of epiglottitis and who do not appear seriously ill, x-rays of the neck |
* 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. | ||