Differential Diagnosis for Tonsillitis and Glandular Fever

When clinically differentiating between tonsillitis and glandular fever, it's crucial to consider various diagnoses based on their likelihood and potential impact on patient health. The following categories help organize the thought process:

• Single Most Likely Diagnosis
  • Glandular fever (Infectious Mononucleosis): This is often considered the single most likely diagnosis in patients presenting with symptoms such as sore throat, fever, and lymphadenopathy, especially in young adults. The presence of atypical lymphocytes on a blood smear and positive monospot test can support this diagnosis.
• Other Likely Diagnoses
  • Bacterial tonsillitis: Caused by Group A beta-hemolytic streptococcus, this condition presents with severe sore throat, fever, and exudates on the tonsils. A rapid streptococcal antigen test or throat culture can confirm the diagnosis.
  • Viral pharyngitis: Other viruses can cause similar symptoms to glandular fever, including sore throat, fever, and lymphadenopathy, but the absence of atypical lymphocytosis and a negative monospot test can help differentiate.
• Do Not Miss Diagnoses
  • Lemierre's syndrome: A rare but potentially life-threatening condition characterized by bacterial pharyngitis followed by septic thrombophlebitis of the internal jugular vein. It's crucial to consider this diagnosis in patients with severe pharyngitis and signs of sepsis or neck pain.
  • Epiglottitis: Although more common in children, adults can also present with this condition, characterized by severe sore throat, difficulty swallowing, and shortness of breath. It requires immediate medical attention due to the risk of airway obstruction.
• Rare Diagnoses
  • Toxoplasmosis: Can mimic glandular fever in its presentation, including lymphadenopathy and fever, but is less common and typically associated with exposure to cats or undercooked meat.
  • Cytomegalovirus (CMV) infection: Similar to glandular fever in its symptoms, but more commonly seen in immunocompromised individuals or those with significant exposure risks.
  • Human Immunodeficiency Virus (HIV) acute infection: Can present with symptoms similar to glandular fever, including fever, lymphadenopathy, and sore throat, making it a rare but important consideration in the differential diagnosis, especially in high-risk individuals.

Each of these diagnoses has distinct clinical features and diagnostic tests that can help differentiate them from tonsillitis and glandular fever. A thorough clinical evaluation, including history, physical examination, and appropriate laboratory tests, is essential for accurate diagnosis and management.