Lymphadenopathy in Viral and Bacterial Infections
Yes, lymphadenopathy occurs with both viral infections like EBV and bacterial infections like strep throat, though the pattern and characteristics differ between the two.
Lymphadenopathy in Streptococcal Pharyngitis (Bacterial)
Tender, enlarged anterior cervical nodes are a characteristic feature of Group A streptococcal pharyngitis. 1
- The lymphadenopathy in strep throat typically presents as tender, enlarged anterior cervical lymph nodes that are part of the classic clinical presentation. 1
- This is one of the key clinical features that helps distinguish bacterial from viral pharyngitis, though overlap exists. 2
- The nodes are usually unilateral or bilateral anterior cervical in location. 3, 4
- Acute bilateral cervical lymphadenitis is usually caused by viral upper respiratory tract infection or streptococcal pharyngitis. 3, 4
Lymphadenopathy in EBV Infection (Viral)
EBV causes acute pharyngitis that is often accompanied by generalized lymphadenopathy and splenomegaly, which is a distinguishing feature from strep throat. 1
- The lymphadenopathy in infectious mononucleosis is characteristically more generalized rather than confined to anterior cervical nodes. 5
- Generalized lymphadenopathy is often caused by viral infection, with EBV being a frequent cause. 3, 4
- The presence of more generalized lymphadenopathy, significant fatigue, and absence of cough and rhinorrhea helps differentiate EBV from bacterial pharyngitis. 5
- EBV-related lymphadenopathy occurs in 70-92% of patients with infectious mononucleosis. 5
Key Distinguishing Features
The pattern of lymph node involvement differs significantly between these two infections:
- Strep throat: Tender, enlarged anterior cervical nodes (usually unilateral or bilateral but localized). 1
- EBV: Generalized lymphadenopathy involving multiple node groups throughout the body, often with splenomegaly. 1, 5
Clinical Pitfall to Avoid
The sore throat of infectious mononucleosis may be mistaken for streptococcal pharyngitis, leading to unnecessary antibiotic treatment. 5
- The signs and symptoms of streptococcal and viral pharyngitis overlap too broadly for diagnosis to be made with certainty on clinical grounds alone. 1, 2
- Even experienced physicians cannot reliably differentiate between viral and bacterial pharyngitis based solely on clinical presentation. 2
- Microbiological confirmation with throat culture or rapid antigen detection test is required for suspected bacterial pharyngitis. 1, 2