What is the differential diagnosis (Ddx) for acute pharyngitis (sore throat)?

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Last updated: April 13, 2025View editorial policy

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Differential Diagnosis for Sore Throat

Single Most Likely Diagnosis

  • Viral Pharyngitis: This is the most common cause of sore throat, often associated with other symptoms like cough, runny nose, and fever. It's usually self-limiting and caused by viruses such as rhinovirus, coronavirus, or adenovirus.

Other Likely Diagnoses

  • Streptococcal Pharyngitis (Strep Throat): Caused by Group A beta-hemolytic streptococcus, this condition presents with severe sore throat, fever, and swollen lymph nodes. It requires antibiotic treatment to prevent complications.
  • Influenza: Influenza virus can cause sore throat, especially during flu season, accompanied by high fever, body aches, and cough.
  • Mononucleosis (Mono): Caused by Epstein-Barr virus, mono can lead to severe sore throat, fever, fatigue, and swollen lymph nodes, often affecting adolescents and young adults.

Do Not Miss Diagnoses

  • Epiglottitis: A life-threatening condition where the epiglottis becomes inflamed, potentially causing airway obstruction. It's characterized by severe sore throat, difficulty swallowing, and shortness of breath.
  • Peritonsillar Abscess: A collection of pus behind the tonsils, which can cause severe sore throat, difficulty swallowing, fever, and a muffled voice. It requires prompt drainage and antibiotic treatment.
  • Lemierre's Syndrome: A rare but serious condition following a sore throat, characterized by jugular vein thrombosis and septicemia, often caused by Fusobacterium necrophorum.

Rare Diagnoses

  • Diphtheria: A bacterial infection causing a sore throat and a distinctive greyish membrane covering the tonsils and throat. It's rare in areas with high vaccination coverage but can be deadly if not treated promptly.
  • Gonococcal Pharyngitis: Caused by Neisseria gonorrhoeae, this condition can lead to sore throat, often without other symptoms, and is typically seen in sexually active individuals.
  • Tuberculous Pharyngitis: A rare form of tuberculosis affecting the throat, causing sore throat, difficulty swallowing, and weight loss, often in immunocompromised individuals or those from endemic areas.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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