What are the differential diagnoses for streptococcal (strep) pharyngitis in a pediatric (peds) patient?

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Last updated: April 25, 2025 • View editorial policy

Differential Diagnosis for Strep Throat in Pediatric Patients

Single Most Likely Diagnosis

  • Viral Pharyngitis: This is the most common cause of sore throat in pediatric patients, often presenting with similar symptoms to strep throat but usually without the severe pain and fever.

Other Likely Diagnoses

  • Influenza: Can cause pharyngitis and should be considered, especially during flu season.
  • Mononucleosis (Mono): Caused by Epstein-Barr virus, it can present with sore throat, fever, and lymphadenopathy, similar to strep throat.
  • Adenovirus: Can cause pharyngoconjunctival fever, presenting with sore throat, fever, and conjunctivitis.

Do Not Miss Diagnoses

  • Epiglottitis: A medical emergency that can present with severe sore throat, difficulty swallowing, and respiratory distress. It's less common but critical to identify early.
  • Retropharyngeal Abscess: A serious condition that can cause severe throat pain, difficulty swallowing, and respiratory distress, often requiring prompt surgical intervention.
  • Lemierre's Syndrome: A rare but potentially life-threatening condition following a bacterial pharyngitis, characterized by jugular vein thrombosis and metastatic infections.
  • Diphtheria: Although rare in areas with high vaccination rates, it can cause severe respiratory illness with a membrane covering the tonsils and throat.

Rare Diagnoses

  • Tularemia: A rare bacterial infection that can cause pharyngitis among other symptoms, typically associated with contact with infected animals.
  • Toxoplasmosis: Can cause lymphadenopathy and occasionally sore throat, especially in immunocompromised patients.
  • Syphilis: Primary syphilis can present with a painless sore throat and should be considered in sexually active adolescents or those with a history of sexual abuse.
  • Gonococcal Pharyngitis: A sexually transmitted infection that can cause sore throat, usually in adolescents with a history of sexual activity.

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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.