Differentials
Infectious mononucleosis
SIGNS / SYMPTOMS
Most common in slightly older age group (adolescents) and, unlike acute tonsillitis, does not resolve after 1 week.
It is associated with lymphadenopathy (cervical or generalized), splenomegaly, and fatigue.
Rarely, the swelling of the pharyngeal tissues may become so significant as to impair breathing.
INVESTIGATIONS
Heterophile antibody testing is most commonly used to diagnose infectious mononucleosis. However, it has only moderate sensitivity, particularly in the first week of symptoms; sensitivity is lower in children than in adults.[16]
Epiglottitis
SIGNS / SYMPTOMS
Classically described in children ages 2 to 6 years, although can occur at any age. Rare in countries with routine Haemophilus influenzae type B (Hib) vaccination. A child with epiglottitis will have a muffled voice and will be drooling; there may be stridor and difficulty in breathing.
INVESTIGATIONS
On suspicion of epiglottitis, it is important not to spend time performing blood tests or even attempting to examine the child's throat: prompt referral to the emergency room or consultation with a pediatric anesthetist to secure the airway is crucial.
Peritonsillar abscess (quinsy)
SIGNS / SYMPTOMS
Causes more severe symptoms, including trismus (lockjaw), a muffled voice, a displaced uvula, and an enlarged, displaced tonsil, with swelling of the peritonsillar region.[Figure caption and citation for the preceding image starts]: Right-sided peritonsillar abscessFrom the collection of Dr Eleftherios Margaritis [Citation ends].
INVESTIGATIONS
The diagnosis is based on examination of the oropharynx and is confirmed on needle aspiration of pus from the peritonsillar swelling.
Retropharyngeal abscess
SIGNS / SYMPTOMS
Symptoms may be similar to those of a severe sore throat.
However, the symptoms do not resolve after a few days, and there may be trismus (lockjaw) or visible neck swelling.
INVESTIGATIONS
Elevated C-reactive protein may be a predisposing factor.[22]
Exclusion is made on the basis of lateral neck radiograph, or neck CT or ultrasound.
Gonococcal pharyngitis
SIGNS / SYMPTOMS
Adolescent and adult patients with a history of oral-genital sex.
INVESTIGATIONS
Throat culture (in Thayer-Martin medium) of Neisseria gonorrhoeae.
Diphtheria
SIGNS / SYMPTOMS
Examination of the oropharynx reveals the typical gray-green membrane.
Serosanguineous nasal discharge will be noted.
Patient will not have been immunized against diphtheria.
INVESTIGATIONS
Microbiology showing Corynobacterium diphtheriae.
HIV infection
SIGNS / SYMPTOMS
Patients with primary HIV infection are more likely to have risk factors for HIV infection and severe constitutional symptoms (e.g., malaise, tiredness, weight loss, generalized lymphadenopathy).
INVESTIGATIONS
Diagnosis is made by a positive HIV test.
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