Differential diagnosis
Differential diagnoses
In making a diagnosis be aware of the common (non-streptococcal) infectious causes of acute sore throat, and their signs and symptoms. These are set out in the NICE CKS on acute sore throat. They include:
- Common cold — suggested by rhinorrhoea, nasal congestion and cough
- Influenza — suggested by headache, weakness and fatigue, myalgia, malaise, anorexia, insomnia, dry unproductive cough and fever
- Pharyngoconjunctival fever — suggested by fever and conjunctivitis. Malaise, myalgia, headache, rhinitis, and cervical adenitis may also be present
- Acute herpetic pharyngitis — suggested by vesicles and shallow ulcers on the palate (not always present)
- Glandular fever — suggested by pharyngitis of longer than several days’ duration, adenopathy and splenomegaly
- Covid-19 — suggested by fever, new continuous cough, shortness of breath, malaise, muscle aches and pains, rhinorrhoea and gastrointestinal symptoms.
Non-infectious causes include:
- Physical irritation — consider in people who smoke
- Hay fever
- Gastro-oesophageal reflux disease
- Drugs that can cause blood disorders leading to infection and acute sore throat including cytotoxic drugs, carbimazole, clozapine and sulfasalazine
- Oropharyngeal cancer — suggested by hoarseness, dysphonia, sore throat, difficulty swallowing, and neck mass or adenopathy.