Sore Throat: Or something else? Differential Diagnosis

Respiratory System (J00-J99)

  • Acute laryngitis (inflammation of the larynx).
  • Acute pharyngitis (pharyngitis) [viral pharyngitis: 50-80% of cases; bacterial pharyngitis: mostly Group A Streptococcus (GAS), about 15-30%, other pathogens and asymptomatic colonization possible!]
  • Acute tonsillitis (tonsillitis).
  • Acute tonsillopharyngitis (pharyngitis and / or tonsillitis).
  • Chronic laryngitis (inflammation of the larynx).
  • Chronic pharyngitis (pharyngitis)
  • Chronic tonsillitis (deficiency inflammation)
  • Epiglottis abscess – encapsulated collection of pus in the area of the epiglottis.
  • Epiglottitis (inflammation of the epiglottis) in children (stridor).
  • Palatine tonsillar hyperplasia – enlargement of the palatine tonsil.
  • Laryngeal perichondritis – inflammation of the tissue surrounding the cartilage in the area of the larynx.
  • Laryngeal phlegmon – diffuse inflammation of the connective tissue surrounding the larynx.
  • Parapharyngeal abscess – encapsulated accumulation of pus in the throat.
  • Peritonsillar abscess (PTA) – spread of inflammation to the connective tissue between tonsil (tonsils) and M. constrictor pharyngis with subsequent abscessation (accumulation of pus); predictors of peritonsillar abscess: male sex (1 point); age 21-40 years and smoker; clinical findings: unilateral sore throat/severe pain (3 points), trismus (lockjaw; 2 points), lumpy voice (1 point), and uvular/palatal deviations (1 point). Interpretation: threshold above which the probability of the presence of PTA increases significantly is a total score of 4.Note: test achieved a near-maximal negative predictive value and high sensitivity (percentage of diseased patients in whom the disease is detected by use of the test, i.e., a positive test result occurs), but relatively low specificity (probability that actually healthy individuals who do not have the disease in question are also detected as healthy in the test).
  • Peritonsillitis – inflammation of the tonsils and surrounding tissue.

Blood, blood-forming organs – immune system (D50-D90).

  • Angina agranulocytotica – inflammation of the lymphatic pharyngeal ring associated with ulceration (ulcers), indicating agranulocytosis (absence of certain cells of the immune defense).
  • Plummer-Vinson syndrome – combination of several symptoms caused by mucosal atrophy in the upper gastrointestinal tract (oral cavity to stomach); the disease leads to difficulty swallowing and burning tongue due to mucosal atrophy in the mouth, furthermore occur: Mucosal defects, oral rhagades (tears in the corner of the mouth), brittle nails and hair and dysphagia (difficulty swallowing) due to larger mucosal defects; the disease is a risk factor for the development of esophageal cancer (esophageal cancer).

Skin and subcutaneous (L00-L99).

  • Erythema exsudativum multiforme (synonyms: erythema multiforme, cocard erythema, disc rose) – acute inflammation occurring in the upper corium (dermis), resulting in typical cocard-shaped lesions; a distinction is made between a minor and a major form.
  • Pemphigus vulgaris – form of blistering skin diseases.

Cardiovascular system (I00-I99)

  • Lemierre syndrome (synonyms: Postanginal septicemia, postanginal sepsis, postanginal sepsis, necrobacillosis) – simultaneous occurrence of a triad of oropharyngeal infection (infection of the oral cavity and pharynx), Jugular vein thrombosis (thrombotic occlusion of one of the large jugular veins (jugular veins), usually the internal jugular vein), and septic pulmonary embolism (occurring when infectious material causes emboli/vascular occlusions of the pulmonary arteries)Note: Septic clinical picture develops several days after oropharyngeal infection.

Infectious and parasitic diseases (A00-B99).

  • Candida mycosis – fungal infection with shoot fungi (yeasts).
  • Diphtheria – infectious disease caused by Corynebacterium diphtheriae.
  • Gonorrhea (gonorrhea, venereal disease).
  • Herpangina – infectious disease of the lymphatic pharyngeal ring (with vesicle formation), which usually occurs in childhood; the causative agent is group A coxsackie virus.
  • Herpes zoster (shingles)
  • HIV (human immunodeficiency virus)
  • Infectious mononucleosis (synonyms: Pfeiffer’s glandular fever, infectious mononucleosis, mononucleosis infectiosa, monocytic angina or kissing disease, (Student’s) kissing disease, called) – common viral disease caused by the Epstein-Barr virus (EBV); this affects lymph nodes but can also affect the liver, spleen, and heart.
  • Malleus humidus (nasal glanders) – disease caused by the bacterium Burkholderia mallei, usually affecting equines such as horses or donkeys, occasionally camels, but rarely dogs and cats. Humans can also contract glanders (= melioidosis); transmission: Inhalation or via contaminated drinking water; life-threatening bacteremia may occur – typically after an ascending infection; course: Bacteria infect liver, spleen, skeletal muscle or prostate; antibiotic therapy usually comes too late; mortality (death rate) in sepsis up to 80%; risk groups: Diabetics, immunocompromised patients.
  • Anthrax – notifiable bacterial infectious disease with the rod-shaped bacterium Bacillus anthracis, which mainly affects animals (pigs, cattle, horses, sheep and goats) and which mainly affects professional groups working with animals; furthermore, there is the so-called injection anthrax in i.v. drug users through the injection of heroin contaminated with anthrax spores.
  • Scarlet fever
  • Syphilis (angina specifica) – sexually transmitted disease caused by Treponema pallidum (here resulting purulent tonsillitis).
  • Ulcerous (ulcerated) mucosal tuberculosis.

Mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93).

Musculoskeletal system and connective tissue (M00-M99).

  • Kawasaki syndrome (synonym: mucocutaneous lymph node syndrome, MCLS) – acute, febrile, systemic disease characterized by necrotizing vasculitis (vascular inflammation) of small and medium-sized arteries; furthermore, systemic inflammation is present in many organs
  • Behçet’s disease (synonym: Adamantiades-Behçet’s disease; Behçet’s disease; Behçet’s aphthae) – multisystem disease from the rheumatic form circle, which is accompanied by recurrent, chronic vasculitis (vascular inflammation) of the small and large arteries and mucosal inflammation; The triad (the occurrence of three symptoms) of aphthae (painful, erosive mucosal lesions) in the mouth and aphthous genital ulcers (ulcers in the genital region), as well as uveitis (inflammation of the middle eye skin, which consists of the choroid (choroid), the ray body (corpus ciliare) and the iris) is stated as typical for the disease; a defect in cellular immunity is suspected
  • Sjögren’s syndrome – disease of the rheumatic type: autoimmune disease from the group of collagenoses, in which immune cells attack the salivary glands and lacrimal glands.
  • Scleroderma – group of various rare diseases associated with hardening of connective tissue of the skin alone or the skin and internal organs (especially digestive tract, lungs, heart and kidneys).

Neoplasms – tumor diseases (C00-D48).

  • Tumors of the larynx, unspecified.
  • Tumors of the pharynx, unspecified
  • Tonsillar tumors, unspecified – neoplasms arising from the lymphatic pharyngeal ring.
  • Tongue base tumors, unspecified.

Psyche – nervous system (F00-F99; G00-G99).

  • Paresis (paralysis) of the glossopharyngeal nerve (tongue-gullet nerve) or the vagus nerve (the most important nerve of the autonomic nervous system)
  • Mental disorders, unspecified