Which organisms cause viral pharyngitis (sore throat)?

Updated: May 06, 2020
  • Author: John R Acerra, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Viral pharyngitis [4]

  • Adenovirus: The distinguishing feature of an adenovirus infection is conjunctivitis associated with pharyngitis (pharyngoconjunctival fever). It is the most common etiology in children younger than 3 years.

  • Herpes simplex: Vesicular lesions (herpangina), especially in young children, are the hallmark. In older patients, pharyngitis may be indistinguishable from GABHS infection.

  • Coxsackieviruses A and B: These infections present similarly to herpes simplex, and vesicles may be present. If vesicles are whitish and nodular, it is known as lymphonodular pharyngitis. Coxsackievirus A16 may cause hand-foot-and-mouth disease, which presents with 4- to 8-mm oropharyngeal ulcers and vesicles on the hands and feet, and, occasionally, on the buttocks. The oropharyngeal ulcers and vesicles resolve within 1 week.

  • Epstein-Barr virus (EBV): Clinically known as infectious mononucleosis, it is extremely difficult to distinguish from GAS infection. Exudative pharyngitis is prominent. Distinctive features include retrocervical or generalized adenopathy and hepatosplenomegaly. Atypical lymphocytes can be seen on peripheral blood smear. Viral cultures from washings are about 20% sensitive in adults.

  • CMV: Presentation of CMV is similar to the presentation of infectious mononucleosis. Patients tend to be older, are sexually active, and have higher fever and more malaise. Pharyngitis may not be a prominent complaint.

  • HIV-1: This is associated with pharyngeal edema and erythema, common aphthous ulcers, and a rarity of exudates. Fever, myalgia, and lymphadenopathy also are found.

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