Throat hurts but no fever
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Understanding Sore Throat Without Fever: Causes and Considerations
Common Causes of Sore Throat Without Fever
A sore throat without fever can be caused by various factors, ranging from viral infections to environmental irritants. One of the most common causes is viral pharyngitis, which often presents with symptoms such as throat pain, mild erythema, and tenderness of the anterior neck without accompanying fever3. Viral infections like the common cold or mild cases of infectious mononucleosis can also lead to a sore throat without a significant rise in body temperature4.
Bacterial Infections and Sore Throat
While bacterial infections like streptococcal pharyngitis typically present with fever, there are instances where a sore throat may occur without fever. For example, a rapid antigen test for group A streptococcus can sometimes be negative even in the presence of a sore throat, as seen in some clinical cases1 2. Additionally, group C streptococcus has been identified in patients with sore throat and other symptoms but without fever2.
Non-Infectious Causes
Non-infectious causes of sore throat without fever include environmental factors such as dry air, pollutants, and allergens. These irritants can cause inflammation and discomfort in the throat without triggering a systemic fever response. Additionally, conditions like gastroesophageal reflux disease (GERD) can lead to throat irritation and pain without fever3.
Diagnostic Considerations
When evaluating a patient with a sore throat but no fever, it is essential to consider both infectious and non-infectious causes. A thorough history and physical examination are crucial. Rapid antigen detection tests and throat cultures can help identify bacterial causes, while serologic tests may be necessary for viral infections like Epstein-Barr virus (EBV)2 5. In cases where initial tests are negative, further evaluation for non-infectious causes or less common pathogens may be warranted6.
Treatment Approaches
Treatment for a sore throat without fever depends on the underlying cause. For viral infections, supportive care such as hydration, rest, and over-the-counter pain relievers is typically sufficient. Bacterial infections may require antibiotics, although it is essential to confirm the diagnosis to avoid unnecessary antibiotic use7. For non-infectious causes, addressing the specific irritant or underlying condition, such as using humidifiers for dry air or managing GERD, can provide relief3.
Conclusion
A sore throat without fever can result from various causes, including viral and bacterial infections, as well as non-infectious factors. Accurate diagnosis through clinical evaluation and appropriate testing is essential to determine the underlying cause and guide effective treatment. Understanding the diverse etiologies of sore throat without fever can help clinicians provide targeted care and improve patient outcomes.
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CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 22-2015. A 20-Year-Old Man with Sore Throat, Fever, Myalgias, and a Pericardial Effusion.
A 20-year-old man with persistent myalgias and fever was initially diagnosed with streptococcal pharyngitis, but later developed a pericardial effusion and needed hospitalization for treatment.
Case Report
Rigorous JournalCase records of the Massachusetts General Hospital. Case 36-2014. An 18-year-old woman with fever, pharyngitis, and double vision.
A young woman with fever, pharyngitis, facial swelling, and diplopia was initially diagnosed with infectious mononucleosis, but later developed a bacterial superinfection and a fever.
Case ReportA Case of Sore Throat and Fever
A previously healthy 41-year-old man developed a sore throat, headache, fever, and fatigue, but was initially diagnosed with pharyngitis, then consulted for internal medicine after his symptoms worsened.
Case ReportGlandular Fever: Infectious Mononucleosis
Glandular fever is a viral infection that causes sore throat, swollen lymph glands, fever, muscle aches, and headaches, but may not show symptoms in some people.
A 35-year-old man with persistent cough, fever, and sore throat.
A 35-year-old Belgian man with a history of tunnel work and a 10-kg weight loss was referred for evaluation after persistent symptoms and a 10-kg weight loss.
Case ReportA Teenager With Sore Throat and Neck Pain
A 15-year-old girl with a history of throat and neck pain was admitted with a history of high fever, joint pain, and increasing shortness of breath, ultimately diagnosed with nodular pneumonia.
Case ReportA simple sore throat?
Apreviously healthy 26-year-old man presented with a 3-day history of sore throat, fever, rigors, loin pain and vomiting. He was pyrexial (40°C) and tachycardic (104 beats/minute), but had a normal blood pressure. Clinical examination revealed erythematous fauces without any exudates, and bilateral submandibular Iymph node enlargement. There was no meningism or para-spinal tenderness. The platelet count was decreased (108 × 109/litre, normal range (NR) 150–400x109/litre) and white cell count was elevated (16.1×109/litre, NR 4–11x109/litre) with a neutrophilia. Markers of inflammation (erythrocyte sedimentation rate 61mm/h and C-reactive protein 226mg/litre) and urea (11.1 mmol/litre, NR 3–7 mmol/litre) were also elevated. Chest X-ray and glandular fever slide test were both normal. The patient was started on intravenous ceftriaxone after blood, urine and throat swabs were sent off for culture. The patient's temperature settled over the next 4 days, and he was converted to oral antibiotics. Gram-negative a...
Case ReportClinical practice. Streptococcal pharyngitis.
The patient should be evaluated and treated for group A streptococcus pharyngitis, as her physical exam shows tender lymph nodes and erythema over enlarged tonsils and the posterior pharynx.
Case Report
Highly CitedCase records of the Massachusetts General Hospital. Case 34-2009. A 20-year-old man with sore throat, fever, and rash.
A 20-year-old man developed a rash and fever after starting antibiotic therapy, but the cause was not identified until he was admitted to the hospital.
Case ReportFever, Chest Pain, and Recent Sore Throat
A 25-year-old man with fever, chills, and malaise was diagnosed with pneumonia and given intravenous metronidazole and cefotaxime.
Case Report