Common Cold vs. Viral Pharyngitis: Clinical Comparison & Diagnostic Pearls

Table: Common Cold vs. Viral Pharyngitis

Feature	Common Cold (URI)	Viral Pharyngitis
Etiology	Rhinovirus, coronavirus, RSV, adenovirus	Adenovirus, EBV, HSV, enterovirus, influenza
Primary Site	Nasal mucosa, sinuses, upper airway	Pharyngeal mucosa, lymphoid tissue
Onset	Gradual	Gradual or abrupt
Fever	May be absent or low-grade (<38.3°C)	Often present, can be high-grade in some viral cases
Sore Throat	Mild or absent	Prominent, often painful
Cough	Prominent (dry or productive)	Mild or absent unless bronchitis overlaps
Rhinorrhea/Nasal Congestion	Common	May or may not be present
Tonsils	Normal size, no exudate	Mild/moderate erythema, sometimes petechiae (e.g. EBV)
Pharynx	Mildly injected	Marked erythema; vesicles (HSV/herpangina), ulcers
Lymphadenopathy	Rare or mild, non-tender	Tender anterior cervical or posterior (EBV)
Fatigue/Malaise	Mild	Moderate to severe (EBV, influenza)
Red Flags	Rare	Airway compromise, odynophagia, drooling (if severe)
Typical Duration	5–7 days	3–10 days; EBV may last >2 weeks
Antibiotics?	❌ No	❌ No, unless secondary bacterial infection is suspected
Special Findings	Aphthous-like ulcers in the oropharynx (viral)	Exudate, vesicles, ulcerations (virus-dependent)
Complications	Sinusitis, otitis media	Dehydration, airway swelling, splenic rupture (EBV)

🧠 Clinical Tips to Differentiate

• Runny nose + cough > sore throat? → Think Common Cold

• Severe sore throat + odynophagia + fever? → Think Viral Pharyngitis

• No tonsillar hypertrophy or exudate? → The Common Cold is more likely

• Marked pharyngeal erythema with malaise? → Viral Pharyngitis (e.g., EBV, adenovirus)

• Posterior cervical LN tender? → Think EBV

• Small vesicles/ulcers on the soft palate or tonsils? → Think Herpangina or HSV
  

  
  

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📊 CENTOR Criteria: When to Suspect Bacterial Pharyngitis

Criteria	Points
Tonsillar exudates	+1
Tender anterior cervical lymph nodes	+1
Fever >38°C	+1
Absence of cough	+1

Interpretation:

• 0–1 point: No testing or antibiotics

• 2–3 points: Consider rapid strep test or backup culture

• ≥3 points: Consider empiric antibiotics or a test-and-treat strategy
  

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📍Why Use CENTOR Score?

• The CENTOR score is a clinical prediction rule designed to estimate the likelihood of Group A β-hemolytic Streptococcus (GAS) pharyngitis.

• It helps avoid unnecessary antibiotic use in patients unlikely to have streptococcal infection.

• In contrast to viral causes, GAS pharyngitis often shows:

  • Sudden onset of sore throat

  • High fever

  • Tonsillar exudates

  • Tender anterior cervical adenopathy

  • No cough