C1349594

 A

For a 9-year-old boy in the UK presenting with 5 days of fever, dry cough, and a red throat, the differential diagnosis (DDx) includes a mix of viral and bacterial etiologies, as well as some less common causes. Here’s a structured DDx list:

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🦠 Common Viral Infections

• Viral pharyngitis or URTI (most likely)

  • Adenovirus, rhinovirus, influenza, parainfluenza, enterovirus.

  • Features: red throat, fever, dry cough, often self-limiting.

• Influenza

  • Fever, dry cough, myalgia, sore throat.

• COVID-19

  • Fever, cough, sore throat, possible anosmia.

• EBV (Infectious mononucleosis)

  • Fever, pharyngitis, fatigue, +/- cervical lymphadenopathy.

  • Red throat may mimic strep; consider if prolonged or atypical.

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🧫 Bacterial Infections

• Group A Streptococcal (GAS) pharyngitis

  • More likely if: no cough, tonsillar exudates, anterior cervical lymphadenopathy, high fever.

  • Consider Centor/McIsaac criteria.

• Mycoplasma pneumoniae

  • Atypical pneumonia; dry cough, prolonged fever, sore throat.

  • Often milder presentation; may have extrapulmonary symptoms (e.g. rash, arthralgia).

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❗️Other Considerations

• Pertussis (Whooping Cough) (less likely if vaccinated, but possible)

  • Paroxysmal cough, post-tussive vomiting, prolonged course.

• Kawasaki Disease (less common, but important to exclude)

  • Prolonged fever >5 days, red lips/throat, rash, conjunctivitis, lymphadenopathy.

• Retropharyngeal abscess (if neck stiffness, drooling, or torticollis)

  • Deep neck infection; more in younger children but possible.

• Sinusitis (if headache, facial pain, purulent nasal discharge)

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📋 Suggested Investigations (if persistent or severe):

• Throat swab (strep testing or PCR for viruses)

• COVID-19 testing

• FBC, CRP

• Chest X-ray (if concern for pneumonia)

• Monospot/EBV serology (if prolonged symptoms or splenomegaly)

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