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Investigations and management
An acute presentation of odynophagia, associated fevers / chills, a feeling of general malaise, but without a cough or rhinorrhoea was highly suggestive of a bacterial infection. Group A beta-haemolytic streptococcus (GABHS) is generally the most likely cause (Patel et al., 2019; Del Mar, 2016 and Gottlieb et al., 2018). The absence of both palatine petechiae and a “strawberry red” tongue, rated the probability of scarlet fever an unlikely cause of the sore throat (Patel et al., 2019; Muhrer, 1991 and CKS, 2018). Red flag causes excluded a working diagnosis of a streptococcal tonsillitis was arrived at.
The literature highlights the difficulty of establishing the aetiology of infectious sore throats from the data generated from history taking and physical examination alone (van der Velden et al., 2013; Del Mar, 2016; Aalber et al., 2011 and Patel et al., 2019). It is generally accepted that the information to be derived from the identification of individual symptoms is not sufficiently specific or sensitive to provide a definitive diagnosis of GABHS. Swabs are the known gold standard for diagnosing GABHS and they can have a role in cases of treatment failure of high-risk patients or in establishing the aetiology of recurrent sore throats (Cheung et al., 2017, and NICE, 2018). However, the use of swabs is not advocated for the routine management of sore throats (Cheung et al., 2017).
The Centor or the FeverPain criteria are clinical prediction tools recommended for basing a decision on whether to treat for a likelihood of GABHS infection. (NICE, 2018; Taylor, 2018; Moore et al., 2017 and Gottlieb et al., 2018). Both tools use similar elements of the history and physical examination data.