### What you need to know
A 5 year old girl presents to her GP with a three day history of fever up to 39°C, sore throat, myalgia, headache, lack of appetite, and lethargy. When afebrile, her observations are within normal limits. On examination, both tonsils are red, inflamed, and have exudate. The child’s parents work in healthcare, and have a recent history of sore throats that were not medically treated. A clinical diagnosis of suspected streptococcal pharyngitis is made and a 10 day course of penicillin V prescribed. The child re-presents 48 hours later with persistent fevers and new onset vomiting and diarrhoea. She has managed to take only half of her prescribed doses of penicillin V. On examination, she is tachycardic and has cool peripheries. She has developed a sandpaper rash on her trunk, and her tonsils remain inflamed, with exudate. Her forearm is moderately swollen, and she screams when it is palpated lightly.
Group A beta-haemolytic streptococci (GAS) are Gram posi