Peads: Next step in diagnosis
meduploader - 06-01-09 06:51

A 13-year-old girl, accompanied by both parents, presents at a family medical center during the month of February complaining of a sore throat associated with pain on swallowing, an elevated temperature, and headache. These symptoms had been present for a day or so prior to visiting the medical center. The family has recently relocated to the area and no medical records are available for the clinician. On examination, the girl is found to have marked tonsillopharyngeal erythema with exudate, a swollen red uvula, enlarged anterior cervical lymph nodes, and a fever of 38.5°C (101.5°F), but is not exhibiting any respiratory distress, cough, or hoarseness, and no other abnormal physical signs (eg, splenomegaly) are found. Both parents also have sore throats, as well as pharyngeal erythema accompanied by cough, mild hoarseness and coryza, but without fever or headache. Neither has any difficulty in swallowing. On further questioning about the girl's medical history, the parents volunteer that she had suffered an episode of "glandular fever" about 6 months ago; she developed a sore throat with a high temperature 3 months after this, and then again about 4 weeks ago as the family was preparing to move to their new home. On the first occasion, prior to the confirmation of "glandular fever" by their former medical practitioner, "an antibiotic" had been prescribed for the girl, which the mother believed to have been a "penicillin-type medicine." This drug produced an "itchy rash" about 2 to 3 days after starting treatment, and it was replaced by doxycycline. The sore throat and other symptoms of glandular fever subsided over a period of about a week. During the second and third sore throat episodes, which occurred about 3 and 5 months later, doxycycline was again prescribed by the same medical practitioner. This treatment evidently abated the sore throat, though the symptoms of the third episode lasted about 4 to 5 days. The parents are not at all concerned about their own conditions but both appear anxious about their daughter's fourth severe sore throat in 6 months.
What confirmatory laboratory tests should be undertaken?