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Invasive Group A Streptococcal infections have increased in incidence and need to be assessed rapidly in hospital. Maintain a high index of suspicion in patients with a high fever, severe muscle aches, confusion, unexplained D&V, local muscle tenderness, or severe pain out of proportion to external signs, hypotension, a flat red rash over large area of the body, conjunctival suffusion. |
Ulcers are always colonised.
Culture swabs and antibiotics are only indicated if cellulitis is present. Treat with cellulitis regimen (see here for guidance).
Antibiotics should only be used in active infection (increased pain, pyrexia, erythema beyond 2cm, localised heat). If antibiotics given, review with culture results.