What is the diagnosis and treatment for an 18-year-old female with a 3-day history of body aches, sore throat, and difficulty swallowing?

Diagnosis at Pagsusuri

Ang pasyenteng ito ay malamang na may Acute Viral Pharyngitis (Viral Upper Respiratory Tract Infection) batay sa clinical presentation ng body aches, sore throat, at difficulty swallowing na walang signs ng bacterial infection. 1, 2

Clinical Assessment

Ang 18-taong-gulang na babae ay nagpresenta ng:

• 3 araw na body aches (myalgia) - karaniwang sintomas ng viral infection 1
• Sore throat na hindi namamaga - walang tonsillar exudates o swelling na nagmumungkahi ng bacterial pharyngitis 3
• Difficulty swallowing - dahil sa throat irritation mula sa viral inflammation 2

Ang absence ng mga sumusunod ay strongly suggests viral etiology: 3

• Walang tonsillopharyngeal exudates
• Walang tender anterior cervical lymphadenopathy
• Walang sudden onset ng severe sore throat
• Walang fever na nabanggit

Differential Diagnosis Considerations

Hindi kailangan ng throat culture o rapid antigen test dahil walang clinical features ng Group A Streptococcal pharyngitis: 3

• Ang GAS pharyngitis ay typically may sudden-onset severe sore throat, tonsillar exudates, at tender cervical nodes 3
• Ang edad na 18 years old ay nasa labas ng peak age range (5-15 years old) para sa GAS 3
• Ang gradual onset ng symptoms over 3 days ay mas consistent sa viral infection 1, 2

Treatment Plan

Symptomatic Management (PhilHealth Konsulta Formulary-compliant, under ₱300):

1. Para sa body aches at pain relief:

• Paracetamol 500mg tablets 3
  • Dose: 1-2 tablets every 6 hours as needed
  • Dispense: 20 tablets
  • Duration: 5-7 days (hanggang gumaling ang symptoms)
  • Cost estimate: ₱40-80

2. Para sa sore throat at difficulty swallowing:

• Warm salt water gargles - 3-4 times daily 2
• Adequate hydration - increase fluid intake 2

Expected Course:

• Ang viral URI symptoms ay typically resolves within 5-7 days, pero pwedeng umabot ng 10 days 1, 2
• Walang indication para sa antibiotics 3, 1

Red Flags - Return for Re-evaluation if:

• Symptoms worsen after 3 days or persist beyond 10 days 2
• Development ng high fever (>38.5°C), severe throat swelling, o difficulty breathing
• Development ng tonsillar exudates o tender neck swelling 3

---

Medical Certificate

DIAGNOSIS: Acute Viral Pharyngitis (Viral Upper Respiratory Tract Infection)

RECOMMENDATION:

• Symptomatic treatment with Paracetamol 500mg 1-2 tablets every 6 hours as needed for pain and body aches
• Adequate rest and hydration
• Warm salt water gargles 3-4 times daily
• Fit to return to work/school after 2-3 days kung walang fever at improving na ang symptoms
• Return for follow-up kung symptoms persist beyond 7-10 days o kung lumala

MEDICATION PRESCRIBED:

• Paracetamol 500mg tablets - Dispense: 20 tablets - Take 1-2 tablets every 6 hours as needed for pain/body aches - Duration: 5-7 days

Total estimated cost: ₱40-80 (well within ₱300 budget)

---

Important Clinical Pearls

Antibiotic therapy is NOT indicated dahil: 3, 1

• Walang microbiological confirmation ng bacterial infection
• Clinical presentation ay consistent sa viral etiology
• Inappropriate antibiotic use ay may risks (adverse effects, resistance, unnecessary cost)

Ang key sa diagnosis ay ang absence ng bacterial pharyngitis features at ang presence ng constitutional symptoms (body aches) na typical sa viral infections. 1, 2