sore throat

Respond to both post below of your colleagues on and respectfully agree or disagree with your colleague’s assessment and explain your reasoning. In your explanation, include why their explanations make physiological sense or why they do not

POST 1

Scenario 1: A 16-year-old boy comes to clinic with chief complaint of sore throat for 3 days. Denies fever or chills. PMH negative for recurrent colds, influenza, ear infections or pneumonias. NKDA or food allergies. Physical exam reveals temp of 99.6 F, pulse 78 and regular with respirations of 18. HEENT normal with exception of reddened posterior pharynx with white exudate on tonsils that are enlarged to 3+. Positive anterior and posterior cervical adenopathy. Rapid strep test performed in office was positive. His HCP wrote a prescription for amoxicillin 500 mg po q 12 hours x 10 days disp #20. He took the first capsule when he got home and immediately complained of swelling of his tongue and lips, difficulty breathing with audible wheezing. 911 was called and he was taken to the hospital, where he received emergency treatment for his allergic reaction.

Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:

Strep Throat

Strep throat is one of a varied range of conditions caused by the bacterium known as group A Streptococcus (GAS). One study found that recurrent tonsillitis (RT) with pediatric group A Streptococcus (GAS) RT had smaller germinal centers, with an underrepresentation of GAS-specific CD4+ germinal center T follicular helper (GC-TFH) cells (Dan, et al., 2019). This translates to a smaller area in lymph organs where B cells proliferate, differentiate, and mutate their antibody genes. B cells/lymphocytes responsible for producing antibodies. B lymphocytes  and CD4+ T cells are important cells in the adaptive immune system. Some people have a genetically based weaker immune response to group A strep bacteria.

The GAS bacteria gained entry into the patient’s respiratory tract and multiplied. This triggered an inflammatory response. His tonsils became enlarged related to vasodilation, increased vascular permeability, which allowed white blood cells to adhere to the vessels and surrounding tissue (McCance, 2019, p. 195). This caused tonsilar edema/swelling. The cervical lymphadenopathy was caused as the immune system moved bacterial products, dead cells, and other inflammatory material through the lymph system’s channels (McCance, 2019, p. 195) The patient’s immune response produced the fever. Endogenous pyrogens create a beneficial host-defense reaction during infection (McCance, 2019, p. 291).

Anaphylaxis

The angioedema (swelling of tongue and lips) and wheezing were signs and symptoms of anaphylaxis. This is an acute and possibly life-threatening emergency. This was caused by a Type I  hypersensitivity reaction mediated by mast cells and basophils, most likely from the antibiotic. Sometimes the host response to an antigen is excessive, causing a damaging response while trying to be defensive. Anaphylaxis can occur immediately and can either be cutaneous or systemic (McCance, 2019, p. 256).

On a cellular level, anaphylaxis is a chain of events. IgE recognizes and binds to an antigen. The activated IgE fixates to mast cells and basophils, which initiates the release of chemical mediators such as histamine (Stone, Prussin, & Metcalfe). This then triggers a more intensified response, releasing more histamine. Respiratory distress occurs because histamine causes smooth muscle contraction, producing bronchial constriction; wheezing/stridor (McCance, 2019, p. 256). The tongue and lip swelling/angioedema are caused by the chemical mediators increasing vascular permeability, leading to fluids leaking from vessels (Theresa Capriotti, 2018).

Our text indicates that some people are genetically predisposed to have allergies, Type I in particular. This is called Atopic. If one parent has an allergy, 40% of offspring have a chance of allergies occurring, and 80% if both parents have allergies (McCance, 2019, p. 263).  This happens because atopic persons make more IgE and have more Fe receptors on their mast cells.

I did not read where gender would play any part in Step throat or anaphylaxis. The patient was listed as NKDA and food allergies; it might have been prudent to ask if siblings or parents were allergic to any medications or foods.

 

References

Dan, J. M., Havenar-Daughton, C., Kendric, K., Al-kolla, R., Kaushik, K., Rosales, S. L., . . . Ottensmeier, C. H. (2019). Recurrent group A Streptococcus tonsillitis is an immunosusceptibility disease involving antibody deficiency and aberrant TFH cells. Science Translational Medicine. doi:10.1126/scitranslmed.aau3776

McCance, K. L. (2019). Pathophysiology: The Biologic Basis for Disease in Adults and Children Eighth edition. Elselvier. Retrieved 3 3, 2021

Stone, K. D., Prussin, C., & Metcalfe, D. D. (n.d.). IgE, Mast Cells, Basophils, and Eosinophils. Journal of Allergy and Clinical Immunology, 125(2), s73-s80. doi:10.1016/j.jaci.2009.11.017

Theresa Capriotti. (2018). Pathophysiology Made Incredibly Easy. Philadelphia: Wolters Kluwer. Retrieved 3 3, 2021

 

 

POST 2

Thomas Brooks NURS 6501 Week 1 initial Discussion Post

 

The assigned scenario assessment has shown the 16-year-old child tested positive for strep throat. “Strep throat is a painful condition that’s potentially life-threatening if not treated promptly. Research has found that children who have multiple strep infections in a year may have a genetic trait that makes it hard for them to fight the infection (Citroner,2019).” Therefore, genetics can play a role in the disease.

 

“According to the  Centers for Disease Control and Prevention Trusted Source , strep throat is caused by a bacterial infection called group A Streptococcus.  When group A strep is a recurring problem, the result can be utter misery. It’s one reason why children may have their tonsils removed. Now researchers at the La Jolla Institute for Immunology (LJI) have uncovered the first clues as to why some children may frequently contract group A strep. In a study published in the journal Science Translational Medicine on Feb. 6, researchers examined the surgically removed tonsils of 26 children between the ages of 5 and 18 years who had recurrent tonsillitis. They also looked at the tonsils of 39 children who had their tonsils removed for other reasons, such as sleep apnea. What they found is that tonsils from kids with repeat infections had a genetically based poor immune response to group A strep bacteria. When the medical histories of these children were checked, the researchers confirmed the problem did run in some families (Citroner, 2019).”

The patient is presenting with a temperature just below a low-grade fever also known as pyrexia which I believe to be a reaction to his infection. A person may have an increase in body temperature “because your body is trying to kill the virus or bacteria that caused the infection. Most of those bacteria and viruses do well when your body is at your normal temperature. But if you have a fever, it is harder for them to survive. Fever also activates your body’s immune system (Health, 2020).”

 

The pain, redness, and white exudate are due to the infection. The white spotting can be caused by “A group of bacteria called streptococcus. Your doctor can take a throat swab and do a quick test to tell if you have the infection. If the sample comes back positive, they’ll give you antibiotics to kill the bacteria. You may start to feel better in as little as a day, but the antibiotics need about 10 days to finish the job (Brennan, 2019).”

 

Once the patient mentioned had an anaphylactic reaction which “causes your immune system to release a flood of chemicals that can cause you to go into shock — your blood pressure drops suddenly and your airways narrow, blocking breathing. Signs and symptoms include a rapid, weak pulse; a skin rash; and nausea and vomiting (Mayo,2020)” it was critical that the patient be treated in order to ensure they do not stop breathing due to airway closure.

 

Streptococcus pyogenes (Group A streptococcus) is a Gram-positive, nonmotile, nonsporeforming coccus that occurs in chains or in pairs of cells. Individual cells are round-to-ovoid cocci, 0.6-1.0 micrometer in diameter (Figure 1). Streptococci divide in one plane and thus occur in pairs or (especially in liquid media or clinical material) in chains of varying lengths. The metabolism of S. pyogenes is fermentative; the organism is a catalase-negative aerotolerant anaerobe (facultative anaerobe) and requires enriched medium containing blood in order to grow. Group A streptococci typically have a capsule composed of hyaluronic acid and exhibit beta (clear) hemolysis on blood agar (Todar, 2020).”

 

Although the infection strep throat can be healed through medical treatment and antibiotics it is important to remember that seeking medical attention early will always assist with receiving the best outcome possible.

 

References:

 

Anaphylaxis. American College of Allergy, Asthma and Immunology. http://acaai.org/allergies/anaphylaxis. Accessed Nov. 20, 2016.

 

Brennan, D. (2019, May 9). 4 common causes of white spots in your throat. https://www.webmd.com/cold-and-flu/white-spots-throat-causes.

 

Citroner, G. (2019, February 06). Here’s Why Certain Kids Repeatedly Get Strep Throat. Retrieved March 02, 2021, from https://www.healthline.com/health-news/why-your-kid-keeps-getting-strep-throat#Preventing-strep-infection

 

Kenneth Todar, M. (2020). Streptococcus pyogenes and streptococcal disease. http://textbookofbacteriology.net/streptococcus.html.

 

 

Respon

d

 

to

 

both

 

 

post

 

below

 

of

 

your

 

colleagues

 

on

 

and

 

respectfully

 

agree

 

or

 

disagree

 

with

 

your

 

colleague’s

 

assessment

 

and

 

explain

 

your

 

reasoning.

 

In

 

your

 

explanation,

 

include

 

why

 

their

 

explanations

 

make

 

physiological

 

sense

 

or

 

why

 

they

 

do

 

no

t

 

POST

 

1

 

Scenario

 

1

:

 

A

 

16

year

old

 

boy

 

comes

 

to

 

clinic

 

with

 

chief

 

compla

int

 

of

 

sore

 

throat

 

for

 

3

 

days.

 

Denies

 

fever

 

or

 

chills.

 

PMH

 

negative

 

for

 

recurrent

 

colds,

 

influenza,

 

ear

 

infections

 

or

 

pneumonias.

 

NKDA

 

or

 

food

 

allergies.

 

Physical

 

exam

 

reveals

 

temp

 

of

 

99.6

 

F

,

 

pulse

 

78

 

and

 

regular

 

with

 

respirations

 

of

 

18.

 

HEENT

 

normal

 

with

 

exception

 

of

 

reddened

 

posterior

 

pharynx

 

with

 

white

 

exudate

 

on

 

tonsils

 

that

 

are

 

enlarged

 

to

 

3+.

 

Positive

 

anterior

 

and

 

posterior

 

cervical

 

adenopathy.

 

Rapid

 

strep

 

test

 

performed

 

in

 

office

 

was

 

positive

.

 

His

 

HCP

 

wrote

 

a

 

prescription

 

for

 

amoxicillin

 

500

 

mg

 

po

 

q

 

12

 

hours

 

x

 

10

 

days

 

disp

 

#20

.

 

He

 

took

 

the

 

first

 

capsule

 

when

 

he

 

got

 

home

 

and

 

immediately

 

complained

 

of

 

swelling

 

of

 

his

 

tongue

 

and

 

lips,

 

difficulty

 

breathing

 

with

 

audible

 

wheezing.

 

911

 

was

 

called

 

and

 

he

 

was

 

taken

 

to

 

the

 

hospital,

 

where

 

he

 

received

 

emergency

 

treatment

 

for

 

his

 

allergic

 

reaction.

 

Post

 

an

 

explanation

 

of

 

the

 

disease

 

highlighted

 

in

 

the

 

scenario

 

you

 

were

 

provided.

 

Include

 

the

 

following

 

in

 

your

 

explanation:

 

Strep

 

Throat

 

Strep

 

throat

 

is

 

one

 

of

 

a

 

varied

 

range

 

of

 

conditions

 

caused

 

by

 

the

 

bacterium

 

known

 

as

 

group

 

A

 

Streptococcus

 

(GAS).

 

One

 

study

 

found

 

that

 

recurrent

 

tonsillitis

 

(RT)

 

with

 

pediatric

 

group

 

A

 

Streptococcus

 

(GAS)

 

RT

 

had

 

smaller

 

germinal

 

centers,

 

with

 

an

 

underrepresentation

 

of

 

GAS

specific

 

CD4+

 

germinal

 

center

 

T

 

follicular

 

helper

 

(GC

TFH)

 

cells

 

(Dan,

 

et

 

al.,

 

2019).

 

This

 

translates

 

to

 

a

 

smaller

 

area

 

in

 

lymph

 

organs

 

where

 

B

 

cells

 

proliferate,

 

differentiate,

 

and

 

mutate

 

their

 

antibody

 

genes

. B cells/lymphocytes responsible for producing antibodies. B

lymphocytes

 

and CD4+ T cells are important cells

 

in the adaptive immune system.

Some people have a genetically based weaker immune response to group A strep

bacteria.

 

The

 

GAS

 

bacteria

 

gained

 

entry

 

into

 

the

 

patient’s

 

respiratory

 

tract

 

and

 

multiplied.

 

This

 

triggered

 

an

 

inflammatory

 

response.

 

His

 

tonsils

 

b

ecame

 

enlarged

 

related

 

to

 

vasodilation,

 

increased

 

vascular

 

permeability,

 

which

 

allowed

 

white

 

blood

 

cells

 

to

 

adhere

 

to

 

the

 

vessels

 

and

 

surrounding

 

tissue

 

(McCance,

 

2019,

 

p.

 

195).

 

This

 

caused

 

tonsilar

 

edema/swelling.

 

The

 

cervical

 

lymphadenopathy

 

was

 

caused

 

a

s

 

the

 

immune

 

system

 

moved

 

bacterial

 

products,

 

dead

 

cells,

 

and

 

other

 

inflammatory

 

material

 

through

 

the

 

lymph

 

system’s

 

channels

 

(McCance,

 

2019,

 

p.

 

195)

 

The

 

patient’s

 

immune

 

response

 

produced

 

the

 

fever.

 

Endogenous

 

pyrogens

 

create

 

a

 

beneficial

 

host

defense

 

rea

ction

 

during

 

infection

 

(McCance,

 

2019,

 

p.

 

291).

 

Anaphylaxis

 

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