Case Study: Strep Throat in an Adolescent
The case study describes a 16-year-old male who was exhibiting symptoms of step throat and given amoxicillin, ultimately discovering this individual was allergic to penicillin. The male had no known drug history and was treated with the common medication for this disease. Had the patient had this diagnosis previously, the allergy would have been discovered a while ago and avoided at this age.
Genetics
A group of immunologists at La Jolla Institute for Immunology (n.d) stated they believed recurrent strep throat has a genetic factor, and it was noted children had less B and Tfh cells to produce antibiotics to fight this particular disease. While this child has not had step throat before, he could be at risk of recurrent infections if he received a gene from his parents causing decreased immunity, as he does not have the proper antibodies to fight step throat. However, having the gene passed to him alone would not be the only cause of this disease. McCance and Huether (2019) discussed the occurrence genes interacting with their environment as a multifactorial trait, as the child must come into contact with the bacteria in order to uncover the gene (p.161). Other factors that may impact the increased incident of getting strep throat could be poor diet and poor hygiene.
Symptoms Presented
Strep throat symptoms can vary from patient to patient. Strep Throat (2016) reported symptoms of step throat could include white or yellow spots in the back of the mouth, fever, sore and red throat, and swollen lymph nodes on the neck. According to the case study, the child had a sore, red throat with white spots, as well as swollen lymph nodes (cervical adenopathy). The practitioner had assessed the signs and symptoms and ordered a strep test, which had come back positive. McCance & Huether (2019) discussed the various ways the body protects itself, such as with physical barriers in the respiratory tract, goblet cells trapping bacteria and moving it to be expelled by coughing or sneezing, and through the inflammation process (191). The inflammation process means the body increases blood flow to the infected or injured site (redness), which causes swelling due to more fluid in one area (swollen lymph nodes), the swelling then causes pain (sore throat), and purulent exudate (white spots on tonsils) from a build up of white blood cells attempted to fight the bacteria (McCance & Huether, 2019, p.210). At times, the body may also raise its temperature to fight bacteria, hence the low-grade fever which can be high in some patients.
Response to Stimulus and Cells Involved
Amoxicillin had been prescribed to the child, as is with common practice for strep throat treatment. However, the practitioners did not know the child was allergic to this medication since he had not needed to take it in the past. Instead of allowing the drug to do its job and fight the bacteria, the body became hypersensitive to it and caused swelling, difficulty breathing, and wheezing. Torres et al. (2016) stated the IgE immune mechanisms are involved in response to allergic reactions, and for some reason with penicillin, the patient can become allergic to all penicillin (cross-reactive) or the body can be selective. Multiple cells are involved with the process of allergic reactions, as inflammation has caused the bronchial tubes and airway to start to close, as well as lip and tongue swelling. The decreased airflow through the lungs caused the wheezing. According to Warrington (2012), some of the cells involved in this type of reaction are basophils and mast cells, which encourage the release of inflammatory mediators. The mediators can trigger activation of other cells. Per McCance & Huether (2019), additional cells involved are phagocytes, lymphocytes, endothelial cells, natural killer cells, and platelets (p.216). The body views the medication as an intruder and attacks the same way it would attack a bacteria or virus.
Other Characteristics
Strep throat can occur in all genders and ages. However, it does not occur as often in adults (under 65), especially if they are not immune-compromised or work with children closely. If the patient had coughing, runny nose, I would not necessarily think it was strep as those are not regular symptoms. There is not much that would change my response unless the child was completed isolated from others, which one could assume a 16-year-old male would not be. I believe the reaction to provide the antibiotic was appropriate, as they could not predict the allergic reaction. The symptoms appeared to correlate with strep throat, and the test was positive.
References
La Jolla Institute for Immunology (LJII). (n.d.) Strep throat. https://www.lji.org/diseases/strep-throat/
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children(8th ed.). St. Louis, MO: Mosby/Elsevier.
Strep Throat. (2016). American Family Physician, 94(1), 1.
Torres, M. J., Montañez, M. I., Ariza, A., Salas, M., Fernandez, T. D., Barbero, N., Mayorga, C., & Blanca, M. (2016). The Role of IgE Recognition in Allergic Reactions to Amoxicillin and Clavulanic Acid. Clinical & Experimental Allergy, (46), 2, 264-274. doi: 10.1111/cea.12689.
Warrington, R. (2012). Drug Allergy. Human Vaccines and Immunotherapeutics, 8(10), 1513–1524. doi: 10.4161/hv.21889
Sample Answer 4 for NURS 6501 Discussion: Alterations in Cellular Processes
, it is true that cells are the basic structural components of the body and are specialized to conduct different functions in the body. The central dogma also illustrates the pivotal role of genes in dictating the specialization of cells and subsequent events. Disease can alter the nature of cells thereby interfering with the normal cell functions. I find your case analysis quite intriguing, there are many patients who complain of sore throat that is related to allergic conditions and your analysis through genetic involvement is informative (Centers for Disease Control and Prevention,2021).
Group A streptococcus pharyngitis among children and adolescents is common and the identification of the genes associated with the common occurrence provides an avenue for solving the menace. Hypersensitivity relation to genetic composition also provides a better understanding of the recurrence of such cases (McCance & Huether, 2019). I also think that the bod defense system is triggered by recognition of the pathogen and the process of acting against the identified antigen leads to the symptoms, which include inflammation that would be felt as sore throat.
I agree hat the physiological processes upon identification of the antigen includes a variety of cells mediators that take part in the inflammatory pathway. These processes cause heat, swelling and redness. The patient characteristics that define different responses include age as age relates to immunity. Children are more susceptible to some diseases as compared to adults. Elderly people are also prone to some diseases that are not so common among young adults. Allergy to drugs also links to age as the allergy increases with age (Soderholm et al., 2018). I concur with you that severe allergic reaction would definitely be a concern
References
Soderholm, A. T., Barnett, T. C., Sweet, M. J., & Walker, M. J. (2018). Group A streptococcal
pharyngitis: Immune responses involved in bacterial clearance and GAS‐associated immunopathology. Journal of leukocyte biology, 103(2), 193-213.
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in
adults and children (8th ed.). Mosby/Elsevier.
Centers for Disease Control and Prevention. (2021, November 23). Pharyngitis (strep throat): Information for clinicians. Retrieved March 1, 2022, from https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html
Sample Answer 5 for NURS 6501 Discussion: Alterations in Cellular Processes
It is true that cell environment stressors cause alterations within the cell and different diseases cause alterations as cells respond to change. Ultimately, the processes of reacting to change would be expressed as symptoms as evident in the child in the case study. Pharyngitis, caused by bacteria and treatable by administering Amoxicillin 500 mg would involve different processes and responses. Consideration of genetic and age factors become critical in analyzing the symptomatic expressions and the outcome upon administration of the medication (Mccance & Huether, 2018).
I believe that association of streptococcus Group A (SGA) bacteria with genetic variations at the HLA region define the susceptibility of children to SGA (Medline Plus, 2021). This is expressed through symptoms like sore throat as a result of inflammatory reactions that links to the immune cell interaction with the perceived pathogen. Patients who have an alteration of the gene are not capable of producing g sufficient antibodies in response to the pathogen (Mccance & Huether, 2018). This leads to a recurrence and the need for medication. Inflammatory mediators triggered upon detection of pathogens may lead to redness, heat, swelling and pain.
Type-1 hypersensitive reaction involving immune cells such as the Helper-T cell results to the symptoms evident by the patient. Additionally, I agree that research indicate that there is a relation between age and susceptibility to disease. Some diseases are common among the elderly while some are common among children. It is true that pharyngitis is most common among children between age 5 and 15 (Mccance & Huether, 2018). Adults may also present with sore throat regardless of attaining remarkable immunity. Treatment require consideration of age in order to administer the correct doses and to prevent cases of adverse reactions.
References
Mccance, K. L., & Huether, S. E. (2018). Pathophysiology – e-book: The biologic basis for
disease in adults and children (8th ed.). Mosby.
Medline Plus. (2021, February 22). What is a cell?: Medlineplus genetics. Retrieved March 1,
2022, from https://medlineplus.gov/genetics/understanding/basics/cell/
Alterations in Cellular Processes
At its core, pathology is the study of disease. Diseases occur for many reasons. But some, such as cystic fibrosis and Parkinson’s Disease, occur because of alterations that prevent cells from functioning normally.
Understanding of signals and symptoms of alterations in cellular processes is a critical step in diagnosis and treatment of many diseases. For the Advanced Practice Registered Nurse (APRN), this understanding can also help educate patients and guide them through their treatment plans.
For this Discussion, you examine a case study and explain the disease that is suggested. You examine the symptoms reported and explain the cells that are involved and potential alterations and impacts.
resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To prepare:
By Day 1 of this week, you will be assigned to a specific scenario for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
by day 3 of Week 1
Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:
- The role genetics plays in the disease.
- Why the patient is presenting with the specific symptoms described.
- The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
- The cells that are involved in this process.
- How another characteristic (e.g., gender, genetics) would change your response.
Read a selection of your colleagues’ responses.
by day 6 of Week 1
Respond to at least two of your colleagues on 2 different days 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.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your peers’ posting. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Sample Answer 6 for NURS 6501 Discussion: Alterations in Cellular Processes
. I agree that this is a type one hypersensitivity reaction the patient suffers from due to the ingestion of penicillin. The fact that he is 16 years old and has anaphylactic symptoms, with the only new medication mentioned as penicillin, leads me to believe this is a genuine hypersensitivity reaction. Penicillin is typically the first-line antibiotic prescribed to patients when being treated for strep A. Other medications can be utilized, but it is noted that most physicians rely on this one most of the time. Strep A is commonly seen in the age group of 5 to 15. It is widely practiced by pediatricians to not test for strep in children three years in younger. This is because the risk of children under three developing rheumatic fever is extremely rare (Centers for Disease Control and Prevention [CDC], 2022).
The main reason for treating strep A with antibiotics is to prevent the risk of rheumatic fever and post-streptococcal glomerular nephritis. Children (5-15yrs) worldwide develop acquired heart disease due to rheumatic fever after pharyngitis, impetigo, or scarlet fever brought on by group A -hemolytic streptococcal infection is a delayed, nonsuppurative, autoimmune condition (Alqanatish et al., 2019).
An uncommon kidney condition called post-streptococcal glomerulonephritis (PPSGN) can appear following group A strep infections (Centers for Disease Control and Prevention [CDC], 2023). PPSGN is not a kidney-related strep infection. Instead, PSGN is the result of the body’s immune system combating strep throat, scarlet fever, or impetigo. The typical development time for PSGN is ten days after the onset of strep throat or scarlet fever symptoms. It takes around three weeks for PSGN to manifest after the first sign of impetigo. (CDC, 2023)
“Penicillin is a member of an important class of antibiotics known as beta (ß)-lactam antibiotics, which are generally efficient at eradicating common bacterial infections and are frequently used to treat skin, ear, sinus, and upper respiratory tract infections because they are very affordable. This category of antibiotics consists of penicillin and derivatives of penicillin, such as ampicillin and amoxicillin, as well as cephalosporins, monobactams, carbapenems, and ß-lactamase inhibitors. Like most pharmaceuticals, penicillin has common side effects and unpleasant reactions. Nevertheless, IgE-mediated genuine drug allergy represents a small percentage of all reported adverse medication responses” (Bhattacharya, 2010, p. 1).
S Strep A has always been an infection that has caused great concern for me. When I first got out of nursing school, there was a Sentinel event in our emergency room involving a 6-year-old girl who had had strep A, and the parents had not sought treatment for her before coming to the emergency room. She had been sick for a few days, and when they brought her in, the triage nurse had not thoroughly assessed her. When they got her back and started working on her, they noted that her hands and feet were cyanotic. Shortly after that, she coded. They were unable to revive her. In the medical community, we often hear about such infections that we forget they can have catastrophic ends. Understanding why and how things occur in the body on a cellular level makes understanding how to help much easier.
References
Alqanatish, J., Alfadhel, A., Albelali, A., & Alqahtani, D. (2019). Acute rheumatic fever diagnosis and management: Review of the global implications of the new revised diagnostic criteria with a focus on saudi arabia. Journal of the Saudi Heart Association, 31(4), 273–281. https://doi.org/10.1016/j.jsha.2019.07.002Links to an external site.
Bhattacharya, S. (2010). The facts about penicillin allergy: A review. Journal of advanced pharmaceutical technology & research, 1(1), 11–17. https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22247826/?tool=EBILinks to an external site.
Centers for Disease Control and Prevention. (2022, December 19). Pharyngitis (strep throat): Information for clinicians. https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.htmlLinks to an external site.
Centers for Disease Control and Prevention. (2023, January 18). Post-streptococcal glomerulonephritis (psgn): All you need to know. Center for disease control and prevention. https://www.cdc.gov/groupastrep/diseases-public/post-streptococcal.htmlLinks to an external site.
Sample Answer 7 for NURS 6501 Discussion: Alterations in Cellular Processes
Case Study Discussion
“The role genetics plays in the disease.”
Individuals with the essential condition known as rhabdomyolysis are prone to developing because of the enzyme phospholipids. Some of these include Duchenne muscular dystrophy and other genetic disorders. Although genetics play a role in the development of rhabdomyolysis, it is not the cause. Instead, it is the compression of muscles caused by substance abuse and immobility.
“Why the patient is presenting with the specific symptoms described.”
The damage to the muscles in the hip caused by Rhabdomyolysis is one of the reasons why the patient was experiencing burning pain in their hip. The inflammation and destruction of the muscle tissues caused by the leakage of plasminogen and thromboplastin can lead to vascular obstruction and necrosis. This condition can cause burning pain over the forearm. The high potassium level people experience due to this condition can be attributed to potassium leakage into the circulation. (McCance & Huether, 2019b)
“The physiologic response to the stimulus presented in the scenario and why you think this response occurred.”
Naloxone reverses opioid overdoses by blocking the opioid receptors in the CNS, thus reducing or eliminating the depressant effects of opioids. It is an antidote used clinically to treat respiratory depression caused by overdose or poisoning due to opioids (Johansson et al., 2019). Most of the drugs that are abused can affect the skeletal muscles. This can lead to Rhabdomyolysis. The patient’s condition shows that he or she was lying down at an unknown time, which might have caused the pressure in specific muscle compartments to rise. These include the hip, gluteal, and leg muscles.
“The cells that are involved in this process”
The cells involved in this process are the neurons within the central nervous system. The neurons most commonly affected by opioid overdoses and overdoses associated with substance abuse are located in the locus coeruleus, a part of the brain stem and spinal cord (Daga et al., 2019). The damage to muscle cells is the leading cause of this process. Myoglobin then leaks into the blood, which can cause renal toxicity. In addition, muscle ischemia can lead to nerve damage and fluid shift resulting from hypovolemia. Also, hyperkalemia can cause dysrhythmias.
“How another characteristic (e.g., gender, genetics) would change your response”
Individuals suffering from genetic disorders such as McArdle disease or those with missing or deficient enzymes are more prone to experiencing Rhabdomyolysis. However, this condition is not caused by congenital defects. Instead, it is a result of substance abuse and immobility. Differences in gender and genetics may affect a patient’s physiologic response to opioids. Research shows that women are more sensitive to the effects of opioids than men due to their smaller body size and differences in opioid receptors (Wang et al., 2019). Women and men with the mu-opioid receptor gene produce less of them, making them physically dependent on opioids faster than their non-carriers.
References
Wang, S. C., Chen, Y. C., Lee, C. H., & Cheng, C. M. (2019). Opioid addiction, genetic susceptibility, and medical treatments: a review. International journal of molecular sciences, 20(17), 4294.
Daga, M. K., Kumar, L., & Shukla, J. (2019). Central nervous system depressants: overdose and management. Princ Pract Crit Care Toxicol, 77.
McCance, K. L. & Huether, S. E. (2019a). Alterations of Musculoskeletal Function. In V. Brashers & N. Rote. (Eds.), Pathophysiology: The biologic basis for disease in adults and children (8th ed.). (pp. 1430-1432). St. Louis, MO: Mosby/Elsevier.
Johansson, J., Hirvonen, J., Lovró, Z., Ekblad, L., Kaasinen, V., Rajasilta, O., … & Scheinin, M. (2019). Intranasal naloxone rapidly occupies brain mu-opioid receptors in human subjects. Neuropsychopharmacology, 44(9), 1667-1673
