Class:
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
, 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
Hello
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/