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

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.