Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay
The assigned case study is a 16y.o. male presenting with sore throat and low grade fever. There are two separate conditions or events to describe. The patient presents with a red pharynx, enlarged tonsils, white patches, enlarged cervical lymph nodes, and low grade fever. There are differential diagnoses, but for describing the pathophysiology, I will describe the body’s reaction to bacterial pharyngitis, specifically strep throat. Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay. The patient is exhibiting an inflammatory response to a foreign substance that has made it past one of the first lines of defense. In the case that I am describing, a bacterial agent such as group A beta hemolytic streptococcus (Streptococcus pyogenes) may likely be the causative agent. Findings common with this infection are the presence of tonsillar exudate, erythema, and fever (Ebell et al., 2000). Initial, non-specific attempts are made to kill the foreign matter such as mucus secretions, and proteins produced by the epithelial tissue in the pharynx. The streptococci have survived and multiplied to a point that the immune system is launching an inflammatory response. Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay
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The bacterial microbes are now present in the tissue of the pharynx and initial immune response begins with mast cells, as well as damage to normal cells in the affected tissue. Mast cells release histamine which causes blood vessels to dilate and become somewhat permeable as the endothelial cells on the vessels separate slightly. Plasma will leak out into the surrounding tissue. This results in edema. The dilation of the vessels and exit of proteins and other solutes creates the red engorged appearance in the throat. The engorgement, edema, and the prostaglandin chemical mediator result in pain. Phagocytes arrive and will engulf and eliminate microbes indiscriminately. Neutrophils have also been signaled, and will enter the area from the now permeable blood vessels. As the neutrophils destroy microbes, they break down and the dead cell matter and other molecules create collections of waste material that present as pus. In the case of our patient, we see these collections as white patches or pockets on the throat. These actions are non-specific to the type of antigen. Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay
While the non-specific processes are taking place, dendritic cells which were present along with the mast cells at the beginning of the response are also destroying the bacterial microbes. Dendritic cells break down microbe and determine if bacteria or virus. Proteins from the microbe adhere to the cell wall. If bacteria, dendritic cell travels to lymph gland to activate T cell response. The proteins on the dendritic cell surface will match up and attach to specific T cells. When one of these helper T cells is activated it quickly begins to reproduce. Some of the resulting cells stay in the lymph node and become memory T cells waiting for an attack at some point in the future. They also go to center of the node and activate B cell which begins antibody production. Antibodies travel to the area of infection and bind to surface of bacteria. Once bound by the antibodies, the bacteria are targets for macrophages, resulting in more phagocytosis. Lymph nodes in the neck as well as the tonsils have become enlarged as they hold newly created T cells as well as waste that will be eliminated by the lymphatic system. The patient’s fever, although considered low grade, is most likely related to endotoxins from damaged tissue or destroyed bacteria, or from an interleukin (IL-1) released by white blood cells and causing the hypothalamus to increase body temperature (Garner & Fendius, 2010).
Based on clinical examination and presumptive diagnosis, the patient received a prescription for the antibiotic amoxicillin. Shortly after the first oral dose, the patient began to have signs and symptoms of allergic reaction. This is the second condition/event in the case study. The medication amoxicillin has been introduced into the patient’s system via his gastrointestinal tract and has entered into the bloodstream. It is immediately recognized as antigen. Mast cells immediately release histamine which is the major mediator and causes another inflammatory response. So again there is blood vessel dilation, plasma fluid leaking out of the blood vessels causing edema in lips, tongue, and possibly face and hands. More importantly, the mediator histamine acts on receptors in the bronchi of the lungs causing contraction of the smooth muscle tissue surrounding the airways. The result is difficulty breathing. Dendritic cells attach the antigen and proceed to a lymph node. Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay. Cytokines in the node called interleukins activate T cells and cause B cells to begin production of immunoglobulin E (IgE) antibodies and eosinophil leukocytes. Eosinophils release cytotoxins that cause damage to the allergen, but also to host cells. Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay
The severity of the reaction, if not caused by previous sensitivity could be a genetic predisposition to hypersensitivity. For example, if a parent has an allergy, especially type I which is food or drug, the child is predisposed to developing allergies as well (McCance & Huether, 2019). They will likely generate greater amounts of IgE than other individuals creating the hypersensitivity (McCance & Huether, 2019).
References
Ebell MH, Smith MA, Barry HC, Ives K, Carey M, Ebell, M. H., Smith, M. A., Barry, H. C., Ives, K., & Carey, M.
(2000). The rational clinical examination. Does this patient have strep throat? JAMA: Journal of the
American Medical Association, 284(22), 2912–2918.
Garner A, & Fendius A. (2010). Temperature physiology, assessment and control. British Journal of
Neuroscience Nursing, 6(8), 397–400.
McCance, K.L., & Huether, S.E. (2019). Pathophysiology The Biologic basis for desease in adults and children
(8th ed.). Elsiever. Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay
CHELSEY GASKIN Vania your discussion post was thorough and easily understood. When discussing this infection, I forgot to mention how dendritic cells and their connection to lymph glands. Dendritic cells are “the primary phagocytic cells located in the peripheral organs and skin, where molecules released from infectious agents are encountered, recognized through PRRs, and internalized through phagocytosis” (McCance & Huether, 2019). Though the dendritic cells are phagocytic cells meant to destroy they provide information to our lymph glands to activate our T cells, which then activate out B cells. When talking about our T cells we have the cytotoxic T Cells and Helper T cells fight on our side. The cytotoxic T Cells are going to disrupt or destroy the bacteria cells were the Helper T Cells stimulate our B cells. I feel you described the function of T cells and B cells well. As for the reaction to the medication I would agree with you regarding a possible previous exposure. Cows can receive antibiotics like penicillin or amoxicillin for different types of infections that can be secreted through their milk. Which could’ve been his first exposure to the medication causing a severe reaction this time. Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay
References:
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
Soo, P. (2018, July 28). Pathophysiology Ch 10 alterations in immune function
. Retrieved from https://www.youtube.com/watch?v=Jz0wx1-jTds
Case Study
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.
The role genetics plays in the disease
According to a study performed by La Jolla Institute of Immunology, reports show a correlation between genetic susceptibility and the predisposition of children having recurrent Group A Strep (La Jolla Institute for Immunology, 2019). Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay
Why the patient is presenting with the specific symptoms described.
Strep throat (Group A Streptococcal Pharyngitis) is an inflammation of the mucous membranes in the throat and tonsils caused by the bacterial streptococcus (Ahmad & Saleem, 2018). Characteristics of the illness can include pharyngeal and tonsillar erythema, tonsillar hypertrophy with or without exudates, palatal petechiae, and anterior cervical lymphadenopathy, fever, and difficulty swallowing (CDC, 2018). The virus (streptococci chains) enters the body through the respiratory system and colonizes. An inflammatory response then occurs due to the release of extracellular toxins by Group A Streptococcus (MedScape, 2018).
The physiologic response to the stimulus presented in the scenario and why you think this response occurred
The physiologic response in this scenario was an anaphylactic response to Amoxicillin. For an allergic reaction to occur there must be prior sensitization of the immune system. After the immune system has been sensitized to a drug, reexposure to that drug can trigger an allergic response. Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay
The cells that are involved in this process.
B-cells and T-cells are lymphocytes that help protect your body from foreign invaders. A foreign invader causes the production of antibodies or also known as an antigen. After the B-cell lymphocytes identify that antigen, it will change into a plasma cell and produce antibodies specifically made to kill the foreign invader identified. The antibody responsible for the allergic response is IgE. Once the B-cells identify that same foreign invader, a large quantity of IgE antibodies are produced that attach themselves to mast cells and basophils throughout the body. When the mast cells and basophils are destroyed, histamine from those cells is released into the bloodstream and body tissues. This process brings on symptoms such as hives, itching, swelling, sneezing, and wheezing (Beach, 2017).
How another characteristic (e.g., gender, genetics) would change your response
According to Faitelson et al., having asthma, being older, and having a family history of amoxicillin allergy are associated with higher risk of allergy (2018). Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay
Resources
Ahmad, S., & Saleem, M. (2018). β-hemolytic streptococcal pharyngitis; diagnosing group a β-hemolytic streptococcal pharyngitis (strep throat) by brisk antigen detection. The Professional Medical Journal, 25(12), 1882–1886. doi: 10.29309/TPMJ/18.4585
Beach, S. (2017). How allergies work. Retrieved June 3, 2020, from https://health.howstuffworks.com/diseases-conditions/allergies/allergy-basics/allergy2.htm
Centers for Disease Control and Prevention. (2018). Group A strep. Retrieved June 3, 2020, from https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html
Choby, B. A. (2019). Diagnosis and treatment of streptococcal pharyngitis. Retrieved June 3, 2020, from https://www.aafp.org/afp/2019/0301/p383.html
Faitelson, Y., Boaz, M., & Dalal, I. (2018). Asthma, family history of drug allergy and age predict amoxicillin allergy in children. Journal of Allergy and Clinical Immunology.in Practice, 6(4), 1363-1367. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1016/j.jaip.2017.11.015 Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay
Group A Streptococcal (GAS) Infections. (2019, November 11). Retrieved from https://emedicine.medscape.com/article/228936-overview#a3
La Jolla Institute for Immunology. (2019). Why your kid’s strep throat keeps coming back. Retrieved June 3, 2020, from https://www.lji.org/news-events/news/post/why-your-kids-strep-throat-keeps-coming-back/
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier. Streptococcal pharyngitis (Strep Throat) Alterations in Cellular Processes Discussion Essay