NURS 6501: Advanced Pathophysiology week 1 Discussion: Alterations in Cellular Processes

NURS 6501: Advanced Pathophysiology week 1 Discussion: Alterations in Cellular Processes

Streptococcal pharyngitis (Strep Throat)

There are several disorders that may mimic strep throat (Gottlieb, Long, Koyfman, 2018). However, I am confident that treating this patient for strep throat is a good decision.  Research indicates that strep throat may be genetically -connected, particularly among children who get strep throat frequently. It is believed that an antibody deficiency aberrant TFh cell is involved (Dan et al, 2019) NURS 6501: Advanced Pathophysiology week 1 Discussion: Alterations in Cellular Processes.

The cause of strep throat is group A hmoltic Streptococcus. Children may be at risk of developing strep throat for a number of reasons such as socializing crowded  places at school where someone else is infected, brushes their teeth where moist bacteria is found on uncleaned toothbrushes, and contaminated foods.In most cases, Beta-hemolytic streptocccus leads to acute pharyngiti NURS 6501: Advanced Pathophysiology week 1 Discussion: Alterations in Cellular Processes. The body initiates an inflamamatory response in the pharynx, which ultimately results in fever, pain vasodilation edema, and tissue swelling.

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On the cellular level, the involvement of epithelial cells, neutrophils, macrophages, and dendritic cells , all secret inflammatory mediators. Th1 and Th17 responses  are involved in adaptive immunity in both murine models of GAS pharyngitis and tissues in the tonsil (Soderholm, Barnett, Sweet, & Walker, 2018). Another characteristic would not change my response to diagnosing this illness. This was a relatively strong case for strep throat. NURS 6501: Advanced Pathophysiology week 1 Discussion: Alterations in Cellular Processes

References

Dan, J., Daughton, C., Kendric, K., Al-Kolla, R., Kaushik, K.  (Feb. 2019). Recurrent group A Streptococcus tonsillitis is an immunosusceptibility disease involving antibody deficiency and aberrant TFH cells. Science Translational Medicine, 11, 478. doi:10.1126/scitranslmed.aau3776.

Gottlieb, M; Long, B; Koyfman, A (May 2018). Clinical Mimics: An Emergency Medicine-Focused Review of Streptococcal Pharyngitis Mimics. The Journal of Emergency Medicine. 54 (5): 619–629. doi:10.1016/j.jemermed.2018.01.031

.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 immunopathologies. J Leukoc Biol.,103(2):193‐213. doi:10.1189/jlb.4MR0617-227RR

Responses

Thank you for sharing with us, your discussion post and I would like to offer a few pointers. Strep throat, also known as streptococcal pharyngitis, is caused by a bacterium called Group A streptococcus (GAS) (Centers for Disease Control and Prevention, 2018).  After infecting an individual, GAS lives in the nose or throat and can be easily transmitted as droplet infection through coughing and sneezing. Children are most susceptible to this disease because they tend to congregate in large groups as they play and are not up to the task on matters of hand hygiene.

Like you pointed out, studies have shown that recurrent infections of strep throat could point to a genetic connection. The antibody specific to fighting GAS is anti-streptococcal pyrogenic exotoxin (Anti-SpeA) and lack of it or any genetic alteration in the body of a child makes them vulnerable to infections.  “Recurrent Tonsillitis children exhibited reduced antibody responses to an important GAS virulence factor, streptococcal pyrogenic exotoxin A (SpeA)” (Dan et al, 2019). Children who are born with genetically transmitted immunocompromising conditions are also prone to infections like these. Cases include HIV, hemophilia, leukemia, neutropenia, and systemic lupus erythematosus (SLE).

References

Centers for Disease Control and Prevention (2018). GroupA streptococcal (GAS) Disease. Retrieved from https://www.cdc.gov/groupastrep/diseases-public/strep-throat.html

Dan, J, M., Havenar-Daughton, C  Kendric, k., Al-Kolla, R., Kaushik, K., Rosales, S. L., Anderson, E. L., LaRock, C. N., Vijayanand, N., Seumois, G., Layfield, D., Cutress, R. I., Ottensmeier, C. H., Lindestam, C. S., Alessandro A. S., Nizet, V., Bothwell, M., Brigger, M., 

& Crotty, S.(2019). Recurrent group A Streptococcus tonsillitis is an immune susceptibility disease involving antibody deficiency and aberrant TFH cells. Science translational medicine 11(478). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6561727/

Great post! It is very true that many illnesses exist that mimic these respiratory symptoms and as nurse practitioners it will be important for us to distinguish between these different illnesses in order to properly treat our patients. Mayo clinic (2019) states the two important tests to help confirm or rule out strep throat is a rapid antigen test or a throat culture. The Provider took the important step of testing the little boy and it came back positive for strep. As you mentioned Strep throat is caused by group A Streptococcus, which is a bacteria, and the appropriate course of treatment for this infection is antibiotic. Per the CDC the common course of treatment is antibiotics, usually penicillin or amoxicillin (2018). Although we did not get the information on the little boy’s allergies, this is an important step when prescribing any medication. It is possible the little boy had never had this medication before, but when he took the medication, he had a severe allergic reaction. There are different levels of allergic reaction but to be considered anaphylaxis there must be a rapid onset of symptoms that may lead to death (Reber, Hernandez, & Galli, 2017). Based off the patient’s rapid allergic response and it was affecting his airway and work of breathing this could be considered an anaphylactic reaction. The characteristic of having an allergy to penicillin or amoxicillin would have changed the course of treatment. There are alternative antibiotics that can be used to treat strep throat, which include narrow spectrum cephalosporins. This was a great scenario in order to learn more about the immune and inflammatory response, but also the important tests and questions to ask when treating our patients.

CDC. (2018, November 01). Group A Strep. Retrieved June 03, 2020, from https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html

Mayo Clinic. (2018, September 28). Strep Throat. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/strep-throat/diagnosis-treatment/drc-20350344.

Reber, L. L., Hernandez, J. D., & Galli, S. J. (2017). The pathophysiology of anaphylaxis. Journal of Allergy and Clinical Immunology, 140(2), 335-348. doi:http://dx.doi.org.ezproxy.liberty.edu/10.1016/j.jaci.2017.06.003

Discussion: Alterations in Cellular Processes

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.

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 colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. 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! NURS 6501: Advanced Pathophysiology week 1 Discussion: Alterations in Cellular Processes

Streptococcal Pharyngitis

Strep throat is also known as streptococcal pharyngitis.It is an infection of the throat, pharynx, and tonsils caused by a bacteria called Group A streptococcus (GAS) or streptococcus pyogenes. It is commonly diagnosed with a rapid strep test or throat culture (Cohen, Bertille, Cohen,

& Chalumeau,2016). The rapid strep test is indicated when other differential diagnoses have been eliminated; If symptoms are unclear, a throat culture is more reliable due to the rapid strep test, also showing positive for carriers. The case study indicated a positive rapid strep test for the patient, in addition to presenting signs and symptoms hence the diagnosis of strep throat. Strep throat is highly contagious. The bacteria typically enter the body through the respiratory tract and mouth and spread through direct contact with respiratory droplets from an infected person’s cough, saliva, or sneezes (Centers for Disease Control and Prevention, 2018). It also spreads through

indirect contact by sharing of eating utensils like cup or spoons and touching contaminated surfaces and then touching the mouth or nose. NURS 6501: Advanced Pathophysiology week 1 Discussion: Alterations in Cellular Processes

The Role of Genetics in Strep Throat

Strep throat is commonly seen in children between the ages of three and 15 (American Academy of Family physicians, 2016). The strep A bacteria is highly contagious, and because of its mode of spread, children are more susceptible, especially children in groups. However, some children may have recurring strep throat infections, which may be related to genetics that prevent or disrupt activation of the immune response that helps fight against infections (La Jolla Institute, 2019). Dan, Havenar-Daughton, and Crotty (2019), indicated that children with recurrent strep throat infection were found to have a family history of tonsillectomy, suggesting possible hereditary traits that predispose children to a recurrent strep throat infection.

In humans, when an infectious agent enters the respiratory tract, it is recognized by pattern recognition receptors (PRRs), after which a series of the immune response is activated. The innate and adaptive immunity may be activated in response to infection; if adaptive immunity is activated, a specific antibody is developed to fight against that specific infection. A study by La Jolla Institute, (2019), found a decreased level of the anti-streptococcal pyrogenic exotoxin (anti-SpeA) in some children. Anti-speA is an antibody specific to the streptococcal A bacteria’s antigen, thus indicating a genetic alteration in the development or activation

of the anti-SpeA, which could increase the susceptibility of some children to a recurrent strep throat infection.

PhysiologicalResponse to the Stimulus

The streptococcus A Beta hemolytic bacteria gains entrance into the body through the mouth or the upper respiratory tract and attaches to the upper resp system walls, releasing its toxins. The cell surface of the strep A bacteria contains the M-proteins and hyaluronidase, which promotes adhesion to epithelial cells, attack host cells, and also promotes the spread of the bacteria causing more toxins to be released (Todar, 2015). When these toxins are released, they activate the inflammatory response. Some of these toxins released also cause hemolysis and slow down the process of phagocytosis, thereby making the immune system work harder to fight the infection (Todar, 2015).

The incubation period for streptococcal pharyngitis is2-5 days after which more symptoms begin to manifest (Centers for Disease Control and Prevention, 2018). The presence of phagocytic cells and the toxins in the blood intensify the inflammatory response; the toxins and inflammatory response trigger systemic symptoms such as fever, swelling, and redness of the tonsils and pharynx, production of exudates, palatal petechiae, anterior cervical lymphadenopathy, and sore throat similar to the symptoms of the patient in this case study. The inflammatory response occurred as a defense mechanism against microorganisms in the body. The inflammatory process is characterized by swelling, fever, pain, and redness, which may be local or systemic, depending on the severity of the response needed to fight against the infection (McCance, & Huether, 2019). In the case of strep throat, the symptoms could be mild, moderate or severe. Patients could also be asymptomatic. Some of the physiologic responses, as seen in this scenario, could also be a result of the toxins from the strep pyogenes for example, hyaluronidase released from the microorganism destroys hyaluronic acid causing local inflammation. NURS 6501: Advanced Pathophysiology week 1 Discussion: Alterations in Cellular Processes

Streptococcal pharyngitis can be self-limiting and may resolve by itself within a few days; however, to avoid complications, treatment is recommended with antibiotics. Penicillin or amoxicillin is the recommended antibiotic to treat strep throat unless the patient is allergic to penicillin (Centers for Disease Control and Prevention, 2018). In this scenario, the patient was

prescribed amoxicillin 500mg every 12 hours for ten days; the patient reportedly took the first dose when he got home and complained of swollen tongue and lips, difficulty breathing, and audible wheezing. The patient experienced an anaphylactic reaction to amoxicillin, evidenced by swelling of tongue and lips as well as shortness of breath, anaphylactic reactions are life-threatening and should be treated immediately. This patient will need to be prescribed a different antibiotic to treat the streptococcus pharyngitis. NURS 6501: Advanced Pathophysiology week 1 Discussion: Alterations in Cellular Processes

Cells involved in the process

The cells involved in the process are commensurate with the cells involved in immune response, including the inflammatory process, innate, and adaptive immune response. Some of these cells include; neutrophils, lymphocytes (T-cells and B-cells), macrophages, dendritic, and mast cells around the Respiratory tract (McCance, & Huether, 2019) NURS 6501: Advanced Pathophysiology week 1 Discussion: Alterations in Cellular Processes.

How Gender or genetics affects streptococcal pharyngitis

Streptococcus pharyngitis can affect all age groups, but it is more common in children age three to 15; this is especially true in school-aged children (Centers for Disease Control and Prevention, 2018). Due to the mode of transfer, people, seen in large groups are more susceptible to contracting strep throat, especially children whose immune system is yet to be mature. Genetics play an important role in the infection with strep throat, strep throat can be self-limiting because the immune system can fight against the infection. However, it is recommended to treat with antibiotics due to the risk of overworking the immune system and leading to complications such as rheumatic fever, which occurs as a result of the immune system attacking cells that are similar to group A streptococcus even after the infection has been resolved.

After the immune response is activated to fight streptococcus pyogenes, the adaptive immune system develops specific antibody against the strep A antigen, therefore when reinfection occurs, the body is able to recognize and fight the infection more quickly, the individuals with the compromised immune system are at risks for recurrent infection because they may have a delayed or inadequate immune response, for example, individuals congenital neutropenia may be unable to produce sufficient B-cells and T-cells needed for normal immune response. Also, some genetically inherited conditions may deter the production of antibodies in response to infections; this could be seen with individuals who have genetically transmitted immune deficiencies like HIV or lupus. NURS 6501: Advanced Pathophysiology week 1 Discussion: Alterations in Cellular Processes

References

American Academy of Family physicians (2016). Strep throat. American Family Physician,

94(1). Retrieved from https://eds-b-ebscohostcom.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?vid=13&sid=bf175544-1fe1-479f-8327-40e4926963d1%40pdc-v-sessmgr03

Centers for Disease Control and Prevention (2018). GroupA streptococcal (GAS) Disease. Retrieved from https://www.cdc.gov/groupastrep/diseases-public/strep-throat.html

Cohen, J. F, Bertille, N., Cohen, R., & Chalumeau, M.(2016). Rapid antigen detection test for group A streptococcus in children with pharyngitis. Cochrane Database of Systematic Reviews, 7. DOI:10.1002/14651858.CD010502.pub2. NURS 6501: Advanced Pathophysiology week 1 Discussion: Alterations in Cellular Processes

Dan, J, M., Havenar-Daughton, C  Kendric, k., Al-kolla, R., Kaushik, K., Rosales, S. L., Anderson, E. L., LaRock, C. N., Vijayanand, N., Seumois, G., Layfield, D., Cutress, R. I., Ottensmeier, C. H., Lindestam, C. S., Alessandro A. S., Nizet, V., Bothwell, M., Brigger, M., 

& Crotty, S.(2019). Recurrent group A Streptococcus tonsillitis is an immune susceptibility disease involving antibody deficiency and aberrant TFH cells. Science translational medicine 11(478). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6561727/

La Jolla Institute for Immunology (2019). Why strep throat comes back. Science& Children, 56(7), 10–11.Retrieved from https://eds-a-ebscohost-com.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?vid=4&sid=4f92c9ec-71cf-4939-900b-61dd7f1c1e65%40sdc-v-sessmgr01

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children. Innate Immunity: Inflammation and wound healing. (8th ed., pp 191-217). St. Louis, MO: Mosby/Elsevier.

Todar, K (2015). Streptococcus pyogenes and StreptococcalDisease (page 2). Retrieved from

http://textbookofbacteriology.net/streptococcus_2.html   NURS 6501: Advanced Pathophysiology week 1 Discussion: Alterations in Cellular Processes