At its core, pathology is the study of disease. Diseases occur for many reasons. But some, such as cystic fibrosis and Parkinson\u2019s Disease, occur because of alterations that prevent cells from functioning normally.<\/span>\u00a0<\/span><\/p>\n 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.<\/span>\u00a0<\/span><\/p>\n 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.\u202f<\/span>\u00a0<\/span><\/p>\n Be sure to review the Learning Resources before completing this activity.<\/span> By Day 1 of this week, you will be assigned to a specific scenario for this Discussion. Please see the \u201cCourse Announcements\u201d section of the classroom for your assignment from your Instructor.<\/span>\u00a0<\/span><\/p>\n Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:<\/span>\u00a0<\/span><\/p>\n Read<\/span><\/b>\u202fa selection of your colleagues\u2019 responses.<\/span>\u00a0<\/span><\/p>\n Respond\u202f<\/span><\/b>to\u202f<\/span>at least two\u202f<\/span><\/b>of your colleagues on\u202f<\/span>2 different days<\/span><\/b>\u202fand respectfully agree or disagree with your colleague\u2019s assessment and explain your reasoning. In your explanation, include why their explanations make physiological sense or why they do not.<\/span>\u00a0<\/span><\/p>\n In this week\u2019s case study, the patient presents with a chief complaint of a sore throat and multiple other symptoms that resulted in a positive strep test. Strep throat, also known as bacterial pharyngitis, is caused by the presence of Streptococcus group A bacteria that is spread by respiratory droplets and is the most common cause of pharyngitis in children (Chauhan, et al., 2016). In a recent meta-analysis, 37% of children less than 18 years old were diagnosed with Group A Strep and presented to an outpatient center for treatment for a sore throat in comparison to only 15% of adults (Ashurst & Edgerley-Gibb, 2022).<\/span>\u00a0<\/span><\/p>\n The patient presented with a sore throat, reddened posterior pharynx with white exudate, and 3+ tonsils- all due to the presence and colonization of the streptococcus bacteria. The positive sign of anterior and posterior cervical adenopathy is due to the infection and the body’s response to try and fight the infection. The patient was prescribed ten days\u2019 worth of amoxicillin and after consumption, immediately experienced swelling of the tongue and lips, difficulty breathing, and wheezing. The patient was having an anaphylaxis reaction to the antibiotics. An anaphylaxis response is IgE mediated and results in mast cells releasing a large amount of histamine and leukotrienes that cause bronchospasm and edema (Vaillant, Vashisht, & Zito, 2022).<\/span>\u00a0<\/span><\/p>\n Even after antibiotic treatment, some children get recurrent strep throat due to a genetic basis. A study performed by Dr. Shane Crotty and Dr. Jennifer Dan (2019), explored the germinal centers of both children with a normal rate of infection and those with recurrent tonsillitis. Their findings suggested that children with recurring strep throat had smaller germinal centers with fewer B and helper T cells which are responsible for producing antibodies and fighting invading pathogens. Upon further research, it was discovered that the genetic component was identified as two variants in the HLA genomic region which are associated with increased susceptibility to recurrent tonsillitis as well as protecting against the disease. If a child presented with recurring group A streptococcus pharyngitis, it may warrant a different response than treating with just antibiotics, such as referring them to an ENT for a tonsillectomy.<\/span>\u00a0<\/span><\/p>\n \u202f<\/span>\u00a0<\/span><\/p>\n Ashurst, J. V., & Edgerley-Gibb, L. (2022). Streptococcal Pharyngitis.\u202f<\/span>National Library of Medicine<\/span><\/i>. Retrieved from https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK525997\/<\/a><\/span>\u00a0<\/span><\/p>\n Chauhan, S., Kashyap, N., Kanga, A., Thakur, K., Sood, A., & Chandel, L. (2016). Genetic diversity among group A streptococcus isolated from throats of healthy and symptomatic children.\u202f<\/span>Journal of Tropical Pediatrics, 62<\/span><\/i>(2), 152-157. doi:10.1093\/tropej\/fmv092<\/span>\u00a0<\/span><\/p>\n Crotty, S., & Dan, J. (2019). Recurrent group A streptococcus tonsillitis is an immunosusceptibility disease involving antibody deficiency and aberrant TFH cells.\u202f<\/span>Science Translational Medicine, 11<\/span><\/i>(478). doi:DOI: 10.1126\/scitranslmed.aau3776<\/span>\u00a0<\/span><\/p>\n Vaillant, A. A., Vashisht, R., & Zito, P. M. (2022). Immediate hypersensitivity reactions.\u202f<\/span>StatPearls<\/span><\/i>. doi:https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK513315\/<\/a><\/span>\u00a0<\/span><\/p>\n \u202f\u202f\u202f\u202f\u202f\u202f\u202f\u202f\u202f\u202f\u202f In this scenario, an otherwise healthy 16-year-old boy is diagnosed with strep pharyngitis (strep throat) via an in-office rapid strep test, which tests for group A streptococcus bacteria (Cohen et al., 2016). He was prescribed penicillin, which is the antibiotic of choice for a patient with no known allergy to penicillin given that there is no strain of group A streptococcus bacteria that is resistant to it (\u201cCenters for Disease Control,\u201d 2022). Unfortunately for this young man, upon taking his first dose of penicillin he experienced an anaphylactic response, as evidenced by lip and oral swelling and breathing difficulties. This response is the most rapid and severe, and characteristic of a Type I hypersensitivity reaction, or IgE-mediated response resulting from the sensitization of mast cells by the binding of IgE to Fc protein receptors on the plasma membranes (McCance & Huether, 2019). Once sensitized, further exposure results in degranulation and release of histamine causing bronchial constriction and increased vascular permeability producing the breathing difficulties and lip and oral swelling respectively seen in this patient (Patterson & Stankewicz, 2020; McCance & Huether, 2019). Though type IV (IgG-mediated) hypersensitivity reactions are found in penicillin allergies, the primary result of this would be related to a delayed hypersensitivity mechanism resulting in dermatologic symptoms, not reported in this case (McCance & Huether, 2019).<\/span>\u00a0<\/span><\/p>\n \u202f\u202f\u202f\u202f\u202f\u202f\u202f\u202f\u202f\u202f\u202f Of note, Type I allergic responses can only occur with prior sensitization of the Fc proteins on mast cells. This patient was presented as having no known drug allergies, and while he could have taken penicillin in the past, which could have resulted in sensitization without evidence of allergic reaction, consideration should be given to the possibility that the patient carries a genetic erroneous beta (b)-lactam allergy. This could result in the allergic reaction without previously having taken the drug (Bhattacharya, 2010). Knowing the patient has a serious sensitivity to penicillins, the clinician should be aware of a cross-sensitivity to cephalosporins due to similarities in the chemical structure (Patterson & Stankewicz, 2020). Though research has shown females have a greater predisposition to penicillin allergy than males, the case presentation demonstrates a clear hypersensitivity reaction in this patient (Park et al., 2007).<\/span>\u00a0<\/span><\/p>\n Bhattacharya, S. (2010). The Facts About Penicillin Allergy: A Review.\u202f<\/span>Journal of Advanced Pharmaceutical Technology and Research<\/span><\/i>,\u202f<\/span>1<\/span><\/i>(1), 11\u201317.<\/span>\u00a0<\/span><\/p>\n Centers for Disease Control and Prevention. (2022, June 27).\u202f<\/span>Pharyngitis (strep throat): Information for clinicians<\/span><\/i>. Centers for Disease Control and Prevention. https:\/\/www.cdc.gov\/groupastrep\/diseases-hcp\/strep-throat.html#:~:text=Penicillin%20or%20amoxicillin%20is%20the,that%20is%20resistant%20to%20penicillin.<\/a><\/span>\u00a0<\/span><\/p>\n Cohen, J. F., Bertille, N., Cohen, R., & Chalumeau, M. (2016). Rapid antigen detection test for group A streptococcus in children with pharyngitis.\u202f<\/span>Cochrane Database of Systematic Reviews<\/span><\/i>. https:\/\/doi.org\/10.1002\/14651858.cd010502.pub2<\/a><\/span>\u00a0<\/span><\/p>\n McCance, K., & Huether, S. (2019).\u202f<\/span>Pathophysiology: The biologic basis for disease in adults and children<\/span><\/i>\u202f(8th ed.). Elsevier.<\/span>\u00a0<\/span><\/p>\n Park, M. A., Matesic, D., Markus, P. J., & Li, J. T.-C. . (2007). Female sex as a risk factor for penicillin allergy.\u202f<\/span>Annals of Allergy, Asthma & Immunology<\/span><\/i>,\u202f<\/span>99<\/span><\/i>(1), 54\u201358. https:\/\/doi.org\/10.1016\/s1081-1206(10)60621-7<\/a><\/span>\u00a0<\/span><\/p>\n Patterson, R. A., & Stankewicz, H. A. (2020).\u202f<\/span>Penicillin Allergy<\/span><\/i>. PubMed; StatPearls Publishing. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK459320\/<\/a><\/span>\u00a0<\/span><\/p>\n Great explanation of the type I hypersensitivity presented in this week’s case study. I was interested to learn about the genetic component and the possibility of the beta (b)-lactam allergy you spoke of and did not consider it when I was reviewing this patient. My assumption was that the patient likely took penicillin before making him hypersensitive to it now. Upon further research, I found an article that studied the prediction of penicillin allergy through genome mapping. This study researched 387 patients with immediate allergic reactions to B-lactams and found significant associations between gene variants HLA-DRA and an allergy to penicillin (Gueant, et al., 2015). It is important to note that this study confirmed predictors of penicillin allergies but not to cephalosporins. Although rare, it is interesting to understand that there could be a genetic component to those with allergies to penicillin.\u202f Another aspect to consider with this case study is how recurring strep throat could be a genetic component. Germinal centers of individuals with recurrent strep were found to be smaller, there were fewer B and helper T cells and two variants in the HLA genomic region could make them more susceptible to tonsillitis (Crotty & Dan, 2019).\u202f<\/span>\u00a0<\/span><\/p>\n \u202f<\/span>\u00a0<\/span><\/p>\n Crotty, S., & Dan, J. (2019). Recurrent group A streptococcus tonsillitis is an immunosusceptibility disease involving antibody deficiency and aberrant TFH cells.\u202f<\/span>Science Translational Medicine, 11<\/span><\/i>(478). doi:DOI: 10.1126\/scitranslmed.aau3776<\/span>\u00a0<\/span><\/p>\n Gueant, J.-L., Romano, A., Cornejo-Garci, J.-A., Oussalah, A., Chery, C., Blanca-Lopez, N., . . . Gaeta, F. (2015). HLA-DRA variants predict penicillin allergy in genome-wide fine-mapping genotyping.\u202f<\/span>Journal of Allergy and Clinical Immunology, 135<\/span><\/i>(1), 253-259. doi:https:\/\/doi.org\/10.1016\/j.jaci.2014.07.047<\/a><\/span>\u00a0<\/span><\/p>\n The case scenario for this week’s discussion is regarding a sixteen-year-old who was diagnosed with strep throat and then had a reaction to the antibiotic prescribed. An<\/p>\n office-based rapid strep test confirmed that the patient had strep.<\/p>\n The bacteria that cause strep throat is A Streptococcus (CDC, 2019). The most common age group for this disease is between five and fifteen (CDC, 2019). Droplets of<\/p>\n respiratory secretions, such as coughing or sneezing, are responsible for their spread (CDC, 2019).<\/p>\n All proteins in the body are derived from DNA, the primary component of genes (McCance & Huether, 2019). Gene sequence changes can cause genetic disorders<\/p>\n (McCance & Huether, 2019). Invasive group A Streptococcus (GAS) patients have different susceptibilities and clinical outcomes. Recurrent tonsillitis is associated with specific<\/p>\n gene variations that reduce strep throat immunity. People with these gene variations are more likely to develop recurrent tonsillitis because their bodies cannot mount an<\/p>\n effective immune response to GAS. DebRoy et al. (2018) state that GAS weakens the host’s immune response, leading to infection. Vaccines against GAS infections target the<\/p>\n M proteins (DebRoy et al., 2018).<\/p>\n Genetics also play a role in the patient’s reaction to amoxicillin. The use of beta-lactam antibiotics such as amoxicillin has been associated with predisposing genetic factors<\/p>\n (Chen et al., 2018). In the case of strep throat, amoxicillin is recommended as a treatment (Carter et al., 2023). Since penicillin is the first-line treatment for strep throat,<\/p>\n patients are given alternative antibiotics when they report false penicillin allergies. This can lead to antibiotic overuse and increased antibiotic resistance, meaning they may no<\/p>\n longer be effective when the patient needs antibiotics (Carter et al., 2023). Additionally, the patient is at risk of experiencing an adverse reaction to antibiotics to which they<\/p>\n were not previously exposed.<\/p>\n The symptoms the patient presents with occur due to the immune system working. Reddened posterior pharynx results from an inflammatory response caused by the<\/p>\n immune system. \u00a0This is caused by the body’s response to foreign bodies or pathogens that invade the body. The immune system releases antibodies to fight the pathogens,<\/p>\n which in turn causes inflammation that results in the reddening of the posterior pharynx. Exudate on the tonsils indicates the immune system creates a physical defense<\/p>\n against infection. The exudate is produced by white blood cells and contains antibodies and other substances that help fight infection. In addition, swelling, cervical<\/p>\n adenopathy, fever, and pain are signs of the inflammatory response.<\/p>\n The immune system’s function is to defend against infection and foreign invaders.\u00a0When people suffer from an allergy, their body responds with hypersensitivity.<\/p>\n Amoxicillin is the stimulus or allergen in this scenario in which the body responds to it.\u00a0Symptoms of anaphylaxis include wheezing, difficulty breathing, and swelling of the lips<\/p>\n and tongue due to the body mistaking the allergen for a harmful substance and releasing antibodies to fight it.<\/p>\n IgG or IgM responses are elicited by allergens that bind to cells’ surfaces and cause type II allergic hypersensitivity. The allergen binds to IgE antibodies already attached to<\/p>\n the surface of mast cells and basophils, triggering the release of histamine and other substances that cause allergic reaction symptoms. These IgE antibodies also trigger the<\/p>\n body to produce IgG and IgM antibodies, which help to fight the allergen. The immune system attacks allergens on the cell membrane, which destroys the cells (McCance &<\/p>\n Huether, 2019). Amoxicillin’s antigen binds to erythrocytes or platelet plasma membranes and induces an antibody response that destroys the cell in this type of reaction<\/p>\n (McCance & Huether, 2019).\u00a0 Then neutrophil-mediated mechanisms occur, which causes the granulation of the neutrophils. The following mechanism is antibody-dependent<\/p>\n cell-mediated cytotoxicity or ADCC. ADCC occurs when antibodies produced by the immune system attach to foreign invaders. This triggers the release of chemicals that<\/p>\n attack and destroy invaders. Antireceptor antibodies block the normal function of receptors in the last mechanism.<\/p>\n In this scenario, a male teenager reacted to the medication. In the research, I found female patients have reactions to medications. In this case, I do not think being female<\/p>\n would have changed the response. Female patients are more likely to have a penicillin allergy than men, with the incidence of penicillin allergy being higher in females than<\/p>\n males (Albin & Agarwal, 2014). Drug allergies occur more frequently in women and young and middle-aged adults (Warrington et al., 2018).<\/p>\n Albin, S., & Agarwal, S. (2014). Prevalence and characteristics of reported penicillin allergy in an urban outpatient adult population.\u00a0Allergy and Asthma Proceedings<\/em>,\u00a035<\/em>(6), 489-<\/p>\n Carter, E. J., Kaman, K., Baron, K., Miller, M., Krol, D. M., Harpalani, D., Aseltine, R. H., & Pagoto, S. (2023). Parent-reported penicillin allergies in children: A qualitative<\/p>\n study.\u00a0American Journal of Infection Control<\/em>,\u00a051<\/em>(1), 56\u201361.\u00a0https:\/\/doi.org\/10.1016\/j.ajic.2022.04.008Links to an external site.<\/a><\/p>\n CDC. (2019, April 19).\u00a0Is your sore throat strep?\u00a0Centers for Disease Control and Prevention.\u00a0https:\/\/www.cdc.gov\/groupastrep\/diseases-public\/strep-throat.html#bacteria-Links to an external site.<\/a>Links to an external site.<\/a><\/p>\n cause-strepLinks to an external site.<\/a><\/p>\n \u200cChen, C.-B., Abe, R., Pan, R.-Y., Wang, C.-W., Hung, S.-I., Tsai, Y.-G., & Chung, W.-H. (2018). An Updated Review of the Molecular Mechanisms in Drug Hypersensitivity.\u00a0Journal<\/em><\/p>\n \u00a0 \u00a0 \u00a0of Immunology Research<\/em>,\u00a02018<\/em>, 1\u201322.\u00a0https:\/\/doi.org\/10.1155\/2018\/6431694Links to an external site.<\/a><\/p>\n \u200cDebRoy, S., Li, X., Kalia, A., Galloway-Pena, J., Shah, B. J., Fowler, V. G., Flores, A. R., & Shelburne, S. A. (2018). Identification of a chimeric emm gene and novel emm pattern in<\/p>\n currently circulating strains of emm4 Group A Streptococcus.\u00a0Microbial Genomics<\/em>,\u00a04<\/em>(11).\u00a0https:\/\/doi.org\/10.1099\/mgen.0.000235Links to an external site.<\/a><\/p>\nRESOURCES<\/span>\u00a0<\/span><\/h2>\n
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\nClick the weekly resources link to access the resources.\u202f<\/span>\u00a0<\/span><\/p>\nWEEKLY RESOURCES<\/span><\/b><\/a>\u00a0<\/span><\/h2>\n
To prepare:<\/span><\/b>\u00a0<\/span><\/h2>\n
BY DAY 3 OF WEEK 1<\/span>\u00a0<\/span><\/h2>\n
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BY DAY 6 OF WEEK 1<\/span>\u00a0<\/span><\/h2>\n
A Sample Answer For the Assignment: NURS 6501 ALTERATIONS IN CELLULAR PROCESSES<\/strong><\/h2>\n
Title: NURS 6501 ALTERATIONS IN CELLULAR PROCESSES<\/strong><\/h2>\n
References<\/span>\u00a0<\/span><\/h2>\n
A Sample Answer 2 For the Assignment: NURS 6501 ALTERATIONS IN CELLULAR PROCESSES<\/strong><\/h2>\n
Title: NURS 6501 ALTERATIONS IN CELLULAR PROCESSES<\/strong><\/h2>\n
References<\/span><\/b>\u00a0<\/span><\/h2>\n
A Sample Answer 3 For the Assignment: NURS 6501 ALTERATIONS IN CELLULAR PROCESSES<\/strong><\/h2>\n
Title: NURS 6501 ALTERATIONS IN CELLULAR PROCESSES<\/strong><\/h2>\n
References<\/span>\u00a0<\/span><\/h2>\n
A Sample Answer 4 For the Assignment: NURS 6501 ALTERATIONS IN CELLULAR PROCESSES<\/strong><\/h2>\n
Title: NURS 6501 ALTERATIONS IN CELLULAR PROCESSES<\/strong><\/h2>\n
Role Genetics Play in the Disease<\/strong><\/h2>\n
Presenting Specific Symptoms<\/strong><\/h2>\n
The Physiologic Response to the Stimulus (Amoxicillin) and why the Response Occurred<\/strong><\/h2>\n
The Cells Involved in this Process<\/strong><\/h2>\n
How Another Characteristic Would Change the Response<\/strong><\/h2>\n
References<\/strong><\/h2>\n
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