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
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