Posted: May 14th, 2023

A 16-year-old boy comes to clinic with chief complaint

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:
Explain. 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.

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The disease highlighted in this scenario is a streptococcal pharyngitis, commonly known as strep throat, which is caused by the bacterium Streptococcus pyogenes. Strep throat is a common bacterial infection that primarily affects children and adolescents. It is highly contagious and spreads through respiratory droplets from an infected person.

Genetics can play a role in the susceptibility to strep throat. Some individuals may have a genetic predisposition to developing infections, including strep throat. Additionally, certain genetic variations can affect the immune response to the infection, leading to increased susceptibility or severity of the disease.

The patient is presenting with specific symptoms of sore throat, fever, swollen tonsils with white exudate, and cervical adenopathy. These symptoms are typical of strep throat and are caused by the inflammation of the pharynx and tonsils, as well as the immune response to the bacterial infection.

The physiologic response to the amoxicillin in the patient’s case is an allergic reaction. Amoxicillin is a common antibiotic used to treat bacterial infections, including strep throat. However, some individuals may develop an allergic reaction to the medication, which can range from mild skin rashes to severe anaphylaxis, as seen in this case. The allergic response occurs when the immune system identifies the medication as a foreign invader and mounts an immune response to eliminate it, leading to the release of inflammatory mediators and the symptoms of swelling, difficulty breathing, and wheezing.

The cells involved in the allergic response include mast cells and basophils, which are responsible for releasing histamine and other inflammatory mediators in response to an allergen. These mediators cause vasodilation, increased vascular permeability, and smooth muscle contraction, leading to the symptoms of the allergic reaction.

Another characteristic that could change the response is the patient’s gender. While gender itself may not play a direct role in the development of strep throat or the allergic reaction to amoxicillin, it can influence the presentation and severity of symptoms. For example, males are more likely to develop severe symptoms of strep throat, while females may be more prone to develop an allergic reaction to antibiotics. Additionally, certain medications may have different side effects or interactions based on gender, so gender should always be considered in medication management.

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