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M‌‍‍‌‌‍‌‌‌‌‌‍‍‍‌‌‌‌‍y initial post highlighted in yellow, so you responding to the post is below my post. It’s basically res‌‍‍‌‌‍‌‌‌‌‌‍‍‍‌‌‌‌‍ponding to what She said or informed but make sure respond in professional manner while proving initial po‌‍‍‌‌‍‌‌‌‌‌‍‍‍‌‌‌‌‍st.

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case study Q2

COLLAPSE

Question: What are the signs and symptoms in the patient indicative of possible GABHS infection compared to symptoms of viral pharyngitis.
John has a sore throat, a common symptom of various throat infections such as viral and bacterial pharyngitis and group A beta-hemolytic streptococcus (GABHS) pharyngitis. The fact that John can only eat liquid and not solid foods indicate that he could have a problem swallowing solid foods. In most cases, problems swallowing solid foods are caused by a painful or swollen throat and other issues in the upper respiratory system. The boy also has a fever common for viral pharyngitis and GABHS infection. In his case, the fever has been on and off for the last 24 hours at 102F. This is exactly what happens in GABHS patients whose temperature can get over 101F and keep changing from time to time (Burns et al., 2019). John has not had a cough, as stated by his mother.
In most cases, if he had a cough on top of his symptoms, we could have ruled out that he had viral pharyngitis. However, with his symptoms and no cough, John is more likely to be suffering from GABHS infection, which has no cough. John has also had a case of otitis media, with the latest one occurring about a year ago. Otitis media is a complication that may arise when an individual suffers from streptococcus pharyngitis. This means he must have suffered from GABHS not long before, which led to the complication. The current diagnosis of GABHS is a recurrent case after the previous one a year ago.
Moreover, the boy has multiple-enlarged anterior cervical lymph nodes greater than two centimeters in size. In GABHS, we find the anterior cervical glands swollen in such a manner as John’s. GABHS is associated with enlarged or swollen tonsils that may have or not have exudate (Burns et al., 2019). In the case of John, he also has tonsils, erythematous with associated white exudates. A faint scarlatiniform rash on John’s arms corresponds to GAHBS symptoms. A GABHS patient will have a rash starting mostly from the neck towards the trunk, which may develop within 24 hours of GABHS contraction and disappear in a week. John has headaches and stomachaches in line with GABHS symptoms despite not vomiting. The stomachache John is having is the abdominal pain symptom of GABHS (APA, 2020). He is also sleeping more than usual which must have been attributed to the fatigue in GABHS patients. John also has a soft palate that has notable petechiae. This is also a common symptom of GABHS. Uvula edematous, where the uvula swells, is also a symptom of GABHS, exhibited by John (Burns et al., 2019). The infection is also most common from three years to thirteen years. This implies that he is likely to contract the disease at John's age.
In conclusion, John is more likely to suffer from GABHS than viral pharyngitis. This is because, despite some symptoms for both infections being a bit similar, most of the symptoms of GABHS are unmatched by viral pharyngitis in the case of John. The boy should also be attended to quickly to avoid complications from untreated or delayed treatment of GABHS pharyngitis.

 References

American Psychological Association. (2020). Publication manual of the American Psychological Association (7th ed.). Washington, DC: American Psychological Association.

Burns, C., Dunn, A., Brady, M., Starr, N., et al. (2019).  Pediatric primary care (7th ed.). Elsevier: Philadelphia

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Jen Faulkner-Duphiney 

RE: case study Q2

COLLAPSE

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Hi Muzammil, 

Your post is very succinct and you did a nice job tying in the case with the theory of GABHS by distinguishing the pt’s symptoms to support the dx of GABHS

and not viral pharyngitis. 

Viral pharyngitis is caused by a number of viruses and present with overlapping symptoms in children. Aung (2019) discusses some of the common viruses

presenting in the younger pediatric population with sore throat including the following: 

 1) The common cold first presents with nasal symptoms: sneezing, watery nasal discharge, nasal congestion, or post nasal discharge. Sore throat symptoms

usually present after nasal symptoms with characteristics of soreness, scratchiness or irritation. As the cold progresses, symptoms can include: thick and yellow

rhinorrhea, non productive cough, low grade fever, and  hoarseness.  Severe sore throat pain or odynphagia (painful swallowing), chills, myalgia and profound

malaise are usually not present.

 2) Pharyngitis caused by various identified entero and coxsackie viruses include:  herpangina (coxsackie A2-6), hand-foot-and-mouth (coxsackie A5, 9, 10, 16 and

enterovirus 71), and Boston examthum (cause by echovirus type 16).

·  Young children presenting with herpangina have a sore throat, sore mouth, severeodynophagia, sudden fever up to 106, coryza, anorexia with 25% vomiting.  

·Hand-foot-and-mouth causes a low-grade fever (100-102), sore throat, anorexia, malaise, and rashes on the hands and feet

· Boston exanthem presents with sudden fever, sore throat, nausea, and rash on face and trunk.

3) RSV can present in children but has decreased in incidence with the RSV vaccination. Infants presenting with RSV present with a sore throat,

low-grade fever, cough, and  develop lower respiratory tract involvement causing dyspnea,, wheezing, and respiratory failure.  Outbreaks usually occur in the fall,

winter, and early spring.

 3) Adenovirus presents with a sore throat, more intense than the common cold, high fever, dysphasia, and red eyes. Red eyes is common in 33-50% of affected

patients caused by a concurrent conjunctivitis. This syndrome is named pharyngoconjunctival fever and can involve a history of swimming in a pool one week before

onset.

4) EBV is more common in adolescents and presents with primarily  sore throat and fatigue; pharyngeal symptoms usually present with other symptoms: fatigue,

skin rash, anorexia

 5) Acute hermetic phyaryngitis, usually in children and young adults, presents with a sore throat, sore mouth, gingivostomatitis, fever, mayalgia, malaise, inability to

eat, irritability.

6) Influenza presents usually occurs  in the late fall or winter in the US. And presents with a sore throat as chief complaint in some patients, occurs with an abrupt

onset, mayalgia, HA,  fever, chills, and dry cough and usually resolves in 3-4 days 

References:

Aung, K.K. (2019). Viral pharyngitis clinical presentation. Emedicine.medscape,com. Retreived on May  20, 2022 from 

https://emedicine.medscape.com/article/225362-clinical

Expert Solution

Jen-Faulkner Duphiney,

Thank you for your response to my post. I appreciate the feedback on the depth and detail of GABHS infection as portrayed in John, a case study we were analyzing. In my post, I used a comparative analysis of viral pharyngitis and GABHS, checking the differences in symptoms that each portrays and ruling out the possibility of the former in John's case. Your response, which has focused on viral pharyngitis, has enlightened me on the condition's symptoms, making it easily detectable. 

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