Epstein Barr Case Study

Patient is a 9 year old adolescent male, presents with a 2 day history of itching encrusted sores especially around the mouth area. Parent is using OTC antibiotic ointment with no improvement, no recent history of fever. Parent states that pat recently visited a petting zoo

Ms. T is an eight year old African American female that presents to Dr. Bill’s Kids today with complaints of her tonsils bothering her again. She has been to this office three times in the past three months with complaints of swollen tonsils and painful swallowing. Each time, she has tested positive for Group A Streptococcus also known as GAS. Her mother is with her today and reports that she had strep throat in the past multiple times about two or three times a year, but it is becoming much more frequent. She began complaining of scratchy throat in the morning and at night, but the symptoms quickly progressed to painful swallowing of solids and liquids. Popsicles are the only thing she will even consider eating at this time because they alleviate the pain.

Streptococcus pyogenes, also known as Group A streptococcus (GAS), is a β-hemolytic, Gram-positive bacterium that most commonly causes respiratory disease, including pharyngitis or tonsillitis, as well as skin infections such as impetigo and cellulitis. The organism is transmitted via respiratory droplets or by contact with fomites, and commonly infects young children. In addition to the common clinical presentations associated with S. pyogenes, some individuals develop the postinfectious sequelae of rheumatic fever and glomerulonephritis. Due to the severity of these medical consequences, prophylactic antibiotic use is often recommended for any patients with otherwise mild S. pyogenes infections (21).

If a streptococcal infection such as pharyngitis or scarlet fever is left untreated, there is a small (~3%) chance that within approximately 20 days, the patient will present with rheumatic fever. After the first bout of rheumatic fever, if the host acquires a second untreated S. Pyogenes infection, the chance of coming down with rheumatic fever jumps substantially to ~50%. Most often this secondary disease will strike people aged 6-15 years old, roughly 20 days after the streptococcal infection, with a 2-5% mortality rate. One of the major diagnostic symptoms of this disease is Erythema Marginatum, snake- or ring-like eruptions covering the trunk, upper arms, and legs. Other symptoms include fever, arthritis (elbows, knees, wrists, and ankles), swollen joints, pain in the abdomen, nodules

According to R.P. she is allergic to sulfa (thrush), eggs, Allegra (cramps) and Penicillin (GI upset. Her past medical history consists of hypothyroidism, chronic sinusitis, endometrial cancer and a mitral valve prolapse. The conditions that required hospitalization was a surgical removal of the ovaries and a hysterectomy in year of 2006. R.P. also had surgery on the right elbow and an appendectomy, but was unable to recall the year. The medications that she is currently taking are levothyroxine, Claritin, Singular, Prilosec and propranolol. R.P. is currently up-to-date with immunizations of Td/Tdap in 2016 and vaccinations of pneumococcal 11/2016. Client refused influenza vaccine.

Streptococcus pharyngitis is a bacterial infection of the throat caused by Streptococcus pyogenes, also known as group A Streptococcus. It can causes throat pain, difficulty with swallowing, red and swollen tonsils which can be accompanied with white patches or streaks of pus, red spots on the palate, swollen lymph glands in the neck, fever, headache, rash, stomach ache, and fatigue. It can lead to more serious conditions such as scarlet fever, inflammation of the kidneys, and rheumatic fever. When Streptococcus pharyngitis is suspected, usually a rapid antigen test is run but a throat culture also needs to be done. Treatment is usually Penicillin and Amoxicillin for children. Nursing intervention for Streptococcus pharyngitis is to make sure the patient gets plenty of rest and also to push fluids to keep the back of the throat lubricated and to prevent dehydration (http://www.mayoclinic.org/diseases-conditions/strep-throat/basics/definition/con-20022811).

Acute tonsillitis is inflammation of the tonsils secondary to an infectious process causing painful swallowing and is more commonly attributed to a viral cause rather than bacterial (Shepherd, 2013). A physical assessment of the tonsils may reveal an increase in size with edema and erythema. This is often associated with upper respiratory symptoms like, headache and cough (Shepherd, 2013). Another diagnosis is pharyngitis. Pharyngitis is also a sore throat which is secondary to inflammation noted at the back of the throat and associated with complaints of pain when swallowing (Shepherd, 2013). Viral pharyngitis is the most common and can be contributed to the rhino or coronavirus which lasts between 5-7 days and presents with associated symptoms like cough, headache, fatigue and mild fever (Ruppert & Fay, 2015). Finally, GABHS or more commonly noted as strep throat is a potential diagnosis. This bacterial infection is most common in children and adolescents. Often individuals present with symptoms including throat pain, fever, chills, headache, cervical lymphadenopathy and exudate noted to tonsils or in the pharyngeal (Ruppert & Fay, 2015). This infectious process in younger children may also present with gastrointestinal symptoms like nausea, vomiting and abdominal pain but is not accompanied by cough or nasal

It is the provider’s plan to prescribe Amoxicillin 50mg/kg/day once daily for 10 days (Cash & Glass, 2014). The child will take 2 and 3/4 teaspoons by mouth daily for 10 days for the diagnosis of strep throat (Epocrates, 2016). In addition, the child will need to remain on the Zyrtec 5mg by mouth daily for allergies and continue taking Tylenol liquid ½ tsp by mouth every 4-6 hours for pain and fever (Epocrates, 2016). Another concern with pharyngitis is hydration levels. Suggestions include use of Pedialyte liquid and popsicles, and the encouragement of other fluids to maintain adequate hydration. The provider explains to the parents via a translator that the decrease in appetite is normal and it is okay if he eats less. The main concern is fluid intake. If the condition worsens or does not improve in seven days, the child should return to the

Strep Throat is an infection of the tonsils and pharynx. Its symptoms include: sore throat, high fever, chills, headache, swollen lymph nodes and trouble swallowing. This disease usually effects school aged children. It is very contagious, and is spread through close contact with those individuals coughing and sneezing. Once strep is identified as the pathogen, with a rapid strep test, the doctor will prescribe a drug in the penicillin family as treatment. Penicillin attacks the cell wall of the bacteria as it is trying to replicate. This decreases the amount of new bacteria forming in the body, giving the immune system time to attack the foreign agent.

B.R. is a 10-year-old previously healthy female that presented with persistent cough after a failed outpatient therapy for pneumonia. Two weeks ago she developed a sore throat and intermittent fever. She was seen by her PCP, where her strep test tested negative; therefore, she was diagnosed with a viral upper respiratory infection. She later developed significant left upper quadrant abdominal pain and was in bed for two days. She was seen again by her PCP, where she was diagnosed with constipation. She continued to have pain and fever; therefore, her parents took her to Kaweah Delta Hospital where and ultrasound was done. The ultrasound, monospot test, and strep test performed at Kaweah Delta were all negative. They then performed a CT and

Epstein-Barr Virus, also known as human herpesvirus type 4, is a common infectious virus that will affect greater than 85% of the population at least once in their lifetime. The virus was first discovered by, and named after, Sir Michael Anthony Epstein and Yvonne Mr. Barr in 1964 in the midst of researching a case of Burkitt’s lymphoma. The Epstein-Barr virus is predominately found in a host’s saliva, and is transmitted through direct and indirect contact with the infected person’s bodily fluids. Epstein-Barr virus (EBV) is responsible for numerous infections that can take place throughout the body, most commonly acute infectious mononucleosis. Infectious mononucleosis, simply referred to as “mono,” is an illness that is directly caused by the Epstein-Barr virus and can frequently affect toddlers, teenagers, and adults. EBV, along with infectious mononucleosis, is primarily spread from person to person orally through the following acts: kissing, sharing food and drinks, and coming in contact with contaminated objects, such as toothbrushes.

Summary: Maria Hernandez, a 29-year-old school teacher, presents to the doctor’s office with fatigue, ptosis and generalized weakness. Ms. Hernandez recently received a series of botox injections, and is currently taking atorvastatin for her hypercholesterolemia. On physical examination, a slight fever (100.2), an erythematous pharynx, and ten-pound weight loss were noted; neurological examination revealed ptosis, facial weakness, decreased motor function as well as bilateral trace reflexes in her patella and ankles. Additionally, chest radiography revealed a small nodule in her right lung, and her lymphocyte and monocyte counts were elevated on her CBC.

My initial belief was that the child might be exhibiting signs of strep throat. However after the physician was able to perform a rapid Strep test, which produced negative results, I felt it was best to further investigate the symptoms occurring

Choice “D” is not the best answer. Wiskott-Aldrich syndrome (WAS) is an X-linked recessive immune disorder with the characteristic triad of recurrent bacterial sinopulmonary infections, eczema (atopiclike dermatitis), and a bleeding diathesis caused by thrombocytopenia and platelet abnormalities. Mortality or infection from EBV is not directly increased in this

Epstein-Barr virus was first discovered in 1964 by Sir Michael Anthony Epstein and Ms. Yvonne Barr. They located it in a Burkitt lymphoma cell line. It was the first virus to be associated with cancer. Infection of Epstein-Barr (EBV) is extremely widespread. The National Institutes of Health estimates that roughly 95% of people carry the virus. The virus was later found to cause infectious mononucleosis. Mononucleosis has since been nicknamed the “kissing disease”. Transmission is spread orally, primarily through saliva. Healthy people are able to spread the virus to uninfected people through kissing or sharing food. The virus remains dormant in the body throughout life. For the most part, EBV presents no serious complications other than the cold-like symptoms and glandular fever related to mononucleosis. However, a growing body of evidence indicates that many cancers are directly attributable to EBV. It is also known to play a significant role in the incidence of certain autoimmune and blood diseases.