A 12 year old boy presents to urgent care with knee swelling and pain. On review of the record, he was seen and diagnosed with strep pharyngitis a month ago. On further questioning, mother admits she was unable to fill his prescription for amoxicillin, but his throat symptoms resolved. History reveals migratory arthritis, intermittent fevers up to 102oF. On physical exam, there are no oral lesions, neck is supple and there is a soft diastolic murmur. His right knee has a small effusion. Which of the following streptococcal complications has likely occured?
A: Acute rheumatic fever
• The reason this is the answer is because acute rheumatic fever is a complication that can occur post strep. In order to be diagnosed with rheumatic fever, a person must have a history of strep infection, plus at least one of the major and 2 minor or two majors. The criteria is known as the Jones criteria. The major symptoms are carditis, polyarthritis, chorea, erythema marginatum, and subcutaneous nodules. The minor criteria include a fever, arthralgia, previous history of disease, acute phase reactions, and prolonged QT interval.
• https://www.uptodate.com/contents/acute-rheumatic-fever-clinical-manifestations-and-diagnosis?source=search_result&search=rheumatic%20fever&selectedTitle=1~119#H3
B: Glomerulonephritis
C: Scarlet fever D: Septic arthritis
• Septic arthritis is also known as infectious arthritis and is normally caused by a bacteria or fungus that is caught in a larger joint, such as
Another type is Rheumatoid arthritis. It is what’s known as an inflammatory arthritis. It is the second most common form of arthritis, right behind osteoarthritis. It affects primarily the small joints in the hands and feet, causing crippling deformities. This is an arthritis that usually starts in middle-life or earlier. Estimates say one out of every hundred people, (females are two to three times as likely) suffer from it. It usually starts in the winter and after a common sickness, but it isn’t considered an infective arthritis. Nobody knows what causes rheumatoid arthritis. It could be some hereditary trait. Scientists think that rheumatoid arthritis may be an autoimmune disease (that means the body acts as though it were allergic to itself). The immune system gets mixed up and attacks normal joint tissue instead of the infection it is supposed to attack.
5. Streptococcal career status that is not responsive to medical therapy in children or families at risk
3) Is her history of rheumatic fever relevant to her current symptoms? Explain. Rheumatic fever caused by Group A Streptococcus bacteria may cause damage to heart tissues including valves. Overtime, congestive heart failure may have developed. However, the pulmonary semilunar valve seems to be the issue in this case study, whereas rheumatic fever normally affects left heart tissue.
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.
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
A 32-year old nurse who has rheumatic fever as a child noticed a persistent tachycardia and light-headedness. Upon examination, chest x rays showed an enlarged left atrium and left ventricle. ECG analysis showed atrial fibrillation. There was also mild pulmonary congestion. Cardiac evaluation resulted in the following information:
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
Stage 3 or late persistent infection will present months after the initial infection. 60% of untreated cases will develop intermittent arthritis causing severe joint pain and swelling. Additionally, approximately 5% will develop
Infections were found to induce Rhabdomyolysis in patients with localized infections like erythema to patients with sepsis and no direct muscle infection. Viral infections have been found in the development of Rhabdomyolysis like influenza A and B viruses. In 2009, Rhabdomyolysis associated with influenza A/H1N1 was reported in a pediatric patient. The patient had showed symptoms of rhabdomyolysis with myoglobinuria, hyperkalemia, cardiac dysfunction and compartment syndrome from this influenza A virus (Naruhiko et. al, 2009). The 8-year-old boy was admitted into the hospital in November of 2009 with complaints of severe leg pain, hypotension, and hypothermia. Six days before prior to developing these symptoms, the young boy had an onset of
Streptococcus pneumoniae is responsible or the main cause of bacterial pneumonia in the community (Liu, 2017). Bacterial pneumonia can be associated with sharp chest pain and occasional blood-tinged sputum, whereas S.T denies chest pain or hemoptysis. I would rule out bacterial pneumonia as S.T.’s diagnosis.
Streptococcal pharyngitis, also known as strep throat, is an infection in the back of the throat and tonsils that causes pain, fever, red and enlarged lymph nodes, and in some cases a sandpaper-like rash known as scarlet fever. This infection typically takes one to three days to breakout after exposure and the symptoms last seven to ten days. Streptococcal pharyngitis is treated with antibiotics and pain medication. Streptococcal pharyngitis is caused by a bacteria known as group A beta-hemolytic streptococcus. It is spread through direct or close contact with the bacteria. This is the reason that the infection spreads so rapidly in schools or other crowded areas.
If group A streptococcus bacterium causes tonsillitis and if it is not treated promptly, it may spread to other tissue and cause more severe infections such as rheumatoid fever and streptococcal glomerulonephritis (Mayo Clinic, n.d). Treatment, however, will vary on whether the tonsillitis is caused by a virus or bacterial infections and the treatment options differ accordingly. Most of the time bed rest, taking adequate fluid and comforting foods help to improve the viral infections and antibiotic for bacterial infections. However, depending on the severity infection, surgical removal is
In the case of Martha, she had an episode of rheumatic fever in her twenties. Rheumatic fever, of which is an illness brought on by Streptococcus A, produces a protein that attaches to the cell wall of an organism causing inflammation. This can affect the heart and cause pancarditis, which is an infection of the entire heart. Endocarditis is the portion of pancarditis that causes valvular disorders. Though the pulmonic valve is not commonly affected, it is still a possibility. The valve apparatus can become fused leading to stenosis years after a rheumatic fever episode that is acute, and damage can become progressive if there are subsequent episodes (Chin, 2014). With Martha 's murmur being low in pitch and more of a rumbling, it is considered a narrowing of the valve or stenosis. The murmur is located left of the sternal border and in the upper portion. This is the pulmonic valve region, which would make this a pulmonic valve stenosis (Rao, 2014). According to Rao (2014), the murmur is due to the leaflets of the pulmonic valve not completely opening. This causes a resistance of the blood flowing foward through the valve, which happens during systole of the ventricles. This further causes a turbulence of the blood and makes the sound of the murmur. Pulmonic valve stenosis can then lead to ventricular hypertrophy of the right ventricle, which is proportional to how obstructed the valve becomes (Rao, 2014).
Typical presentations of rheumatic fever (RF) include a history of sore throats, head aches, fever, abdominal pain, nausea and vomiting, swollen glands and other common signs and symptoms of streptococcal infection (Porth & Matfin, 2009). The presentation of RF can be acute, recurrent or chronic. The acute stage
Group A streptococcus (GAS) is an important human pathogen rank in the top ten of deadly infectious disease around the world despite being sensitive to most antibiotics that are used clinically. The major population will have suffered a group A streptococcus infection one time or another with non-life threating minor complications in the presence of antibiotic therapy but in some instances it goes on and causes several immune-mediated disorders associated with rheumatic fever affecting a diverse set of organs and tissues including the heart, kidneys, skin, joints, and brain. The propensity and degree to which Group A Streptococcus produces an invasive systemic infection is interrelated to its diverse virulence factor expression,