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Case #92: Say Ahhhh! - A Diagnosis of Group A Beta-Hemolytic Streptococcal Pharyngitis

This case study focuses on an 11-year-old female patient with symptoms of sore throat, difficulty swallowing, and fever. Through a thorough examination, including a diagnosis of group A beta-hemolytic streptococcal pharyngitis, the case illustrates the importance of prompt treatment and the risk of complications if left untreated.

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Case #92: Say Ahhhh! - A Diagnosis of Group A Beta-Hemolytic Streptococcal Pharyngitis

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  1. Case #92: Say Ahhhh! BY Ami Alaniz

  2. Gross Overview Note the: Soft palate: general appearence Tonsil: size and general appearance

  3. The Patient

  4. Profile • female • 11 years old • Caucasion

  5. Past Medical History • Ear infections at ages 3 & 4 • Chickenpox at age 6 • Viral-like URI at age 9 • No previous episodes of streptococcal pharyngitis or rheumatic fever • Up to date immunizations

  6. Social History • Attends 6th grade • Plays baseball • Mother and mother’s boyfriend smoke in the house

  7. The Symptoms

  8. Case Question #1 • List 18 patient-specific clinical features (including signs and symptoms, medical history, findings on physical examination, and laboratory blood test results) that support a diagnosis of group A beta-hemolytic streptococcal pharyngitis.

  9. Case Question #2 • “What is the single major risk factor for acute streptococcal pharyngitis in this case study?”

  10. Present Illness • “My throat hurts and its hard to swallow. I’m cold, too.” • appetite has been poor for 48 hours (steady fluid intake) • “strep has been going around at her school for the past two weeks”

  11. Case Question #2: Answered • Involvement in sports as well as the strep throat going around at her school.

  12. Present Illness (cont’d) • appears… • ill • pale • shivering

  13. Present Illness (cont’d) • ill for three days • sore throat • temperature of 102.3 • chills • pain with swallowing

  14. Testing

  15. Terms to Know • edema • swelling • general response to injury or inflammation • erythema • redness • results from capillary congestion • exudate • a “mass of cells and fluid that seep out of blood vessels or organs” • especially prevalent in inflammation

  16. Testing, Testing! • Vital Signs • temperature: 103.1 F • Head, Eyes, Ears, Nose, and Throat • tonsillar edema and erythema with yellow-white exudate • soft palate erythema • prominent “strawberry” tongue

  17. Tonsilllar edema and erythema with yellow-white exudate

  18. Soft Palate Erythema (extreme!)

  19. Not a Strawberry Tongue

  20. Prominent “Strawberry” Tongue

  21. Testing, Testing (cont’d) • Neck • small, mobile anterior lymph nodes (tender to touch) • Skin • warm • pale • no rash

  22. Lab Results

  23. Case Question #1: Answered • fever • Warm skin • Pale skin • Absence of rash • Tonsillar edema • Tonsillar erythema with yellow-white exudate • soft palate erythema • prominent “strawberry” tongue • white blood cell count • neutrophils • lymphocytes • “strep has been going around school for the past two weeks” • participation in sports (presumably at school) • chills • lack of appetite • tiredness • possible weak immune system • pain with swallowing • tender with palpitation lymph nodes

  24. Final Notes

  25. What is the official diagnosis? • group A beta-hemolytic streptococcus pharyngitis • “Bacteria are responsible for approximately 5 to 10 percent of pharyngitis cases, with group A beta-hemolytic streptococci being the most common bacterial etiology. A positive rapid antigen detection test may be considered definitive evidence for treatment; a negative test should be followed by a confirmatory throat culture when streptococcal pharyngitis is strongly suspected.”

  26. Case Question #3 • “What are the drugs of choice for this patient?” • penicillin • cephalorsporins (like cephalexin) • erythromycin-based medications • clindamycin • azithromycin

  27. Case Question #4 • “For which type of heart disease is this patient at risk if treatment is not started?” • Rheumatic fever.

  28. Sources/Citations • http://www.livestrong.com/article/207279-normal-wbc-range-in-children/ http://www.itpsupport.org.uk/childhooditp.htm http://www.childrensmn.org/manuals/lab/hematology/018981.asp http://www.nlm.nih.gov/medlineplus/ency/article/003657.htm http://www.nlm.nih.gov/medlineplus/ency/article/003051.htm http://www.medicinenet.com/strep_throat_gas/page4.htm http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682733.html http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682381.html http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682399.html http://www.nlm.nih.gov/medlineplus/druginfo/meds/a697037.html

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