Case 2 At Children’s Hospital (CHOP) the ER and Clinics are always busy. A 5-yea

Question

Case 2 At Children’s Hospital (CHOP) the ER and Clinics are always busy. A 5-year old white male child in good general health and physical condition was presented at the Saturday walk-in clinic by his mother. He was brought in because he had a fever, was cranky and had complained of a sore throat for about 24 hours. On physical examination by the attending resident, the patient had a fever of 103oF. He had considerable swelling and drainage of the pharynx and in the conjunctivae. His tonsils were enlarged and coated with a white patchy exudate. He had a red throat and swollen anterior cervical lymph nodes. His ears were clear. His chest sounded clear and he had no additional remarkable findings on routine examination. A rapid Strep test run ASAP by the lab was positive. Bacteria grown from a throat swab taken at the time of examination indicated gram positive Beta hemolytic bacteria. 1. What would be your presumptive diagnosis for this child? Why? 2. What diagnostic testing would be indicated to follow this exam? 3. What is the most likely treatment for this illness? Why is it important? 4. What factors of this case allowed you to make a presumptive diagnosis? 5. What serious consequences can result if treatment for this infectious agent had not occurred in a timely manner? 6. What bacterial virulence factors are associated with this condition? 7. Might this child experience the same infection again? why and why not?

Explanation / Answer

Answer

1 The presumptive diagnosis for this child is presence of streptococcus which causes the acute pharyngitis in the children old 3-14 years

2

3treatment for this disease is the antibiotic therapy along with paracetamol.The antibiotic includes benzathine benzylpenicillin, pencillin Vor amoxicillin as an alternative

4 Symptoms and sign of diesease allow to make a presumptive test. Conversely the conjuctivis, cough, enlarged swollen anterior cervical lymph node favours the viral infection

5 The disease is not severe but once the sign sholud be monitored carefully that suggest for the diagnosis of Pesudomonas pharyngitis.There might be chances that along with bacterial infection, the runni nose, cough red throat favours viral infection. Therefore, timely treatment is essential and dysphagia might increase the fever

6 Erythematous and exudative pharynxitis might be associated with gonococcal or primary HIV infection but before reaching any presumption patient history is enquired but cases with child below age of 10 is rarely reported

7 yes, there might be reoccurrence of this bacterial disease because in developing countries Streptococcus ( gram positive bacteria) infection is common

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