PATHOPHYSIOLOGY NR 507 WK6 TD3

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PATHOPHYSIOLOGY NR 507 WK6 TD3 Week 6: Dermatologic and Musculoskeletal Disorders - Discussion Part Three Loading... Loading... Discussion This week's graded topics relate to the following Course O ... utcomes (COs). Discussion Part Three (graded) 1 Keisha, a 13-year-old female, has come into your urgent care center. She has red conjunctiva, a cough and a fever of about 104 0C, She also has a rash on her face a possibly the beginning of a rash on her arms. About 10 days ago she was around another student who had similar symptoms. • What is the differential diagnosis? • What are some of the complications of this disease, assume that the top of your differential is the definitive? • Assume that the second item you place on your differential is the definitive diagnosis. What are some complications of that disease? Responses Lorna Durfee Discussion Part Three 6/6/2016 8:33:06 PM Keisha, a 13-year-old female, has come into your urgent care center. She has red conjunctiva, a cough and a fever of about 104.0 C. She also has a rash on her face a possibly the beginning of a rash on her arms. About 10 days ago she was around another student who had similar symptoms. • What is the differential diagnosis? • What are some of the complications of this disease, assume that the top of your differential is the definitive? • Assume that the second item you place on your differential is the definitive diagnosis. What are some complications of that disease? Doctor Brown and Class: 13 year-old-female, red conjunctiva, cough, fever 104.0 with a rash. Differential Diagnosis: #1: Measles – The Centers for Disease Control and Prevention explain that Measles is an acute viral respiratory illness. The prodromal symptoms are that of fever as high as 105.0 F, also cough, coryza, and conjunctivitis (the three “C”s). There is also the development of Koplik spots and then a maculopapular rash. The rash appears 14 days after exposure. The incubation period can range from 7 to 21 days. The rash spreads from the head and trunk and then the extremities (The Centers for Disease Control and Prevention, 2015). The Centers for Disease Control and Prevention (2015) explain that some of the complications of measles include otitis media, bronchopneumonia as well as diarrhea and laryngotracheobronchitis (The Centers for Disease Control and Prevention, 2015). Measles can cause serious illness. The facts are that one out of every 1,000 cases of measles will develop into acute encephalitis, and that can lead to brain damage. One or two out of 1,000 children will die from respiratory and neurologic complications (The Centers for Disease Control and Prevention, 2015).Complications: Moss and Griffin (2012) tell us that complications can occur in up to 40 percent of the patients. Age and undernutrition increase the risk. Fatality is highest in infants and young children. Pneumonia is the condition most associated with measles-associated deaths. The cause of Pneumonia is a secondary viral or bacterial infection. In immunocompromised patients, the virus can cause giant cell pneumonitis. Croup, otitis media, and diarrhea are other problems that can occur. Keratoconjunctivitis can also develop as a complication of the infection. There are rare complications such as conditions that involve the central nervous system. Encephalomyelitis can occur in older children and adults. Periventricular demyelination may also occur. Other CNS complications that occur months later can be measles inclusion body encephalitis and sclerosing panencephalitis, caused by persistent infection (Moss & Griffin, 2012, p. 158). #2: Rubella (German Measles): Rubella is a communicable disease of children caused by a ribonucleic acid (RNA) virus that enters into the system through the respiratory route. It is a mild disease, and incubation is from 14 to 21 days. Symptoms are enlarged lymph nodes, fever (low-grade), sore throat and a runny nose with a cough. There is a faint pink or red rash that is maculopapular. This rash can develop on the face and then trunk and extremities. The rash does not present itself on the palms or soles of the feet. The virus causes dissemination of the skin. Children are not contagious after the development of the rash. There is lifelong immunity to rubella, along with measles, chickenpox, and roseola if you contact the disease (McCance et al., 2014, p. 1658). Complications: The Centers for Disease Control and Prevention (2015) relate that the complications from rubella are not common, and they occur more in adults than children. Arthralgia or arthritis may occur in 70 percent of adult women who contract the disease, but it is rare in children and males. Encephalitis can occur in one to 6,000 cases more in adults (females especially) than children. Hemorrhagic manifestations can occur with children. There are low platelets and vascular damage with thrombocytopenic purpura. There can also be a gastrointestinal, cerebral and intrarenal hemorrhage. The long term sequelae can last for months. There can also be neuritis and progressive panencephalitis (The Centers for Disease Control and Prevention, 2015). #3: Varicella (chickenpox): Varicella is a disease that is seen in childhood and approximately 90 percent of children develop the disease during their first decade in life. This virus is very contagious and spreads from person-to-person via airborne droplets. With infection in the household, there is a 90 percent chance that people who are susceptible will get the disease within 14 days. Children remain contagious for one day before the rash develops. Transmission can happen up to 5 to 6 days after onset of lesions in healthy children. There are no prodromal signs (McCance et al., 2014, p. 1660). The illness may appear with vesicles on the trunk, scalp, and face. Later on, it spreads to the extremities. The lesions have various stages. They can present as macules, papules, and vesicles. They rupture easily. They develop a crust. Sometimes they can be found in the mouth, conjunctiva, and pharynx. There is a fever for 2 to 3 days (McCance et al., 2014, p. 1660). #4: Hand, foot, and mouth disease: The Centers for Disease and Control and Prevention (2015) explain that hand, foot and mouth disease is a common viral illness that affects children younger than 5. It does, however, occur in adults. It usually starts with a fever, lack of appetite and sore throat and just not feeling well. Once the fever starts, about two days later, painful sores develop in the mouth. A skin rash with red spots develops that blister. The blisters can appear on the palms, hand, feet (soles) or the elbow, knees or buttocks. Some people do not show signs, but they still pass the virus to others. The viruses that belong to the Enterovirus genus (polioviruses, coxsackieviruses, and echoviruses and enteroviruses. Coxsackievirus A16 is the most common in the United States, but other viruses that are enterovirus can cause illness. Enterovirus 17 has been associated with the disease as well. Transmission can occur through close contact, in the air with coughing and objects contaminated with feces and contaminated surfaces and objects (The Centers for Disease Control and Prevention, 2015). #5: Pharyngoconjunctival fever - The Centers for Disease Control state that this condition combines conjunctivitis as well as fever, and sore throat can also occur with this syndrome. The infection causes it with adenovirus serotypes3, 4 and 7 (The Centers for Disease Control and Prevention, 2014). References Moss, W. J., & Griffin, D. E. (2012). Measles. The Lancet, 379(9811), 153-64.Nicole, N. H. (2014). Alterations of the Integument in Children. In McCance, K. L., Huether, S. E., Brashers, V. L. (Eds.), Pathophysiology: The biologic basis for disease in adults and children (7th ed., pp. 1656, 1658, 1660). St. Louis, MO: Mosby. The Centers for Disease Control and Prevention. (2014). Conjunctivitis. Retrieved from http://www.cdc.gov/conjunctivitis/about/diagnosis.html The Centers for Disease Control and Prevention. (2015). Hand Foot and Mouth Disease. Retrieved from http://www.cdc.gov/hand-foot-mouth/ The Centers for Disease Control and Prevention. (2015). Measles. Retrieved from http://www.cdc.gov/measles/hcp/index.html The Centers for Disease Control and Prevention. (2015). Rubella. Retrieved from http://www.cdc.gov/vaccines/pubs/pinkbook/rubella.html Instructor Brown reply to Lorna Durfee RE: Discussion Part Three Lorna, What is going on from a patho standpoint to cause conjunctivitis? Lorna Durfee reply to Instructor Brown RE: Discussion Part Three 6/10/2016 3:15:49 PM What is going on from a pathophysiological standpoint to cause conjunctivitis? Doctor Brown: Although this text is not current, I felt that it would provide a necessary understanding of the pathophysiological process that is in question. Enders (1996) explains that the measles virus belongs to the family Paramyxoviridae. This family consists of three genera: Paramyxovirus, which includes the parainfluenza viruses and mumps; Pneumovirus, which includes respiratory syncytial virus and Morbillivirus, which the measles virus belong to (Baron & National Center for Biotechnology Information, 1996, p. 1). Paramyxoviruses are enveloped particles that are approximately 150 to 300 nm in diameter. There is a helically symmetrical tube-like nucleocapsid that contains a single-stranded, negative–sense RNA genome and RNA-directed RNA polymerase. The nucleocapsid is associated with the matrix protein which is at the base of the double-layered lipid envelope. The spikes on the envelope have two glycoproteins. One is a viral attachment protein and the other a fusion protein. The paramyxoviruses have a general order for the viral proteins and biochemical properties for viral attachment proteins (Baron & National Center for Biotechnology Information, 1996, p. 1). Measles virus lacks neuraminidase but has hemagglutinating abilities. Enders (1996) relates that attachment of particles of the virus to the cell surface is followed by fusion of the envelope and cytoplasmic membranes and penetrates into the nucleocapsid into the cytoplasm. The virion RNA is a template for the production of mRNA and also for replication of RNA. Maturation of the virus takes place with the budding of the virus from the cell (Baron & National Center for Biotechnology Information, 1996, p. 26). We know that measles is a systemic viral infection. There are manifestations of the disease that involve the lymphatic and respiratory systems, skin and brain. The virus can enter the host through the nose and possibly the conjunctiva. Once the virus multiplies in the respiratory tract and lymph nodes it can spread to the rest of the reticuloendothelial system where the replication sequence takes place (Baron & National Center for Biotechnology Information, 1996, p. 27). 6/9/2016 5:42:01 PMUSC Roski Eye Institute and Keck Medicine of USC, explains that some of the patients they have seen with eye problems with measles have lost vision because it caused damage to the cornea. Measles keratitis is a condition that results from measles infection. The virus can affect the back of the eye and can cause inflammation of any part of the back of the eye, including retina, blood vessels, and the optic nerve. There is swelling of the eye from measles infection that can result in scarring (University of Southern California, 2016). Devries, Duprex and DeSwart (2015) explain that morbilliviruses infect cells of the immune system before they can spread to the epithelium, endothelium or neuronal cells (De Vries, Duprex, & De Swart, 2015, p. 703). Moss and Griffin (2014) tells us that the measles virus is spherical, enveloped and single-stranded negative-sense RNA virus and member of the Morbillivirus genus in the Paramyxoviridae family. The RNA genome for measles has about 16, 000 nucleotides that encode eight proteins. The haemagglutinin binds to receptors in cells and works with the fusion protein to mediate fusion into the viral envelope and then connect with the host cell membrane. This haemagglutinin protein will elicit an immune response. The cell receptors for measles is CD46 and CD150, which activates the lymphocyte molecule (SLAM). Because CD46 is a complement molecule, that is expressed on all nucleated cells. SLAM is activated on T and B lymphocytes and antigen-presenting cells (Moss & Griffin, 2012, p. 155). The virus replication occurs in epithelial cells in the respiratory tract, and this virus spreads to lymphatic tissue. The replication in the tissues is what causes the dissemination of measles to many organs. Host immune responses are responsible for the signs and symptoms. The adaptive immune responses are virus specific humoral and cellular responses. The virus can enter through the conjunctiva and then it becomes systemic. The immune response can occur, and it can cause bacterial infection in the eyes (Moss & Griffin, 2012, p. 156). With measles infection, there can be decreased lymphocyte responses and impaired dendritic cell function (Moss & Griffin, 2012, p. 157). Keratoconjunctivitis can occur in children with Vitamin A deficiency and can cause blindness (Moss & Griffin, 2012, p. 158). Diagnosis of measles can be made by serology, looking for the IgG antibody and IgM antibodies (Moss & Griffin, 2012, p. 158). Measles can be diagnosed with a conjunctival swab (Moss & Griffin, 2012, p. 159). References De Vries, R., Duprex, W., & De Swart, R. (2015). Morbillivirus Infections: An Introduction. Viruses, 7(2), 699-706. doi:10.3390/v7020699 Enders, G. (1996). Paramyxoviruses. In Baron, S., & National Center for Biotechnology Information (U.S.) Medical microbiology. (pp.1-36). Galveston, Tex.: University of Texas Medical Branch at Galveston. Chapter 59. Moss, W. J., & Griffin, D. E. (2012). Measles. The Lancet, 379(9811), 153-164. doi:10.1016/s0140-6736(10)62352-5 University of Southern California. (2016). Measles and the Eye | USC Roski Eye Institute. Retrieved from http://eye.keckmedicine.org/measles-and-the-eye Lanre Abawonse Discussion Part Three 6/9/2016 9:50:46 PM What is the differential diagnosis? Measles Measles is a disease caused by a virus. Hard measles, or 7-10 day measles (rubeola) is a communicable viral disease caused by the morbillivirus. Sometimes it begins on the face and spreads to the appendages (or outgrowth). Before the rash begins, fever, conjunctivitis and cough are present (Watkin,2013). There are koplik spots (small, irregular red with bluish white speck in the center) on the buccal mucosa, and mild to severe photosensitivity. The rash can become severe in nature, becoming more apparent as a maculopapular eruption on the face and into the skin tissue or to another body surface Roseola Roseola (Exanthem Subitum) is caused by herpesvirus (human) type 6, is mostly limited to age 6months to 3 years and is incubated 5-15 days. The rash in this disease is composed discrete rose-pink macules appearing first around the trunk, then spreading to neck, face and extremeities. This can lead to recurrent febrile seizures from latent infection of nervous system that is reactivated by fever. The fever lasts 3-5 days; then a tiny, erythematous, raised papule rash appears (O’Grady, 2014). Fifth Disease Erythema Infectiosum (Fifth disease) is caused by parvovirus B19 (Human parvovirus). This is mostly transfer from an infectious person with an incubation period a 4-21 days. It usually begins with fever, headache, sore throat, pruritus coryza, abdominal pain and arthralgias. 7-10 days after the symptoms go away, the rash begins as a slapped cheek appearance The rash associated with this disease appears in three stages. After the rash appears, the patient is no longer contagious (O’Grady, 2014). Rubella Rubella is a viral infection caused by a rubivirus that occurs in childhood. There are two types know as 3 day measles and German measles,. Its diffuse punctate, macular rash begins on the trunk and spreads to the arms and legs. The child might also present with cold-like symptoms (cough). The virus might be present in the blood, stool, and urine. Patient is contagious a week before symptoms start and 4 days after the rash starts (Watkin, 2014). What are some of the complications of this disease, assume that the top of your differential is the definitive? Measles is more severe in malnourished children and it can lead to complications which include diarrhea, pneumonia, otitis media, and acute encephalitis (rare), corneal ulcers and sub-acute sclerosing anencephalitis (Haq, Masood, Sharif, & Asghar, 2015). It is usually benign but the greatest danger is teratogenic effect of the fetus. Assume that the second item you place on your differential is the definitive diagnosis. What are some complications of that disease? Roseola is a contagious viral disease that affect children younger than 4 with a rapid rise in temperature up to 105 f. This can make this disease to be mis-interpreted or mistaken for rubella. Some complications seen are recurrent febrile seizures, which develop from latent infection of central nervous system that is reactivated by the fever and encephalitis (rare). Long term complications include developmental disorders and autism spectrum disorders (O’Grady, 2014). Reference Haq, M. Z., Masood, N., Sharif, M., & Asghar, R. M. (2015). Measles. Professional Medical Journal, 22 (9), 1116-1121. doi:10.17957/TPMJ/15.2841 O'Grady, J. S. (2014). Fifth and sixth diseases: More than a fever and a rash. Journal of Family Practice, 63(10), E1-E5. Watkins, J. (2014). Rubella: An overview of the symptoms and complications. British Journal of School Nursing, 9(6), 284-286 3p. Watkins, J. (2013). Diagnosing rashes, part 4: Generalized rashes with fever. Practice Nursing, 24(7), 335- 341 7p. Liberty Neoh reply to Lanre Abawonse RE: Discussion Part Three Lanre, I did know about Fifth Disease. Thank you for sharing. I just want to add that the clinical manifestations of fifth disease are different in children than adults. Cold-like symptoms and arthritis are common symptoms for adults but with children it can cause hematologic problems. According to Chatzidimitriou and colleagues (2011), children, specifically, with underlying hemolytic disorders may develop transient aplastic crisis. Fetal infection may lead to heavy fetal anemia causing hydrops fetalis and even fetal death. Reference Chatzidimitriou, E. M., Gioula, M. A., & Diza, Z. L. (2011). Epidemiological and clinical characteristics of human parvovirus B19 infections during 2006-2009 in Northern Greece. Hippokratia, 15(2). Retrieved from http://eds.b.ebscohost.com.proxy.chamberlain.edu:8080/eds/pdfviewer/pdfviewer? sid=5a5f1201-368d-4e73-b937-3adbf3b686cd%40sessionmgr106&vid=7&hid=127 Liberty Neoh reply to Liberty Neoh RE: Discussion Part Three 6/12/2016 12:50:18 AM Edited, Lanre, what I meant was I did not know about Fifth disease. I am sorry about that. Liberty Instructor Brown reply to Lanre Abawonse RE: Discussion Part Three 6/10/2016 6:38:13 PM What part of the patho process causes "koplik spots (small, irregular red with bluish white speck in the center)"? What is going on at the cellular level? Rechel DelAntar Differential Diagnosis Hello Professor and Class, Differential Diagnosis A Case of s 13 year old female who present herself with red conjunctive, cough and fever 104C. She is also having some rashes on her face and some rashes in her arms. The patient states she was around another student approximately 10 days ago with similar symptoms. Based on this history, patient may be having: 6/9/2016 11:49:10 PM 6/10/2016 12:14:14 AM1. Measles (Rubeola) = Measles is caused by the measles virus, a single-stranded, negative-sense, enveloped RNA virus of the genus Morbillivirus within the family Paramyxovirida. It is a highly contagious infection whose symptoms include Fever of 104F (40C), cough, runny nose and inflamed eyes. Red flat rashes appear starting from the face then the rest of the body. Symptoms develop 10-12 days after exposure and lasts 7-10 days. Measles is an airborne disease and spreads easily through coughs and sneezes of those infected. It may also be spread through contact with saliva or nasal secretions (World Health Organization, 2016). 2. German measles (Rubella) = Sometimes knows as the “three day measles” is a contagious disease caused by the rubella virus. This disease is often mild with half of people not realizing that they are sick. Rubella starts with flu like symptoms and low-grade fever of less than 101F. The primary symptom of rubella virus infection is the appearance of a rash (exanthem) on the face, which spreads to the trunk and limbs and usually fades after three days (that is why it is often referred to as three-day measles) (Atkinson, W., 2011). Symptoms are very similar except that the patient in this case study is experiencing fevers of 104F, which is not typical of Rubella. 3. Chickenpox (Varicella) = is a highly contagious disease caused by the Varicella Zoster virus. The disease is characterized by skin rashes that form small, itchy blisters, which eventually scab over. It usually starts on the chest, back, and face then spreads to the rest of the body. The early symptoms in adolescents and adults are nausea, loss of appetite, aching muscles, and headache accompanied by a low-grade fever. The rash begins as small red dots on the face, scalp, torso, upper arms and legs; progressing over 10–12 hours to small bumps, blisters and pustules; followed by formation of scabs (Centers for Disease Control and Prevention, 2015). Although this disease is similar in some aspects to the one presented in the case study, there are some differences that would exclude this as a diagnosis namely the presence of a low grade and the type rash this disease presents compared to the one in the case study. Measles can be a serious in all age groups. Some of the common complications for measles are: ear infections and diarrhea. Severe complications for measles are pneumonia, encephalitis, thrombocytopenia and in the case of pregnant women, premature birth and low birth weight for babies (Centers for Disease Control and prevention, 2015). For German measles (Rubella), some women with rubella experience arthritis in the fingers, wrists and knees, which generally lasts for about one month. In rare cases, rubella can cause an ear infection (otitis media) or inflammation of the brain (encephalitis). However in this particular disease, the consequences of for an unborn child is severe. Infants born to mothers with rubella in the first 12 weeks of pregnancy develop congenital rubella syndrome, which consists of Growth retardation. This would include, cataracts, deafness, congenital heart defects, defects in other organs and Mental retardation (mayo Clinic, 2016). References: Atkinson, W. (2011). Epidemiology and prevention of Vaccine-Preventable Diseases. Retrieved from http://www.cdc.gov/vaccines/pubs/pinkbook/rubella.html. Centers for Disease Control and Prevention. (2015). Chickenpox (Varicella). Retrieved from http://www.cdc.gov/chickenpox/about/index.html. Centers for Disease Control and Prevention (2015). Complications of measles. Retrieved from http://www.cdc.gov/measles/about/complications.html. Mayo Clinic. (2016). Complications of Measles. Retrieved from http://www.mayoclinic.org/diseasesconditions/measles/basics/complications/con-20019675. World Health Organization. (2016). Measles: Factsheets. Retrieved from http://www.who.int/mediacentre/factsheets/fs286/en/. Liberty Neoh Discussion Part Three 6/9/2016 11:52:02 PM Dr. Brown and Class, What is the differential diagnosis? The patient in this case study showed signs of measles. Measles is a communicable disease that lasts approximately eight days. It is transmitted by droplet nuclei. White and her colleagues (2012) stated, “The prodromal stage occurs 10 to 12 days after exposure and is characterized by two to three days of fever, anorexia, and malaise combined with the triad of cough, conjunctivitis, and coryza.”Scarlet fever is caused by infection with Streptococcus pyogenes and mainly affects children. Clinical manifestations may include scarlet-colored rash, fever, and exudative pharyngitis. Although, it is now considered a rare disease, it was once viewed as a significant cause of pandemic childhood morbidity and mortality in the 19th and early 20th centuries (Tse et al, 2012). Patients with Rubella infection may be asymptomatic or symptoms can be mild and self-limiting. A prodromal stage of one to five days is represented by a low-grade fever, malaise, lymphadenopathy and an upper respiratory infection. Forchheimer spots (petechiae on the soft palate) may precede or accompany the rash. The rash is mild and maculopapular, beginning on the face and extending downwards and occurs approximately 14 to 17 days after exposure and typically lasts three days. Rubella frequently leads to arthralgia/arthritis in women (up to 70%). While joint symptoms, along with conjunctivitis, are more common complications in the obstetric patient, encephalitis may develop in 1 in 6,000 cases, affecting female adults more frequently than men or children (White et al, 2012). What are some of the complications of this disease, assume that the top of your differential is the definitive? The most common serious complication of measles and has continued to be life threatening is pneumonia. After acquiring measles, children often die as a result of complications rather than from measles itself. Pneumonia is the most common cause of death related to measles with a relatively high mortality rate. According to Li and colleagues (2015), “The pathogenesis may be associated with secondary severe pneumonia and systematic infection, as well as a systematic inflammatory reaction syndrome (SIRS) induced by the release of large amounts of in vivo inflammatory factors such as surfactant protein D (SP-D) and interleukin-6 (IL-6); damage to pulmonary capillary basement membranes and epithelial cells can also occur.” Assume that the second item you place on your differential is the definitive diagnosis. What are some complications of that disease? If scarlet fever is not treated with the appropriate antibiotics patients can go on to develop late complications. The erythrogenic toxin is produced by the Streptococcus pyogenes bacteria. The toxin is released into the host’s bloodstream when the bacteria are broken down by specific bacteriophages. When the toxins permeate the bloodstream, a condition known as acute glomerulonephritis can result. Although antibiotics are effective for some complications, there is debate as to whether they can also prevent post- streptococcal glomerulonephritis. Rodriguez-Iturbe, and Haas (2016), explained that “The pathogenesis of renal damage involves nephritogenic immune complexes which are formed in circulation and deposited in the glomeruli; alternately, the antigen and antibody arrive separately and meet in or outside the glomerular basement membrane, causing in situ immune complex disease. Immune cell recruitment, production of chemical mediators and cytokines, and local activation of the complement and coagulation cascades drive an inflammatory response that is localized in the glomeruli.” References Li, J., Zhao, Y., Liu, Z., Zhang, T., Liu, Z., Liu, X. (2015). Clinical report of serious complications associated with measles pneumonia in children hospitalized at Shengjing hospital, China. Journal of Infection in Developing Countries, 9(10). doi: 10.3855/jidc.6534 Rodriguez-Iturbe, B. & Haas, M. (2016). Post-streptococcal glomerulonephritis. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK333429/ Tse, H., Bao, J., Davies, M. R., Maamary, P., Tsoi, H. W., Tong, A.,…& Yuen, K. Y. (2012). Molecular characterization of the 2011 Hong Kong Scarlet Fever outbreak. Journal of Infectious Diseases, 206(3). Retrieved from http://eds.a.ebscohost.com.proxy.chamberlain.edu:8080/eds/detail/detail? vid=10&sid=f2c3f8cc-a13a-440a-af64- 3f0285c000b0%40sessionmgr4005&hid=4213&bdata=JnNpdGU9ZWRzLWxpdmU%3d#AN=77686367&db=c9h White, S. J., Boldt, K. L., Holditch, S. J., Poland, G. A., & Jacobson, R. M. (2012). Measles, mumps, and rubella. Clinical Obstetrics and Gynecology, 55(2). doi: 10.1097/GRF.0b013e31824df256 Instructor Brown reply to Liberty Neoh RE: Discussion Part Three 6/10/2016 6:39:34 PM Please explain glomerulonephritis from a patho perspective. What is going on at a cellular level? 6/13/2016 2:14:35 AM Liberty Neoh reply to Instructor BrownRE: Discussion Part Three Dr. Brown, During an infection, antigen is planted where a streptococcal component is deposited in the glomerulus. The antigen and antibody arrive separately and meet in or outside the glomerular basement membrane, causing in situ immune complex. Immune cell recruitment, production of chemical mediators and cytokines, and local activation of the complement and coagulation cascades drive an inflammatory response that is localized in the glomeruli. Streptococcal antigen may cross react with glomerular structures or directly activate complement with subsequent attraction of inflammatory cells. Immune deposits initiate a diffuse proliferative glomerulonephritis particularly affecting mesangial and endothelial cells. This order of events can lead to renal damage (Rodriguez- Iturbe & Haas, 2016). Reference Rodriguez-Iturbe, B. & Haas, M (2016). Post-streptococcal glomerulonephritis. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK333429/ Jonathan Bidey Discussion Part Three 6/10/2016 12:10:47 PM Dr. Brown and Class, Keisha is presenting with symptoms which could be caused from many different reasons. In order to better diagnose her, we must analyze her symptoms and develop a list of differential diagnoses. Keisha’s symptoms are red conjunctiva, cough, high fever, facial rash, and rash on the body. Other pertinent information is that Keisha attends school with someone who was exhibiting the same symptoms. This would lead the clinician to believe the cause is contagious in nature. Differential diagnoses: 1. Rubeola (Measles)- Measles and Rubella present similarly. This patient could be diagnosed with either. However, due to the severity of Keisha’s temperature, my diagnosis would lean towards Measles, which is associated with a high temperature, rather than Rubella which is associated with a low-grade temperature below 102 (Gupta, Gupta, & Gupta, 2015). Measles is viral and highly contagious. The virus replicates in the nose and the throat which are then easily spread when the patient sneezes coughs or talks (Gupta, Gupta, & Gupta, 2015). Measles presents with maculopapular papules on the face and arms. It is associated with a cough and a very high fever. Measles often presents with irritated red eyes (Gupta, Gupta, & Gupta, 2015). Measels complications include pneumonia, bronchitis, encephalitis, and loss of pregnancy (Gupta, Gupta, & Gupta, 2015). 2. Rubella (German Measels)- Rubella is similar to measles in presentation. Although rubella is a different virus than the virus which causes measles, both present with a red rash on the face and body, a cough, red eyes, and fever. Although rubella is less severe in fever, usually below 102, and in duration. Rubella usually lasts around three days, while Measles can last several weeks. Also, rubella is not as contagious as measles (Gupta, Gupta, & Gupta, 2015). Complications of rubella include joint paint, and encephalitis. Like measles, rubella is very dangerous if the patient is pregnant. Rubella during pregnancy can result in stunted growth, congenital heart disease, deafness, and mental retardation (Gupta, Gupta, & Gupta, 2015). 3. Roseola- Roseola is caused by the herpes virus. It presents with red macular papules on the neck and trunk and fever (McCance & Huether, 2014). Although the patient is experiencing a similar rash, Roseola does not often appear on the face. Also, cough and red conjunctiva are not associated with roseola (McCance & Huether, 2014). 4. Varicella (Chickenpox)- Varicella, or chickenpox, is a viral herpes infection caused by the varicella-zoster virus (McCance & Huether, 2014). During a varicella infection, keratinocytes within the skin experience viral invasion and result in inflammation and vesicles appear on the skin. These vesicles eventually rupture and leaves crusted ulcers (McCance & Huether, 2014). Varicella would not remain isolated on the patient’s face and arms. Also, conjunctiva would not be effected. -JonathanReferences: Gupta, S. N., Gupta, N., & Gupta, S. (2015). Modified measles versus rubella versus atypical measles: One and same thing. Journal of Family Medicine & Primary Care, 4(4). http://dx.doi.org/10.4103/2249-4863.174290 McCance, K. L., & Huether, S. E. (2014). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, MO: Elsevier-Mosby. Instructor Brown reply to Jonathan Bidey RE: Discussion Part Three 6/10/2016 6:40:27 PM Please explain the inflammatory process of chicken pox. What is going on to cause the vesicles? 6/12/2016 10:19:35 AM Jonathan Bidey reply to Instructor Brown RE: Discussion Part Three Dr. Brown, The varicella virus invades cells causing the formation of vesicles. The human immune system response elicits the rupture and pruritic clinical manifestation which is classically associated with varicella. Varicella is caused by the varicella-zoster virus (VZV). VZV is DNA virus transmitted through inhalation and begins initial cell invasion through replication in mucus membranes in the respiratory system (Yunlong & Baosheng, 2016). Viral copies are then manufactured in the mucus membranes of the respiratory track and enter the bloodstream. A second phase of cellular invasion begins as the virus undergoes cell invasion in capillary endothelial cells of the epidermis (Yunlong & Baosheng, 2016). This causes malfunction of the keratinocytes which begin to swell and detach from each other, resulting in the formation of vesicles (McCance & Huether, 2014). As the immune system responds to the viral invasion, granulocytes migrate to and enter the vesicle, causing it to fill until its eventual rupture (McCance & Huether, 2014). -Jonathan References: McCance, K. L.,& Huether, S. E. (2014). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, MO: Elsevier-Mosby. Yunlong, L., & Baosheng, Z. (2016). Genotyping of clinical varicella-zoster virus isolates collected from Yunnan in southwestern China. Biomedical Reports, 4(2), 209-214. http://dx,doi.org/10.3892/br.2015.562. Instructor Brown reply to Jonathan Bidey RE: Discussion Part Three 6/12/2016 6:21:31 PM Excellent discussion related to the vesicles. Everyone should understand the full process. Matthew Dove Week 6, Case Study 3 1) Rubeola (Measles) Although considered eliminated in the United States 2000, Rubeola is still a threat both domestically and worldwide. From an epidemiological perspective, this is a serious and highly contagious disease. The Centers for Disease Control and Prevention (CDC) relates that, “Rubeola is so contagious that if one person has it, 9 out of 10 people around him or her will also become infected if they are not protected. Your child can get measles just by being in a room where a person with measles has been, even up to two hours after that person has left. An infected person can spread measles to others even before knowing he/she has the disease—from four days before developing the measles rash through four days afterward. About 1 in 4 people in the U.S. who get measles will be hospitalized, 1 out of every 1,000 people with measles will develop brain swelling, which could lead to the complication brain damage, 1 or 2 out of 1,000 people with measles will die, even with the best care” (2015). 6/10/2016 12:13:08 PMSymptoms include rhinorrhea, cough, red conjunctiva, and rash. There is deviation in the type of rash between the types of measles presented here, with Rubeola presenting as a “erythematous maculopapular rash developing over the head and spreading distally over the trunk, extremities, hands, and feet” (Nicol, Huether, 2013). There are also telltale “Koplik spots” with this type of dermatological manifestation, classified through pinpoint white spots surrounded by the reddened ring over buccal mucosa. These are early prodromal symptoms and are typically missed as the incubation period can be up to 12 days, while the onset is not fully recognized for 3 to 5 days after initial symptoms. Vaccination is the emphasis here in prevention and, if contracting Rubeola, treatment is primarily supportive unless complications arise. In addition to potential increase in cranial pressure and brain damage, possible complications include: opportunistic primary or secondary bacterial infection by group A hemolytic streptococcus, Haemophilus influenzae, or S. aureus (Nicol, Huether, 2013). On a final note, it is imperative for providers to understand state laws surrounding mandatory for this type of reporting and be compliant with detailing infectious disease to prevent or slow outbreaks. 2) Rubella (German or 3-Day Measles) Characteristics of Rubella include low grade fever and cough. Rationale for this being 2 choice in the differential resides in the fever for the patient being 104 (defined as a high grade fever—not low) and absence of any mention of red conjunctiva (present with Rubeola) in all literature researched. While a milder form of a viral infection that enters the bloodstream through of measles compared to Rubeola, both present with a “faint-pink to red, coalescing maculopapular rash that develops on the face spreading to the trunk and extremities sparing the palms of the hand and soles of the feet” (Nicol, Huether, 2013). After the onset, this rash will subside in two to three Rubeola is self-limited and it is believed that once the integumentary symptoms present, children are no longer contagious. Lymph chains are possibly enlarged for many weeks following an occurrence, and if there are complications, they are potentially pneumonia, croup, and encephalitis, and peripheral neuritis (Nichol, Huether, 2013). nd 3) Erythema infectiosum (parvovirus B19) Also known as Fifth disease, the 13 year old child is particularly pertinent due to it being the primary age range whom contracts this ailment. The CDC posits symptom presentation as fever, runny nose, and headache. From their research, “After several days, you may get a red rash on your face called "slapped cheek" rash. This rash is the most recognized feature of fifth disease. It is more common in children and most have contracted it by age 15” (CDC, 2015). The virus is spread through respiratory secretions and droplet precautions are paramount in preventing further transmission. Much like the other diseases presented, treatment is supportive and once the virus is disseminated through the skin and presents as a rash, the child is more than likely not contagious (CDC, 2015). 4) Scarlet fever (Streptococcus pyogenes) The National Institute of Communicable Diseases places Scarlet fever (Streptococcus pyogenes) as a differential diagnosis that must be considered along with Measles despite it being considered a relatively eliminated disease state in the last half century. Wong, Yuen purport this re-emergence could be because, “currently 74 species under the genus Streptococcus.The type species of the genus, Streptococcus pyogenes, is one of the most virulent species causing human infections. S. pyogenes is a prototype bacterium that causes exotoxin-mediated infections. It produces a plethora of exotoxins, superantigens and cell wall-associated proteins resulting in diverse clinical manifestations, ranging from classical pyogenic infections, to toxic shock syndrome and post-infectious immune-mediated sequelae. Despite the fact that systemic infections, such as meningitis and endocarditis, are rare nowadays, streptococcal pyoderma and pharyngotonsillitis remain common infections with a heavy global burden of disease. The past two decades have also witnessed a resurgence of several infective syndromes of S. pyogenes, most notably necrotizing skin and soft tissue infections and scarlet fever. The appearance of outbreaks and changes in the epidemiology could be contributed by changes in herd immunity, genetic mutations or replacement by new circulating S. pyogenes strains. The high incidence of scarlet fever in children less than 10 years old suggests that the lack of protective immunity is an important host factor. A high population density, overcrowded living environment and a low yearly rainfall are environmental factors contributing to outbreak development. Inappropriate antibiotic use is not only ineffective for treatment, but may actually drive an epidemic caused by drug-resistant strains and worsen patient outcomes by increasing the bacterial density at the site of infection and inducing toxin production ” (2012). Symptoms include a high fever and diffuse body wide rash with lymph enlargement traditionally responsive to antibiotics. References Centers for Disease Control and Prevention. Fifth Disease. Retrieved from http://www.cdc.gov/parvovirusb19/fifth-disease.html Centers for Disease Control and Prevention. Rubeola (Measles). Retrieved fromhttp://www.cdc.gov/measles/about/parents-top4.html National Institute of Communicable Diseases (2014). Measles Differential Diagnosis. Retrieved from http://www.nicd.ac.za/?page=measles_faq&id=43#8 Nicol, N.H., Huether, S.E. (2013). Chapter 47 Alterations of the Integument in Children. In McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (Eds.), Pathophysiology: The biologic basis for disease in adults and children (pp. 1591--1616). St. Louis, MO: Mosby. Wong, S.Y., Yuen, K,Y. (2012). Streptococcus pyogenes and re-emergence of scarlet fever as a public health problem. Emergent Microbe Infection, 1(7), 20—27. DOI: 10.1038/emi.2012.9 Sarah Boulware reply to Matthew Dove RE: Week 6, Case Study 3 6/10/2016 6:20:46 PM Matthew, You mentioned in your post that vaccination is the key to preventing the measles. I definitely agree with you on this statement and found some interesting research on the measles vaccine. According to Bentley, Rouse, and Pinfield (2014), the measles vaccine is live and stimulates the body to mount an immune response and produce antibodies and memory cells that enable a prompt response if the virus is encountered again. Active immunity is gained that provides long-lasting protection against the measles. If the vaccine is given during the period when the immune system is responding to another live vaccine, the production [Show More]

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