Altered Physiology
The patient’s chief complaint is a sore throat. Furthermore, the patient presents with swelling of his tongue and lips, difficulty breathing, and audible wheezing after taking his first dose of Amoxicillin. The patient’s sore throat was caused by group A streptococci (GAS), as evidenced by a positive rapid streptococci test. GAS invades pharyngeal mucosa and triggers the release of proteases and extracellular toxins (Sheikh et al., 2021). These substances cause a local inflammatory reaction, presenting as a sore throat (Sheikh et al., 2021).
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On the other hand, the patient’s swollen tongue and lips, difficulty breathing, and wheezing are caused by hypersensitivity to penicillin. The first step in the development of allergic reactions is allergen sensitization. This is accomplished by antigen-presenting cells (APCs) such as macrophages. APCs detect allergens and present them to T-lymphocytes. T-lymphocytes stimulate the production of allergen-specific antibodies from B-cells (Karasuyama et al., 2018). These antibodies are then attached to mast cells. Subsequent exposure to the allergen triggers an allergic reaction by releasing inflammatory mediators such as histamine and leukotrienes. (Karasuyama et al., 2018) Histamine causes bronchoconstriction, hence the difficulty in breathing and wheezing. Leukotrienes cause bronchoconstriction and swelling of the tongue (Karasuyama et al., 2018).
The Genes Associated with the Development of the Disease
Various genes are associated with the development of sore throats. They include MicroRNA 452, Lactamase Beta, MEFV Innate Immunity Regulator, Pyrin, C-X-C Motif Chemokine Ligand 8, Toll-Like Receptor 2, and Prostaglandin-Endoperoxide Synthase 2. MicroRNA 452 mediates post-transcriptional regulation (Malacards.org, n.d.). It affects the translation of messenger ribonucleic acid (mRNA). The other genes (Lactamase Beta, MEFV Innate Immunity Regulator, Pyrin, C-X-C Motif Chemokine Ligand 8, Toll-Like Receptor 2, and Prostaglandin-Endoperoxide Synthase 2) are involved in protein-coding (Malacards.org, n.d.). Similarly, various genes have been implicated in the development of allergic reactions. They include Interleukin 1 receptor-like 1 (IL1RL1), Human Leukocyte Antigen-B (HLA-B), Signal transducer and activator of transcription 6 (STAT6), and Toll-like receptor 6 (TLR6) (ScienceNordic, n.d.).
Immunosuppression and Its Impact on Body Systems
Immunosuppression refers to the decrease in the function of the immune system. It results from a gradual depletion of immune cells in the body. These immune cells include T- and B-lymphocytes, macrophages, neutrophils, natural killer cells, and monocytes (Wilson 2018). Various etiological factors have been linked to the occurrence of immunosuppression. They include medication, medical procedures, and diseases. Examples of medication that increase the risks of immunosuppression include tumor necrosis factor-alpha inhibitors, monoclonal antibodies, corticosteroids, and anti-neoplastic agents (Wilson 2018). Medical conditions that increase the risk of immunosuppression include human immunodeficiency virus, asplenia, and congenital immune deficiencies (Wilson 2018). Medical procedures predisposing individuals to immunosuppression include radiotherapy and bone marrow ablation (Kumar & Ison, 2019).
Immunosuppression lowers the body’s defense against foreign agents and diseases. This predisposes an individual to opportunistic diseases and the recurrence of infections. Common opportunistic infections include histoplasmosis, toxoplasmosis, coccidioidomycosis, and candidiasis (Kumar & Ison, 2019). Lowered immunity against foreign agents is useful in organ and stem cell transplants by preventing inflammatory reactions that could cause organ damage.
Conclusion
The first step in the development of allergic reactions is allergen sensitization, which results in the formation of antibodies. Subsequent exposure to the allergen triggers an allergic response by releasing inflammatory mediators such as histamine and leukotrienes. MicroRNA 452 and Toll-like receptor 6 are examples of genes involved in developing sore throat and allergic reactions, respectively. Immunosuppression causes a gradual depletion of the body’s defense mechanism, predisposing an individual to infections.
References
Karasuyama, H., Miyake, K., Yoshikawa, S., Kawano, Y., & Yamanishi, Y. (2018). How do basophils contribute to Th2 cell differentiation and allergic responses? International Immunology, 30(9), 391–396. https://doi.org/10.1093/intimm/dxy026
Kumar, R., & Ison, M. G. (2019). Opportunistic Infections in Transplant Patients. Infectious Disease Clinics of North America, 33(4), 1143–1157. https://doi.org/10.1016/j.idc.2019.05.008
Malacards.org. (n.d.). Pharyngitis. https://www.malacards.org/card/pharyngitis
ScienceNordic. (n.d.). Allergy genes identified. https://sciencenordic.com/allergies-asthma-biotechnology/allergy-genes-identified/1388080#:~:text=These%20genes%20are%3A%20TLR6%2C%20C11,link%20between%20the%20two%20diseases.
Sheikh, S., Javed, U., & Baig, M. A. (2021). Streptococcal pharyngitis: Delving deeper than the throat. Journal of the College of Physicians and Surgeons Pakistan, 31(6), 732–734. https://doi.org/10.29271/jcpsp.2021.06.732
Wilson, J. D. (2018). What is Immunosuppression? https://www.news-medical.net/health/What-is-Immunosuppression.aspx
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Question 
Scenario 1: A 16-year-old boy comes to the clinic with a chief complaint of a sore throat for three days. Denies fever or chills. PMH negative for recurrent colds, influenza, ear infections, or pneumonia. NKDA or food allergies. The physical exam reveals a temp of 99.6 F, a pulse of 78, and regular respirations of 18. HEENT is normal except for the reddened posterior pharynx with white exudate on tonsils that are enlarged to 3+. Positive anterior and posterior cervical adenopathy. A rapid strep test performed in the office was positive. His HCP prescribed Amoxicillin 500 mg po q 12 hours x 10 days disp #20. When he got home, he took the first capsule and immediately complained of tongue and lips swelling, difficulty breathing, and audible wheezing. 911 was called, and he was taken to the hospital, where he received emergency treatment for his allergic reaction.
Altered Physiology
In this Assignment, you examine a case study and analyze the symptoms presented. You identify cell, gene, and process elements that may be factors in the diagnosis and explain the implications to patient health.
Develop a 1- to 2-page case study analysis in which you:
Explain why you think the patient presented the symptoms described.
Identify the genes that may be associated with the development of the disease.
Please explain the process of immunosuppression and its effect on body systems.