A 10-year-old male presents with his mother, who appears very anxious. She repor
ID: 99213 • Letter: A
Question
A 10-year-old male presents with his mother, who appears very anxious. She reports several episodes of red-brown urine this morning. The patient reports feeling a bit tired, but otherwise has no complaints. At age 5, he had myringotomy tubes placed bilaterally, but his past medical history is otherwise unremarkable. He takes no medications. On review of systems, he reports a sore throat that completely resolved a few days ago. On exam you find a pleasant young man in no acute distress. He is afebrile. His blood pressure is 140/94 mm Hg, and he has trace pretibial edema. The remainder of the exam is unrevealing. Urinalysis shows 2+ blood, 2+ protein, specific gravity 1.015, and numerous red blood cells with red cell casts. BUN is 35 mg/dL and creatinine is 1.8 mg/dL. CBC (Complete Blood Count), coagulation studies, and electrolytes are all normal. Throat culture grows group A beta-hemolytic streptococcus. What do you think is going on? What is the causative agent of this disorder? Which best describes the usual course of post-streptococcal glomerulonephritis? Which are the signs and symptoms of this disease? Is this case a typical one? What is the mechanism of this disease? What is the course of the disease and compare adult vs. Children.Explanation / Answer
1 With the condition and symptoms seen in children we say that the boy is suffering from Tonsillopharyngitis it is acute infection of pharynx, palantine tonsils, the symptoms may include sore throat, dysphasia, cervical lymphadenopathy, and fever and diagnosis is clinical, supplemented by culture or rapid antigen test. Untreated GABHS may lead to local supportive complications and sometimes to rheumatic fever or glomerulonephritis which may cause production of dark red urine due to release of blood and proteins in urine.
2 The causative agent is -hemolytic streptococcus (Streptococcal Infections), but Staphylococcus aureus, Streptococcus pneumoniae, Mycoplasma pneumoniae, and Chlamydia pneumoniae are sometimes involved are causes include pertussis, Fusobacterium, diphtheria, followed by secondary infections caused by common cold viruses adenovirus, rhinovirus, influenza, coronavirus virus.
3 Acute glomerulonephritis following streptococcal infection is characterized by the sudden appearance of hematuria, proteinuria, red blood cell casts in the urine, edema, and hypertension with or without oliguria Poststreptococcal . Poststreptococcal glomerulonephritis in children with symptoms that may be secondary to hypertension or congestive heart failure At the other extreme is the child who presents with severe disease manifested by oliguria, edema, hypertension, and azotemia and with proteinuria, hematuria, and urinary casts.
4 Pain with swallowing is the first and foremost symptom seen in the this type of infection related to the ears. Very young children who are not able to complain of sore throat often refuse to eat. High fever, malaise, headache, and GI upset are common, as are halitosis and a muffled voice. A scarlatiniform or nonspecific rash may also be present. The tonsils are swollen and red and often have purulent exudates. Tender cervical lymphadenopathy may be present. Fever, adenopathy, palatal petechiae,.
Untreated GABHS may lead to local supportive complications (eg, peritonsillar abscess or cellulitis) and sometimes to rheumatic fever or glomerulonephritis which may cause red dark urine due to presence of red blood cell which are not filtered by nephron.
Here the case is seen is typical one because usually infection subsides afetr7 days but untreated may result in dysfunction of nephron and kidneys which is the reason of dark red urine.
5 Tonsils are your first line of defense against illness. They produce white blood cells to help your body fight infection. The tonsils combat bacteria and viruses that enter your body through your mouth. However, tonsils are also vulnerable to infection from these invaders.
Tonsillitis can be caused by a virus, such as the common cold, or by a bacterial infection, such as strep throat. Viruses are the most common cause of tonsillitis. Children come into close contact with others at school and play, exposing them to a variety of viruses and bacteria. This makes them particularly vulnerable to the germs that cause tonsillitis.
6 It is the most common bacterial cause and usually occurs in children between age 5 and age 15 as children of this age play more in groups with other children which may cause risk of exposing the disease and contamination from others Strep throat is less common in children under age 3 and in older adults
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