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URI-Jin-bw - Case#1 Two year old male had an upper...

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Case #1 z Two year old male had an upper respiratory infection for 2 weeks. Ten days after the respiratory infection began, he had anorexia and lethargy. He was seen in the emergency room the next day with a fever of 39.0 o C, clear chest , exudative pharyngitis , and bilaterally enlarged cervical lymph nodes. A throat culture was taken, and he was placed on amoxicillin . His course worsened , becoming increasingly lethargic for two more days. Finally, he developed respiratory distress and was admitted to the hospital. The throat culture was negative for Streptococcus pyogenes . On admission he was febrile at 38.9 o C with an exudate in the posterior pharynx as a yellowish thick membrane which bled when scraped . He eventually developed heart failure and died.
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Case #2 z 5 - week old male was admitted to the hospital with 10 day history of choking spells. Spells began with repetitive coughing, progressing to his turning red and gasping for breath . Lately had been vomiting with coughing . Pulse was 160, respiration 72, clear chest X-ray , fever of 38.0 o C. No tracheal abnormalities . WBC 15,500/mm 3 with 70% lymphocytes.
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Questions z What causes pharyngitis? z Host defenses involved? z How does damage occur? z What caused the heart failure (case #1)? z What can we do to save the patient? z Why antibiotic treatment did not help?
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Respiratory Bacteria: Basic Pathogenesis z Upper respiratory tract (URT) Sinuses Middle ear Oropharynx Trachea Bronchi Bronchioles z Lower respiratory tract (LRT) Alveoli and bronchoalveoli alveolar macrophages
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DEFENSES z Structural Mucus Ciliated epithelium z Mechanical Glottal reflex Coughing z Cellular Alveolar macrophages (lower) Neutrophils - with inflammation z Fluid IgA (upper) IgG and complement transudation from blood (lower)
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