Group A streptococcal Pharyngitis
You are an APN in a Quick Care Clinic. Mom brings Joey, her 8-year-old son, in for possible GAS pharyngitis. You notice that Joey has been seen and treated multiple times this year for the same condition. Your clinic does not have the ability to culture, and mom refuses the rapid test “because it is always negative, but I know he has it.”
Then answer the following questions:
1. Could Joey be a chronic pharyngeal carrier? Why or why not?
2. According to the article by the Infectious Disease Society of America (Links to an external site.), how would you treat Joey? Be sure to support your answer.
3. Provide a very brief SOAP note on how you plan to treat this patient.
Sample Paper
Group A streptococcal Pharyngitis
Yes, Joey could be a chronic pharyngeal carrier because his mother reports that he has been treated multiple times in one year for GAS pharyngitis, which clearly indicates that the patient may be experiencing repeated viral infections. However, despite being a chronic pharyngeal carrier, Joey does not require any identification because he is unlikely to spread GAS pharyngitis to his close contact, including his mother. Joey is also at little or no risk of developing nonsuppurative and suppurative complications such as acute rheumatic fever because he is more than three years old (Shulman et al., 2012).
The ideal treatment for Joe would include the administration of an appropriate antibiotic at the right dose for a period of time that is most likely to eradicate the microorganisms from the patient’s pharynx. Considering Joey does not have any previous history of adverse reactions with antibiotics or any allergic reactions, the administration of amoxicillin for ten days would be the ideal treatment for his condition (Shulman et al., 2012).
Subjective
An eight-year-old patient presenting for possible GAS pharyngitis. The mother highlights that the patient has had recurring incidents of GAS pharyngitis and has received multiple treatments during the year for the same condition. The patient reports no swollen lymph nodes, no fever, no headache, mild cough, and no nausea.
Objective
All systems reviewed do not produce any positive symptoms, with the only observable symptoms being the ones recorded in the history of the present illness. Vital Signs include a BP of 130/80 and a temperature of 100.4°F. Close examination of the patient’s review does not reveal any signs of swollen lymph nodes, rashes, and red throat with white patches. The patient reports sore throat and change in voice
Assessment
The patient is an eight-year-old boy with a history of GAS pharyngitis. The patient has received numerous treatments for the same condition in the same year, which suggests that the patient may be a chronic pharyngeal GAS carrier who is experiencing repeated viral infections. A throat culture test is therefore needed for the patient because clinical features alone cannot be utilized to discriminate between viral and GAS pharyngitis. A patient is only eight years old. A throat culture is therefore needed. The throat culture is also needed to back up a rapid antigen detection test because the previous test for the patient has been negative. Clinical examination of the eight-year-old patient suggests viral pharyngitis because of the absence of many symptoms of bacterial pharyngitis, which include the white patches on the gums and swollen lymph nodes. The patient also does not display any signs of fatigue or high fever, which are associated with pharyngitis (Luo et al., 2019).
Plan
Suspected chronic pharyngeal carrier. Throat culture confirms the presence of viral pharyngitis. The patient was required to take acetaminophen liquid to help reduce pain. The patient was advised to take more fluids, including teas with ingredients that help with the throat, such as cinnamon and Ginger. Patients are advised to gargle at least three times a day with salt water until they see an improvement in their symptoms. The patient was advised to eat smooth and cool foods such as ice pops and gelatin. Because the patient has viral pharyngitis, he will not require any identification of antimicrobial therapy as they are not likely to spread GAS pharyngitis to his close contact, including his mother. Joey is also at little or no risk of developing nonsuppurative and suppurative complications such as acute rheumatic fever because he is more than three years old (Shulman et al., 2012).
References
Luo, R., Sickler, J., Vahidnia, F., Lee, Y. C., Frogner, B., & Thompson, M. (2019). Diagnosis and Management of Group a Streptococcal Pharyngitis in the United States, 2011–2015. BMC Infectious Diseases, 19(1). https://doi.org/10.1186/s12879-019-3835-4
Shulman, S. T., Bisno, A. L., Clegg, H. W., Gerber, M. A., Kaplan, E. L., Lee, G., Martin, J. M., & van Beneden, C. (2012). Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 55(10), e86–e102. https://doi.org/10.1093/cid/cis629
