Discussion: Alterations in Cellular Processes
Scenario 1: A 49-year-old patient with rheumatoid arthritis comes into the clinic with a chief complaint of a fever. Patient’s current medications include atorvastatin 40 mg at night, methotrexate 10 mg po every Friday morning and prednisone 5 mg po qam. He states that he has had a fever up to 101 degrees F for about a week and admits to chills and sweats. He says he has had more fatigue than usual and reports some chest pain associated with coughing. He admits to having occasional episodes of hemoptysis. He works as a grain inspector at a large farm cooperative. After extensive work-up, the patient was diagnosed with Invasive aspergillosis.
Rheumatoid Arthritis is an autoimmune which typically affects women more than men in a 3:1 ratio. The reason for this is not clear, however, it is stated that hormones and genetic x-linked factors play a role causing women to be more affected by the disease than men (Sokka et al., 2009). Also, men have a higher muscle mass opposed to women allowing them to better compensate for the functional loss which is suffered throughout the process. Because there is constant inflammation in the joints, (this disease affects synovial joints), there is loss in function which leads to deterioration of cartilage and bone (Van Vollenhoven, 2009).
Invasive Aspergollosis occurs in patients who are immunocompromised who are prescribed steroids for illnesses such as cancer who are undergoing chemotherapy, the lungs being the most commonly affected. They are found to be neutropenic with a weakened immune system. Aspergollosis genus name is A. fumigatis which is found in tropical climates (Rudramurthy et al., 2019). Some common signs and symptoms of Invasive Aspergollosis are cough, fever, and shortness of breath. Vascularly, a patient presents with chest pain and or hemoptysis resulting from pulmonary infaction (Sherif & Segal, 2010).
In this scenario, the patient’s occupation (closely related to an agricultural worker) as a grain inspector exposes him to fumigants which increase the symptoms associated with RA. Exposure to grain dust can cause what is known as “grain fever” which can manifest as chronic respiratory disease (productive cough, nasal and eye irritation, and wheezing). He is afebrile due to one of the clinical manifestation associated with Invasive Aspergollosis and his feeling fatigue. This patient suffers from Rheumatoid Arthritis and part of the treatment is Methotrexate and Prednisone which immunosupressive drugs causing his immune system to weaken and making him more suseptible to illness. The hemoptysis he has been experiencing is due to Invasive Aspergollosis due to pulmonary infarction as well as the chest pain, sweats and chills. These are all clinical manifestations associated with Invasive Aspergollosis.
According to Hohl (2017), “host defense against conidia and hyphae occurs via distinct molecular mechanisms that involve intracellular and extracellular killing pathways, as well as cooperation between different myeloid cell subsets. The strength and efficacy of the host response is shaped by the tissue microenvironment. In preclinical models of disease, host immune augmentation strategies have yielded benefits, yet translating these insights into therapeutic strategies in humans remains challenging”. Confirmation of the disease is done by CT imaging of the lungs as well as lab work.
Bullock, J., Rizvi, S., Saleh, A. M., Ahmed, S. S., Do, D. P., Ansari, R. A., & Ahmed, J.
(2018). Rheumatoid Arthritis: A Brief Overview of the Treatment. Medical
principles and practice : international journal of the Kuwait University, Health Science
Centre, 27(6), 501–507. journal of the Kuwait University, Health Science Centre,
27(6), 501–507. https://doi.org/10.1159/000493390
Hohl T. M. (2017). Immune responses to invasive aspergillosis: new understanding and
therapeutic opportunities. Current opinion in infectious diseases, 30(4), 364–371.
https://doi.org/10.1097/QCO.0000000000000381
Rudramurthy, S. M., Paul, R. A., Chakrabarti, A., Mouton, J. W., & Meis, J. F. (2019).
Invasive Aspergillosis by Aspergillus flavus: Epidemiology, Diagnosis, Antifungal
Resistance, and Management. Journal of fungi (Basel, Switzerland), 5(3), 55.
Journal of fungi (Basel, Switzerland), 5(3), 55. https://doi.org/10.3390/jof5030055
Sherif, R., & Segal, B. H. (2010). Pulmonary aspergillosis: clinical presentation,
diagnostic tests, management and complications. Current opinion in
pulmonary medicine, 16(3),
242–250. https://doi.org/10.1097/MCP.0b013e328337d6de
Sokka, T., Toloza, S., Cutolo, M., Kautiainen, H., Makinen, H., Gogus, F., Skakic, V.,
Badsha, H., Peets, T., Baranauskaite, A., Géher, P., Ujfalussy, I., Skopouli, F. N.,
Mavrommati, M., Alten, R., Pohl, C., Sibilia, J., Stancati, A., Salaffi, F.,
Romanowski, W., … QUEST-RA Group (2009). Women, men, and
rheumatoid arthritis: analyses of disease activity, disease characteristics, and
treatments in the QUEST-RA study. Arthritis research & therapy, 11(1), R7.
https://doi.org/10.1186/ar2591
van Vollenhoven R. F. (2009). Sex differences in rheumatoid arthritis: more than meets the eye…
BMC medicine, 7, 12. https://doi.org/10.1186/1741-7015-7-12
Discussion: Alterations in Cellular Processes
At its core, pathology is the study of disease. Diseases occur for many reasons. But some, such as cystic fibrosis and Parkinson’s Disease, occur because of alterations that prevent cells from functioning normally.
Understanding of signals and symptoms of alterations in cellular processes is a critical step in diagnosis and treatment of many diseases. For the Advanced Practice Registered Nurse (APRN), this understanding can also help educate patients and guide them through their treatment plans.
For this Discussion, you examine a case study and explain the disease that is suggested. You examine the symptoms reported and explain the cells that are involved and potential alterations and impacts.
To prepare:
- By Day 1 of this week, you will be assigned to a specific scenario for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
By Day 3 of Week 1
Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:
- The role genetics plays in the disease.
- Why the patient is presenting with the specific symptoms described.
- The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
- The cells that are involved in this process.
- How another characteristic (e.g., gender, genetics) would change your response.
Read a selection of your colleagues’ responses.
By Day 6 of Week 1
Respond to at least two of your colleagues on 2 different days and respectfully agree or disagree with your colleague’s assessment and explain your reasoning. In your explanation, include why their explanations make physiological sense or why they do not
Great Post. RA begins with systemic manifestations of inflammation, including fever, fatigue, weakness, anorexia, weight loss, and generalized aching and stiffness (McCance & Huether, 2019, p. 1452). I agree that rheumatoid arthritis is considered an autoimmune disease. The most significant genetic risk factor for RA is variations in the HLA genes, particularly the HLA- DRB1 gene (McCance & Huether, 2019, p. 1452). The proteins produced from HLA genes assist the immune system with distinguishing self-proteins from proteins made by invaders such as bacteria and viruses (McCance & Huether, 2019, p. 1452). The alteration in the HLA gene, along with the medications the patient was taking, made the perfect storm for invasive aspergillosis to set in.
According to Mousavi et al. (2016), in humans, Aspergillus fumigatus is the most common and life-threatening airborne opportunistic fungal pathogen, which is particularly important among immunocompromised hosts.
References
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children. St. Louis, MO: Elsevier Mosby.
Mousavi, B., Hedayati, M. T., Hedayati, N., Ilkit, M., & Syedmousavi, S. (2016). Aspergillus species in indoor environments and their possible occupational and public health hazards. Current Medical Mycology, 2(1), 36-42. doi:10.18869/acadpub.cmm.2.1.36
