cells and genes
Scenario:
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.
The Assignment
(1- to 2-page case study analysis-this does not include title page and reference page)
Develop a 1- to 2-page case study analysis in which you:
Explain why you think the patient presented the symptoms described. (Not a trick question but reflective of a patient on immunosuppressive drugs and a high-risk employment for exposure to Aspergillosis)
Identify the genes that may be associated with the development of the disease.
Explain the process of immunosuppression and the effect it has on body systems.
Developing answers to these 3 questions, each question 1-2 paragraphs will bring you to the 2-page expected limit. 3 pages will not lose points but learning to synthesize points, provide current references (submissions like this would earn 3 primary references) and citations will garner full credit.
The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references, done in APA format. Keep references current, 5 yr. from publication, please, and from primary references (# references to support your points for full credit), like classroom textbooks and peer-reviewed journals.
ORDER A CUSTOM-WRITTEN PAPER HERE
Cells and Genes
Advanced nurse practitioners encounter patients with various medical issues in their clinical practice. The patient is a 49yo male diagnosed with rheumatoid arthritis history. He works in a farm cooperative as a grain inspector. His chief complaint during today’s visit is fever. His medications are Methotrexate 10 mg PO weekly, atorvastatin 40 mg once daily, and Prednisone 5 mg PO QAM. The client has experienced a fever (101 degrees F) for the last week. He also reports chills and sweats. The patient reports increased fatigue and chest pain accompanied by coughing. Other occasional episodes of hemoptysis. He is diagnosed with Invasive Aspergillosis following an extensive work-up.
Reason for the Client’s Symptoms
The client presented Invasive Aspergillosis symptoms. Immunosuppressive drugs, including Methotrexate, Prednisone, and atorvastatin, significantly contribute to development of these symptoms (Neuberger, 2021). First, the client takes Methotrexate to manage swelling associated with rheumatoid arthritis. Being an immunosuppressant, this medication slows down the functioning capacity of the body’s immune system and reduces swelling (inflammation) in persons with inflammatory disorders, such as rheumatoid arthritis (Neuberger, 2021). Secondly, the client takes Prednisone, an FDA-approved corticosteroid or immunosuppressive agent for treating various illnesses, including rheumatic. The client also takes atorvastatin, associated with an immunosuppressive effect due to statin-induced MHC-II repression and T lymphocyte activation (Shahbaz et al., 2019). Therefore, these immunosuppressive agents compromise the client’s immune system, resulting in Invasive Aspergillosis symptoms, including fever ((101 degrees F), chills, cough, excess fatigue, and chest pain. In addition to immunosuppressive drugs, the client’s work environment exposes him to Aspergillosis. Individuals can acquire Aspergillosis by inhaling microscopic Aspergillus spores from their environment (Singh, 2021). Thus, the client developed Invasive Aspergillosis symptoms after breathing in spores at the farm where he works as a grain inspector.
Impact of Genes on the Disease’s Development
Genetics predisposes individuals to Invasive Aspergillosis. TLR-4 is attributed to susceptibility to Invasive Aspergillosis. Cunha et al. (2018) reported that TLR4 genetic polymorphism increases susceptibility to Invasive Aspergillosis pathology. TLR4 receptor is one of the major receptors that recognize pathogenic fungi, activating inflammatory response. Polymorphisms in TLR5 also contribute to Invasive Aspergillosis development (Cunha et al., 2018). The impact of the TLR5 gene in the development of Invasive Aspergillosis symptoms indicates that pulmonary or bronchial epithelial lesions are involved in Aspergillus spp’s immune response dysregulation. Additionally, increased epithelial apoptosis makes epithelial cell homeostasis defective, compromising the immunity system’s defenses against the fungus (Cunha et al., 2018).
Immunosuppression Process and its Effect on Body Systems
Immunosuppression reduces the body’s immune system to effectively detect and destroy foreign antigens. It results from immune effector cell destruction (Neuberger, 2021). Immunosuppression also results from the blockage of intracellular pathways involved in antigen recognition. It weakens the immune system, predisposing individuals to bacterial, viral, and fungal infections. Therefore, people with weak immune systems are more vulnerable to “Opportunistic” infections than those with healthy immune systems. The client takes immunosuppressive drugs, such as Methotrexate, which compromises his immune system, predisposing him to infections, specifically Invasive Aspergillosis.
Overall, the client presented Invasive Aspergillosis symptoms such as high fever, chest pain, cough, and chills. He developed this viral infection since immunosuppressive drugs compromised his immunity system. Additionally, the client might have inhaled Aspergillus spores from the farm, predisposing him to Invasive Aspergillosis. Genetic, including TLR-4 and TLR-5, predispose the client to this disease. Therefore, the client should replace immunosuppressive agents and boost his immunity to reduce the risk of developing viral infections in the future.
References
Cunha, D. D. O., Leão-Cordeiro, J. A. B., Paula, H. D. S. C. D., Ataides, F. S., Saddi, V. A., Vilanova-Costa, C. A. S. T., & Silva, A. M. T. C. (2018). Association between polymorphisms in the genes encoding toll-like receptors and dectin-1 and susceptibility to invasive Aspergillosis: A systematic review. Revista da Sociedade Brasileira de Medicina Tropical, 51, 725-730.
Neuberger, J. (2021). Immunosuppression in gastroenterology and hepatology. Best Practice & Research Clinical Gastroenterology, 54, 101758.
Shahbaz, S. K., Sadeghi, M., Koushki, K., Penson, P. E., & Sahebkar, A. (2019). Regulatory T cells: possible mediators for the anti-inflammatory action of statins. Pharmacological Research, 149, 104469.
Singh, R. K. (2021). Chronic pulmonary Aspergillosis in a patient with AIDS. Cureus, 13(4).