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Case 5 Answers

Geraldine, Gina's 2 year old daughter, came to the clinic with her mother. You notice her face is a little flushed and her mother states that Geraldine is not eating well. Geraldine complains that her throat hurts too. Her vital signs; temperature- 101 degree C, heart rate- 135, respiratory rate- 21, bp- 110/70. Examination reveals the following (see below). Examination of the pharynx revealed enlarged and erythematous tonsils with a white exudate on them. The peritonsilar region was also edematous and erythematous.

Figure 1: Lack of rash round mouth
Figure 2: A white material on the tongue
Figure 3: Patient's antecubital fossa
Figure 4: Does this rash blanche on pressure?

A. Tests on a swab from Geraldine's throat were the same as her mother's (see Case 3). Which of the following is causing Geraldine's rash?

  1. Streptolysin O- the oxygen labile toxin that lyses RBCs, leukocytes, and platelets. Antibodies to streptolysin O are produced after pharyngitis but NOT following skin infections (cholesterol in skin lipids bind up the toxin and it is not available to the immune system for antibody production). Therefore, anti-ASO titers can be obtained from people with strep throat but not from streptococcal infections of the skin.
  2. DNase- breaks down DNA released in abscesses and lowers the viscosity of pus to allow the bacteria to spread
  3. M protein- antiphagocytic and allows the bacterium to adhere to epithelial cells
  4. Pyrogenic exotoxin- this is the toxin that causes scarlet fever. It appears to cause the rash following a hypersensitivity reaction to the toxin*
  5. Streptokinase- lyse blood clots and fibrin deposits and allow the bacteria to spread
  6. Hyaluronic acid capsule- antiphagocytic

B. Match the name for what the image in the Figure depicts or the answer to the question in the Figure with the Figure number.

Possible answers= Yes or No, Strawberry tongue, Pastia's sign, Circumoral pallor

Figure number
Figure 1
Circumoral pallor
Figure 2
Strawberry tongue
Figure 3
Pastia's sign
Figure 4

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Site Last Revised 11/12/13
Neal Chamberlain, PhD. A. T. Still University of Health Sciences/Kirksville College of Osteopathic Medicine.

Take Care and Think Microbiologically!