Pneumonia
Pneumonia is a lower respiratory tract infection typically caused by aspiration. Pneumonia can be caused by multiple organisms: bacteria, viruses, fungi, protozoa or parasites. Depending on the infecting organism, symptoms, severity and length of illness can vary. In general, pneumonia follows an upper respiratory tract infection. Cough, dyspnea and fever follow. So far, the patient exhibits all signs of pneumonia. However, the pathophysiology of pneumonia usually leads to adventitious lung sounds including crackles, a finding incongruent with the presenting patient. Diagnosis of pneumonia includes chest infiltrates shown on chest imaging, typically in one consolidated lung lobe, but can also be diffuse. Meredith’s chest X-ray was clear, suggesting another pathophysiological process.
Chronic Bronchitis
Chronic bronchitis is a chronic obstructive pulmonary disease defined as “hypersecretion of mucus and chronic productive cough that continues for at least 3 months of the year for at least 2 consectutive years” (Pathophysiology). Risk factors include lung irritants: smoking, air pollution and occupational exposure to dust and chemicals. Thus far, we can begin to rule this differential diagnosis out. The patient does not complain of an ongoing or chronic issue, nor does she report any history or current use of tobacco. Her employment at a law firm suggests that she is not being exposed to various irritants and chemicals at work. Inspired irritants play a vital role in the development of chronic bronchitis by promoting inflammation, causing edema and increasing mucus glands and ultimately narrowing the airway. The increased secretion of thick mucus is unable to be cleared from the lungs due to impaired ciliary function (Pathophysiology). The patient’s dyspnea on exertion is consistent with chronic bronchitis.
Tuberculosis
Tuberculosis is an infection caused by Mycobacterium tuberculosis. TB is predominantly spread in crowded living environments, the homeless population, between individuals involved in substance abuse and in populations without access to medical screening and care. TB is incredibly contagious, spreading by airborne droplets. When infected, the lungs become inflamed and neutrophils and macrophages engulf the infective bacilli and isolate them by encapsulating. TB is able to survive within the capsules and lies dormant, a condition called latent TB. From here, the disease can progress into active TB, or remain latent for the remainder of the patient’s life. Latent TB is asymptomatic, while clinical manifestations for the active disease include fatigue, weight loss, lethargy and a low grade fever. Respiratory symptoms include a purulent cough, dyspnea, chest pain and hemoptysis. The presenting patient exhibits a fever, cough (although not productive) and dyspnea. She does not report a productive cough, or any blood in her respiratory secretions. She reports a slight decrease of appetite, but no weight loss.
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