What is the diagnosis for a patient presenting with a 2-week history of cough, chills, and fatigue, with unremarkable Complete Blood Count (CBC) and Comprehensive Metabolic Panel (CMP) results, and a chest X-ray showing acute findings?

From the Guidelines

For a patient presenting with a 2-week history of cough, chills, and fatigue, with unremarkable Complete Blood Count (CBC) and Comprehensive Metabolic Panel (CMP) results, and a chest X-ray showing acute findings, I strongly recommend ordering a C-reactive protein (CRP) test to strengthen the diagnosis of pneumonia, as suggested by the 2019 Chest guideline and expert panel report 1.

Diagnosis and Investigation

The patient's symptoms, including cough, chills, and fatigue, are suggestive of pneumonia, especially with the presence of acute findings on the chest X-ray. According to the guideline, the absence of runny nose and the presence of breathlessness, crackles, and/or diminished breath sounds on auscultation, tachycardia, and fever (38C or greater) are also suggestive of pneumonia 1.

• The normal CBC and CMP results are reassuring but do not rule out pneumonia.
• The chest X-ray is crucial in evaluating for pneumonia, bronchitis, or other pulmonary conditions that could explain the persistent symptoms.

Management

If the CRP test result is 30 mg/L or higher, in addition to suggestive symptoms and signs, it increases the likelihood that the cough may be related to having pneumonia 1.

• In this case, empiric antibiotics should be considered as per local and national guidelines, typically with azithromycin 500mg on day 1 followed by 250mg daily for 4 more days, or amoxicillin-clavulanate 875/125mg twice daily for 7-10 days.
• If the patient's symptoms worsen or if new symptoms develop, such as shortness of breath, chest pain, or hemoptysis, they should seek immediate medical attention.

Supportive Care

While awaiting the CRP test results and chest X-ray findings, supportive care is recommended, including:

• Rest
• Adequate hydration
• Over-the-counter medications like acetaminophen (Tylenol) 650mg every 6 hours as needed for fever or discomfort
• Dextromethorphan (Robitussin DM) 10-20mg every 4 hours as needed for cough The patient should follow up with their healthcare provider if symptoms worsen or if new symptoms develop.

From the FDA Drug Label

14 CLINICAL STUDIES 14. 1 Nosocomial Pneumonia

Adult patients with clinically and radiologically documented nosocomial pneumonia were enrolled in a multicenter, randomized, open-label study

14. 2 Community-Acquired Pneumonia: 7 to 14 Day Treatment Regimen

Adult inpatients and outpatients with a diagnosis of community-acquired bacterial pneumonia were evaluated in 2 pivotal clinical studies

The diagnosis for a patient presenting with a 2-week history of cough, chills, and fatigue, with unremarkable Complete Blood Count (CBC) and Comprehensive Metabolic Panel (CMP) results, and a chest X-ray showing acute findings is likely pneumonia, either nosocomial pneumonia or community-acquired pneumonia 2.

• The patient's symptoms, such as cough, chills, and fatigue, are consistent with a diagnosis of pneumonia.
• The chest X-ray showing acute findings supports this diagnosis.
• The unremarkable CBC and CMP results do not rule out pneumonia, as these tests are not specific for this condition.

From the Research

Diagnosis of Acute Cough

The patient presents with a 2-week history of cough, chills, and fatigue, along with unremarkable Complete Blood Count (CBC) and Comprehensive Metabolic Panel (CMP) results, and a chest X-ray showing acute findings.

• The diagnosis of acute cough can be approached by differentiating it from chronic cough, with acute cough lasting up to 8 weeks 3.
• The most common cause of acute cough is a self-limiting viral infection of the upper respiratory tract, with community-acquired pneumonia being an important differential diagnosis 3.
• The patient's symptoms, such as cough, chills, and fatigue, are consistent with a viral infection or community-acquired pneumonia.
• The chest X-ray showing acute findings supports the diagnosis of community-acquired pneumonia or another respiratory infection.

Role of Chest X-ray in Diagnosis

• A chest X-ray is usually ordered in patients with acute cough to rule out community-acquired pneumonia or other respiratory infections 4.
• The decision to order a chest X-ray is influenced by clinical factors such as advanced patient age, shortness of breath, fever, tachycardia, rales, and rhonchi 4.
• In this case, the chest X-ray showing acute findings suggests that the patient may have community-acquired pneumonia or another respiratory infection.

Diagnostic Approach

• The diagnosis of acute cough can be made based on clinical judgment, including history, physical examination, and epidemiological history 5, 6.
• The patient's symptoms, physical examination findings, and chest X-ray results should be taken into account when making a diagnosis.
• Further diagnostic tests, such as SARS-CoV-2 antigen or nucleic acid tests, may be necessary to confirm the diagnosis, especially if the patient is suspected to have a viral infection such as COVID-19 5.

Differential Diagnosis

• The differential diagnosis of acute cough includes community-acquired pneumonia, viral infections, and other respiratory infections 3, 5.
• The patient's symptoms and chest X-ray results should be evaluated in the context of these potential diagnoses.
• A thorough history and physical examination, along with laboratory tests and imaging studies, can help narrow down the differential diagnosis and guide treatment 7.