Differential Diagnosis for Patient with Strep and Wheezing Cough

Single Most Likely Diagnosis

• Acute Bronchitis: This is likely due to the presence of a wheezing cough, which is a common symptom of bronchitis, especially when combined with a streptococcal infection. The strep infection could be contributing to the severity of the symptoms.

Other Likely Diagnoses

• Pertussis (Whooping Cough): Although less common in adults who have been vaccinated, pertussis can cause a severe cough and wheezing, especially if the vaccination is not up to date or if the patient is immunocompromised.
• Asthma Exacerbation: If the patient has a history of asthma, a streptococcal infection could trigger an asthma exacerbation, leading to wheezing and cough.
• Chronic Obstructive Pulmonary Disease (COPD) Exacerbation: Similar to asthma, if the patient has COPD, a streptococcal infection could exacerbate symptoms, including wheezing and cough.

Do Not Miss Diagnoses

• Pneumonia: While the primary symptoms suggest an upper respiratory infection, pneumonia (especially caused by Streptococcus pneumoniae) must be considered, as it can present with cough and wheezing, and missing this diagnosis could be fatal.
• Epiglottitis: Although rare, epiglottitis is a life-threatening condition that can cause severe respiratory distress, and while it typically presents with more severe symptoms like stridor and difficulty swallowing, it should not be overlooked.
• Foreign Body Aspiration: This is more common in children but can occur in adults, especially if they have a condition that affects their ability to swallow or if they have inhaled something while unconscious or under the influence of substances.

Rare Diagnoses

• Cystic Fibrosis: If the patient is young and has recurrent respiratory infections, cystic fibrosis could be considered, although it would be unusual to diagnose for the first time in adulthood without prior symptoms.
• Bronchiectasis: This condition involves permanent enlargement of parts of the airways and can cause chronic cough and wheezing, but it's less likely to be diagnosed based solely on a streptococcal infection and wheezing cough without other chronic symptoms.
• Allergic Bronchopulmonary Aspergillosis (ABPA): This is a rare condition that occurs in people with asthma or cystic fibrosis, caused by an allergic reaction to a fungus. It could present with worsening respiratory symptoms but would be unusual without a known history of asthma or cystic fibrosis.