Differential Diagnosis for a 15-year-old Female with Respiratory Symptoms
Single Most Likely Diagnosis
- Acute Bronchitis: This is the most likely diagnosis given the symptoms of cough, productive cough, chills, fever, and hoarseness. The presence of clear lung sounds also supports this diagnosis, as bronchitis typically does not cause significant findings on lung auscultation.
Other Likely Diagnoses
- Influenza: The combination of cough, chills, fever, and hoarseness could be indicative of influenza, especially during flu season. Nausea and vomiting can also occur, particularly in children and adolescents.
- Pharyngitis: Although primarily associated with a sore throat, pharyngitis can also cause hoarseness and cough. The absence of significant lung findings supports considering upper respiratory infections.
- Acute Laryngitis: This condition, often caused by viral infections, can lead to hoarseness and cough. The presence of fever and other systemic symptoms like chills aligns with an infectious etiology.
Do Not Miss Diagnoses
- Pneumonia: Despite clear lung sounds, pneumonia must be considered, especially if the patient's condition worsens or if there are risk factors for severe disease. Some cases of pneumonia, especially in early stages or in certain types like pneumococcal pneumonia, might not have abnormal lung sounds initially.
- Pertussis (Whooping Cough): Given the cough and potential for systemic symptoms like fever and chills, pertussis should be considered, especially if the patient is not up to date on vaccinations or if there's an outbreak in the area.
- Epiglottitis: Although less common and typically presenting with more severe symptoms like significant dysphagia and drooling, epiglottitis is a life-threatening condition that requires prompt recognition and treatment.
Rare Diagnoses
- Tuberculosis (TB): While less likely in an immunocompetent teenager without risk factors, TB can present with chronic cough, fever, and systemic symptoms. It's essential to consider TB in the differential, especially if the patient has been exposed or has risk factors.
- Cystic Fibrosis: This genetic disorder can lead to recurrent respiratory infections and chronic cough. Although the diagnosis is typically made earlier in life, it should be considered in any patient with recurrent or severe respiratory symptoms without another clear cause.