Microbiology
Angela, a 25-year-old female patient in the emergency department, is having some trouble communicating verbally because of shortness of breath. A nurse observes constriction and swelling of the airway and labored breathing. The nurse asks Angela if she has a history of asthma or allergies. Angela shakes her head no, but there is fear in her eyes. With some difficulty, she explains that her father died suddenly at age 27, when she was just a little girl, of a similar respiratory attack. The underlying cause had never been identified. What are some possible causes of constriction and swelling of the airway? What causes swelling of body tissues in general?
Part 2
To relieve the constriction of her airways, Angela is immediately treated with antihistamines and administered corticosteroids through an inhaler, and then monitored for a period of time. Though her condition does not worsen, the drugs do not seem to be alleviating her condition. She is admitted to the hospital for further observation, testing, and treatment.
Following admission, a clinician conducts allergy testing to try to determine if something in her environment might be triggering an allergic inflammatory response. A doctor orders blood analysis to check for levels of particular cytokines. A sputum sample is also taken and sent to the lab for microbial staining, culturing, and identification of pathogens that could be causing an infection.
Which aspects of the innate immune system could be contributing to Angela’s airway constriction? Why was Angela treated with antihistamines? Why would the doctor be interested in levels of cytokines in Angela’s blood?
Part 3
Angela’s tests come back negative for all common allergens, and her sputum samples contain no abnormal presence of pathogenic microbes or elevated levels of members of the normal respiratory microbiota. She does, however, have elevated levels of inflammatory cytokines in her blood.
The swelling of her airway has still not responded to treatment with antihistamines or corticosteroids. Additional blood work shows that Angela has a mildly elevated white blood cell count but normal antibody levels. Also, she has a lower-than-normal level of the complement protein C4.
What does this new information reveal about the cause of Angela’s constricted airways? What are some possible conditions that could lead to low levels of complement proteins?