chest congestion,breathing problems

[marcel99]

Hi i am a 39 year old former moderate smoker(20 years) About a year ago i came down with a very congested chest which produced yellow mucus in the mornings and breathing problems.I immediatly quit smoking and went to my GP,i was given antibiotics a few times but symptoms did not improve.Eventually i was refered to a pulmonary doctor who carried out following tests.X ray normal,CT scan normal,Bronchoscopy normal,Spirometry/lung function supra normal,asthma tests normal,sputum culture showed heavy growth of parainfluenzae(was given antibiotics) and immunology showed low antibodies to influenzae(was given hib vaccine 2 weeks ago)Basically i dont feel any better than when this started,still congested,still produce yellow mucus most mornings and still have breathing problems.I have to wait a month to see my pulmonary doctor again and he never diagnosis or gives an inclin to what it might be or how serious it is.Could you shed any light on this and is there any chance of making a recovery after a year..Thanks

[National Jewish Health]

You have experienced a rather unusual series of events, given all the normal/negative tests and studies that have been performed.  Parainfluenza virus infections in adults occur primarily in immuno-suppressed or immunodeficient individuals, not infrequently after transplantation.  Given a favorable milieu for growth, as might be seen with chronic bronchitis secondary to heavy smoking, there is no reason why one could not develop a chronic or sub-acute infection to any of a variety of bacteria or viruses, including parainfluenza.  That is you may have a chronic infectious disease of your lungs.

It appears that your work-up has gone about as far as possible, with the pulmonologist. I would not wait another month, to see him/her.   I suggest that you seek consultation with an Infectious Disease Specialist (IDS).  Should you have traveled abroad, prior to the first signs of a “very congested chest” it would behoove you to seek consultation with an ID Specialist, with a special interest in atypical infection, especially those to be found in tropical countries.  Pseudomonas pseudomalleii, widely prevalent in the far East, would be an example of such.  However, one need not have traveled outside the U.S. to acquire an Atypical Mycobacterial infection (organisms related to TB but not tuberculous..

Basically the negative chest X-ray and CT scan would generally rule-out non-infectious causes of bronchitis/bronchiolitis or ILD but, if I understand the time frame correctly, these may have been taken almost a year ago.  That is a long time for changes to occur, so those studies should be repeated, as part of your current work-up.  Finally, there exists a variety of fungal infections, allergic and invasive, that should also be ruled-out with careful, comprehensive fungal testing.

Good luck