Review Question - QID 214587

A 3-year-old girl is brought to the emergency department by her mother with a 2-week history of cough. Her cough is dry and has kept her awake at night and is occasionally followed by non-bilious vomiting. She denies rhinorrhea, sore throat, abdominal pain, diarrhea, and rashes. The girl and her family are from Sierra Leone and recently moved to the U.S. 3 months ago. Her father has had a cough for a month. Her temperature is 100.1°F (37.8°C), blood pressure is 115/67 mmHg, pulse is 80/min, and respirations are 18/min. Physical exam reveals an uncomfortable child with bilateral small subconjunctival hemorrhages. She has a persistent dry expiratory cough with intermittent high-pitched inspirations. There are subtle crackles bilaterally on pulmonary auscultation. Which of the following is most likely involved in the pathogenesis of this patient's symptoms?