A patient with a history of primary ciliary dyskinesia experiences daily persistent cough associated with purulent sputum production and dyspnea. The symptoms have become progressively worse over several weeks. Sputum culture reveals colonization with Haemophilus influenzae. Chest x- ray shows dilated, thick-walled bronchi forming train track–like patterns radiating from the lung hila. What is the pathophysiologic mechanism of her condition?

(A)          Chronic airway inflammation and bacterial colonization

(B)          Airway hypersensitivity and bronchoconstriction

(C)          Rupture of an apical subpleural bleb

(D)          Necrosis of a localized area of pulmonary parenchyma

(E)          Alveolar macrophage ingestion of acid-fast bacilli

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