A 65 year old man presents to the hospital with a one week history of malaise, headache, fever, and chils. He is admitted and over the next week his disease progressed with a worsening cough and shortness of breath. His physical exam was benign except for pulmonary compromise. The patient is current on all of their vaccinations and has no recent travel history. A chest radiograph showed multilobar infiltrates. Other significant laboratory findings include an elevated white blood cell count with increased polymorphonuclear neutrophils. Because the patient had a prior history of drug abuse and akcoholism, a toxicology screen and HIV serology were performed. Both were negative. A bronchoscopy was performed, with a bronchoalveolar lavage (BAL) showing many white blood cells, but no organisms. Calcofluor white stains for fungi and direct fluorescent-antibody stain (DFA) for Pneumocystis were also negative. Routine bacterial culture of the BAL was negative. An organism was recovered only on buffered charcoal yeast extract agar. Based on this information, what is the most likely pathogen? B. pertussis Lpneumophila H. influenzae Brucella spp.
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A 65 year old man presents to the hospital with a one week history of.docx
1. A 65 year old man presents to the hospital with a one week history of malaise, headache, fever,
and chils. He is admitted and over the next week his disease progressed with a worsening cough
and shortness of breath. His physical exam was benign except for pulmonary compromise. The
patient is current on all of their vaccinations and has no recent travel history. A chest radiograph
showed multilobar infiltrates. Other significant laboratory findings include an elevated white
blood cell count with increased polymorphonuclear neutrophils. Because the patient had a prior
history of drug abuse and akcoholism, a toxicology screen and HIV serology were performed.
Both were negative. A bronchoscopy was performed, with a bronchoalveolar lavage (BAL)
showing many white blood cells, but no organisms. Calcofluor white stains for fungi and direct
fluorescent-antibody stain (DFA) for Pneumocystis were also negative. Routine bacterial culture
of the BAL was negative. An organism was recovered only on buffered charcoal yeast extract
agar. Based on this information, what is the most likely pathogen? B. pertussis Lpneumophila H.
influenzae Brucella spp.
