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Elderly patient who has trouble swallowing and poor dentition
0%
0/30
HIV positive adult with a CD4 count less than 150 and an impaired diffusion capacity
3%
1/30
An otherwise healthy young adult with a week of mild fatigue, chills, and cough
30%
9/30
Hospitalized adult with development of pneumonia symptoms 2 weeks following a viral illness
57%
17/30
An alcoholic with evidence of empyema and "currant jelly sputum"
7%
2/30
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This patient has Staphylococcus aureus pneumonia. S. aureus pneumonia is a common complication of influenza pneumonia. S. aureus, a gram-positive cocci in clusters, is generally an uncommon cause of community acquired pneumonia. However, the classic patient is one with a recent influenza infection. Other individuals at risk include hospitalized patients, nursing home residents, IV drug users, and patients with cystic fibrosis. Bamberger and Boyd describe the typical chest radiograph results in S. aureus pneumonia. Presentation varies from lobar consolidation to abscess or even diffuse infiltrates. Empyemas can develop from extension of local pneumonia possibly necessitating therapy with chest-tube, thorascopic, or open drainage. Wunderink et al., in a retrospective analysis of in patients with nosocomial pneumonia due to methicillin-resistant S. aureus, concluded that initial therapy with linezolid compared to vancomycin was associated with significantly better survival and clinical cure rates. It is hypothesized that this is due to enhanced concentrations of linezolid in lung epithelial lining fluid. Illustration A depicts a Gram-stained smear of Staphylococcus aureus growing on an agar medium (left image) and from the sputum of a patient with Staphylococcus pneumonia (right image). Incorrect Answers: Answer 1: An elderly patient who has trouble swallowing and poor dentition would be at risk for aspiration pneumonia. The most likely causative organisms would be anaerobes. Answer 2: An HIV positive patient with a low CD4 count and impaired diffusion capacity would likely be infected with Pneumocystis jiroveci. Answer 3: This is a description of atypical pneumonia which is typically caused by Legionella pneumophila, Mycoplasma pneumoniae, or Chlamydophila pneumoniae. Generally no organism appears on gram stain. Answer 5: Klebsiella pneumoniae is a common cause of pneumonia in diabetics and alcoholics and is associated with the formation of empyemas, cavitation, and "current jelly sputum". It appears as gram-negative encapsulated rods on gram stain.
2.5
(2)
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