Question

Case Study 4 (PLEASE EXPLAIN all options for Q1-3)

A 63-year old man with chronic obstructive pulmonary disease (COPD) presents to your office with a temperature as high as 39.2°C (102.5

°F) for 3 days, nonproductive cough, headache, abdominal pain, and diarrhea. He has a history of chronic alcoholism but no other underlying medical problems. On examination, he appears toxic; blood pressure is 110/70 mm Hg, heart rate is 95 beats/minute, respiratory rate is 32 breaths/minute, temperature is 38.6 °C (101.6°F). Chest examination reveals bilateral rales in the posterior lower left lung fields. Chest radiograph demonstrates bilateral patchy lower robe infiltrates, no effusion, and normal heart size. Laboratory results are as follows: WBC count 18,600/μL; 90% polymorphonuclear leukocytes (PMNs); 10% bands Hematocrit (Hct) 35% Arterial blood gases (room air): pH7.49 PO2 52 mm Hg PCO2  28 mm Hg Sodium 132 mg/dL Potassium 4.7 mg/dL Chloride 110 mg/dL Bicarbonate 28 mg/dL Sputum Gram Stain (induced) 3+ PMNs, rare mixed organisms

1.What is the most likely cause of this condition?

a.Pseudomonas aeruginosa

b.M. tuberculosis

c.Legionella pneumophila

d.Haemophilus influenza

e. Influenzavirus A

2.What is the most appropriate initial therapy for this patient?

a.Ceftriaxone and azithromycin

b. Levofloxacin and rifampin

c.Isoniazid and rifampin

d. Vancomycin and gentamicin

e. Oseltamivir

3.Which of the following is most likely to be diagnostic in this case?

a.Routine sputum culture

b. Blood cultures

c.Urine for Legionella antigen

d. Sputum acid-fast bacillus smear and culture

e. Nasopharyngeal swab for viral culture

Answer 1

1. C. Legionella pneumophilia as this causative organism is responsible for gastrointestinal symptoms found along with respiratory symptoms. This organism commonly infects in those with weak immune system, chronic lung disease

2. A. Ceftriaxone and azithromycin

3. Urine for legionella antigen as this method is simple, quick and reliable