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ذات رئة ....


ذات رئة ....


حالة سريرية

الوصف الكامل Background
A 74-year-old woman, who has been followed for the past 25 years for chronic obstructive pulmonary disease (COPD) presents complaining of 48 hours of temperatures to 38.6 C (101.4 F) and worsening shortness of breath. She has a chronic productive cough, which has become more copious. On physical examination, she has rhonchi and increased fremitus in the posterior mid-lung field. A Gram's stain reveals many epithelial cells and multiple gram-positive and gram-negative organisms; no neutrophils are seen. Which of the following is the most likely organism causing the symptoms?
A. Escherichia coli
B. Haemophilus influenzae
C. Klebsiella pneumoniae
D. Mycobacterium tuberculosis
E. Mycoplasma pneumonia
by


تم أخذ الموضوع في محاضرات الدكتور مسالمة الاسبوع الماضيEye-wink Eye-wink

بانتظار شبيبة الرابعة...

Vince Carter


where is everybody????
29 reads and not a single answer!!!

Vince Carter


any way...the right answer is Haemophilus influenzae...
so encouraging...

Vince Carter

The Hx provides me the following:
1. we have an acute infection ----> far from TB
2. No Other symptoms directing for other infections in the body (UT ,GIT...) where E.Coli like to have her parties..
then compare the "communism " of the E.coli and H.influenza due to a pneomonia ??
3.now for Klebsiella pneumoniae & Mycoplasma pneumonia , can't say anything about them rather than :
H.influenza more common cause than them ,especially that the pt is non-hospitalized ??
also i'd order a CXR to check any abscess caused by the klebsiella which like to dig in tissues , Although the case is so acute .Rolling Eyes Rolling Eyes
last note : how about Streptococcus pneumoniae, which is the leading pathogen responsible for pneumonia in elderly pts ..???
Quote:
A Gram's stain reveals many epithelial cells and multiple gram-positive and gram-negative organisms; no neutrophils are seen.

kind of rubbish smear ..it doesn't reveal anything??

Green Wave's picture
Green Wave


BTW: Thx Vinci , i've reviewed a lot about these creatures to talk about the case ..
Eye-wink Eye-wink

Green Wave's picture
Green Wave

Quote:
kind of rubbish smear ..it doesn't reveal anything??

exactly......no neutrophil and high epithelial cell and multiple organism = inapropriate smear
but because of hx of chronic COPD the most responsible organisms are:
pneumococus, H.enfluenza and moraxella catharalis
generally...remember this sentence :

pneumonia + smokers, COPD → think of H.Influenzae

klebseilla pn. is more common in alcoholics....also keep this in mind...

many thanks for passing my bro...really revived meEye-wink Eye-wink

Vince Carter

Quote:
she has rhonchi and increased fremitus in the posterior mid-lung field

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