I need the 5 questions below answered about this case study. Thank you!
Infectious Disease Case Study
CC: L.F. is a 20 year old male college student with a 2-week history of
cough and increased sputum production who presents to your clinic with new chest
pain when he coughs, shortness of breath, intermittent fever and chills and
blood-tinged sputum.
HPI: Cough treated with guiafenesin with dextromethorphan obtained form
roommate
Allergies: sulfa (nausea)
Physical examination:
GEN: DOE and pleuritic chest pain
VS: BP
120/75 HR 95 T 100.5 RR 35 WT 90kg HT 6’4″
CHEST: LUL is CTA with
significantly decreased breath sounds. There are E-to-A changes in the LLL and
across the middle of the right lung field.
COR: tachycardic, no
MRG
HENT: WNL
ABD: WNL
GU: WNL
NEURO: WNL
SKIN: WNL
Chest X-ray: Consolidation of the inferior segments of the LLL. Remainder of
the lungs are clear. Heart size WNL.
Sputum Gram Stain: many WBC, few epithelial cells, moderate gram-positive
cocci in chains and pairs
Questions to Answer:
- Based upon what you learned in class and from your readings, what are the 2
most likely pathogens that would cause pneumonia in this patient? - Based upon your answer to the above question, and the gram stain, what is
the most likely causative microorganism in this patient? - What would you prescribe for this patient to treat his infection, and what
would you tell this patient about those medications (i.e. AE, monitoring of
condition…)? - What other medications would you prescribe for this patient?
- How would you follow-up with this patient (i.e. under what circumstances
would you see him back)?
Expert Solution Preview
Introduction:
This case study involves a 20-year-old male college student presenting with symptoms of cough, increased sputum production, chest pain, shortness of breath, intermittent fever and chills with blood-tinged sputum. Based on the physical examination, chest X-ray and sputum gram stain, we need to determine the most likely pathogens causing pneumonia in this patient, the causative microorganism, the appropriate treatment and follow-up plan.
1. What are the two most likely pathogens that would cause pneumonia in this patient?
The two most likely pathogens causing pneumonia in this patient are Streptococcus pneumoniae and Haemophilus influenzae. These are the most common bacteria responsible for community-acquired pneumonia in adults, especially in young adults with risk factors such as college students and smokers.
2. What is the most likely causative microorganism in this patient based on the answer to the previous question and the gram stain?
Based on the answer to the previous question and the gram stain, the most likely causative microorganism in this patient is Streptococcus pneumoniae. The gram-positive cocci in chains and pairs seen in the sputum gram stain are consistent with S. pneumoniae, which is often associated with a high fever, chills, and productive cough with blood.
3. What would you prescribe for this patient to treat his infection, and what would you tell this patient about those medications (i.e. AE, monitoring of condition…)?
For the treatment of pneumonia caused by S. pneumoniae, the first-line antibiotics are penicillins, such as amoxicillin, or macrolides, such as azithromycin. In this case, the patient is allergic to sulfa drugs, ruling out trimethoprim-sulfamethoxazole as a treatment choice. Thus, amoxicillin is the recommended antibiotic for this patient. The patient should be educated about common adverse effects of amoxicillin, such as diarrhea, vomiting, and allergic reactions. They should also be advised to monitor their symptoms and report any worsening or new symptoms to their healthcare provider.
4. What other medications would you prescribe for this patient?
In addition to antibiotics, the patient may benefit from other medications to relieve symptoms. A short course of oral corticosteroids, such as prednisone, may be given to reduce inflammation and improve lung function. Bronchodilators, such as albuterol, may be used to open up the airways and improve breathing. Finally, over-the-counter pain relievers, such as acetaminophen or ibuprofen, can help alleviate chest pain and fever.
5. How would you follow-up with this patient (i.e. under what circumstances would you see him back)?
The patient should be instructed to follow-up in 2-3 days to assess their response to antibiotics and monitor for any complications. If the patient has persistent fever or signs of worsening pneumonia, they should return immediately for further evaluation and treatment. The patient should also be informed about the importance of completing the full course of antibiotics, which is typically 5-7 days for uncomplicated pneumonia. Follow-up chest imaging may be indicated if the patient’s symptoms do not improve or if they have risk factors for complicated pneumonia.