A 62-year-old man with poorly controlled type 2 diabetes mellitus presents to the emergency department with a 3-day history of fever, productive cough with purulent sputum, and progressive dyspnea. He denies recent hospitalization or antibiotic use. Vital signs show temperature 39.2°C, blood pressure 142/88 mmHg, heart rate 108/min, respiratory rate 22/min, and SpO2 94% on room air. Physical examination reveals dullness to percussion and bronchial breath sounds over the right lower lobe. Chest X-ray shows a right lower lobe consolidation with a characteristic bulging fissure sign. Gram stain of sputum demonstrates gram-negative rods that appear mucoid. Which of the following organisms is most likely responsible for this patient's pneumonia?
- A)Escherichia coli
- B)Streptococcus pneumoniae
- C)Pseudomonas aeruginosa
- D)Klebsiella pneumoniaeGABARITO
- E)Legionella pneumophila
Explicação
Klebsiella pneumoniae is the most likely organism. K. pneumoniae classically presents with the bulging fissure sign on chest imaging—a hallmark radiographic finding caused by the organism's heavy mucopolysaccharide capsule and ability to produce necrotizing in... Ver explicação completa e trilha adaptativa →