A 67-year-old man with a 10-day history of productive cough, fever, and dyspnea is admitted to the hospital. He has a history of COPD but denies recent aspiration, dental procedures, or immunosuppression. Vital signs: temperature 39.1°C, heart rate 105/min, respiratory rate 23/min, blood pressure 132/78 mmHg, oxygen saturation 91% on room air. Physical examination reveals dullness to percussion and decreased breath sounds in the right lower lobe. Chest X-ray shows a cavitary lesion with an air-fluid level in the right lower lobe consistent with lung abscess. Laboratory studies reveal WBC 15,400/μL with left shift. Sputum culture is pending but Gram stain shows gram-positive cocci in chains and gram-negative rods. Which of the following organisms is most likely to be isolated from this patient's sputum culture?
- A)Streptococcus pneumoniae
- B)Staphylococcus aureus (methicillin-resistant)
- C)Peptostreptococcus species and Fusobacterium nucleatumGABARITO
- D)Klebsiella pneumoniae and Clostridium perfringens
- E)Pseudomonas aeruginosa and Haemophilus influenzae
Explicação
Lung abscess with cavitation in a patient without obvious risk factors for aspiration typically results from anaerobic infection from oral flora. Peptostreptococcus species (anaerobic gram-positive cocci) and Fusobacterium nucleatum (anaerobic gram-negative ro... Ver explicação completa e trilha adaptativa →