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A 64-year old urbanite male reports to your practice with fever, malaise and a cough. His...

A 64-year old urbanite male reports to your practice with fever, malaise and a cough. His vaccinations are up-to-date, including DPT. His condition worsens over several days, with his temperature increasing to 40.4 oC and development of dyspnea (difficulty of breathing). His lungs show signs of mild inflammation with thin, watery secretion that has a greenish tinge. The patient is given antibiotics and Gram stains made from a bronchial lavage showed a thin gram negative rod. The organism grew well on blood agar plates, producing a flat, metallic colony with beta hemolysis and a fruity odor.

What is the most likely organism causing this man’s infection?

What laboratory testing should be performed to confirm this diagnosis, and what are the expected results? Include any special media as well as routine biochemical testing.

What is the best treatment for this patient? What is the typical pattern of susceptibility for this organism?

Solutions

Expert Solution

1) What is the most likely organism causing this man’s infection?

legionella pneumophila

2) What laboratory testing should be performed to confirm this diagnosis, and what are the expected results? Include any special media as well as routine biochemical testing

Legionella pneumophila can be grown on Buffered Charcoal Yeast Extract [BCYE]agar and the grown on these plates indicates legionella infection.

Urinary antigen test is used to detect a molecule of L.pneumophilia in urine samples

3) What is the best treatment for this patient? What is the typical pattern of susceptibility for this organism?

Treatment with antibiotics such as macrolides (eg. azithromycin) and quinolones (gemifloxacin and levofloxacin etc) are effective against legionella.

Middle-aged and old people are more susceptible to L.pneumophilia infection.

Immune suppressed individuals such as cancer, kidney failure patients, AIDS patients and pateints surviving on immune suppresing medications are likely more susceptible to legionella infections

gladiator answered 1 year ago
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