Question

A young, previously fit man presents with a one-week history of a 'flu-like illness which has worsened over the past 24 hours. His temperature is 39.5 °C with a heart rate of 100 and increased respiratory rate. His chest X-ray shows diffuse mottled shadowing in both lung fields. A diagnosis of community-acquired pneumonia is made, and he is started on co-amoxiclav and clarithromycin. After 24 hours, his condition has not improved, his temperature is 39 °C, and a repeat chest X-ray reveals multiple nodular shadows with the possibility of a fluid level. What investigations will you carry out? What organisms are most likely to cause community-acquired pneumonia in a young patient? What element in the history makes one of these organisms more likely? What features are particularly alarming in this history - what might this be due to? What changes would you make to the antibiotic therapy? What laboratory characteristics will help identify this organism?

          A young, previously fit man presents with a one-week history of a 'flu-like illness which has worsened over the past 24 hours. His temperature is 39.5 °C with a heart rate of 100 and increased respiratory rate. His chest X-ray shows diffuse mottled shadowing in both lung fields. A diagnosis of community-acquired pneumonia is made, and he is started on co-amoxiclav and clarithromycin. After 24 hours, his condition has not improved, his temperature is 39 °C, and a repeat chest X-ray reveals multiple nodular shadows with the possibility of a fluid level.

What investigations will you carry out?
What organisms are most likely to cause community-acquired pneumonia in a young patient?
What element in the history makes one of these organisms more likely?
What features are particularly alarming in this history - what might this be due to?
What changes would you make to the antibiotic therapy?
What laboratory characteristics will help identify this organism?

a young previously fit man presents with a one week history of a flu like illness which has worsened over the past 24 hours his temperature is 395 c with a heart rate of 100 and increased re 23539

Added by Jocelyn D.

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