Patient Profile: 62-year-old male with history of chronic obstructive pulmonary disease (COPD) Signs/Symptoms: temperature 40oC, blood pressure 94/52 mm Hg, respiration 18 breaths/min, chills, nausea and vomiting, production of increasing volumes of tenacious yellowish sputum of 3 days duration
Tests: chest xray revealed extensive infiltrates in the left lower lung involving both the lower lobe and the lingula
multiple blood cultures and culture of sputum yielded Streptococcus pneumoniae
The isolate was susceptible to cefazolin, vancomycin and erythromycin but resistant to penicillin
Diagnosis: Streptococcus pneumoniae - pneumonia
Treatment: Cefazolin, vancomycin or erythromycin
Remarks: S. Pneumoniae is spread from colonization of the nasopharynx. It is found in young children, and in individuals who have trouble clearing bacteria from the respiratory tract - in this case the patient had COPD and therefore was unable to clear the bacteria from his respiratory tract and thus more susceptible to infection of the lungs with the bacteria.
Patient Profile: 56-year-old female postal worker sought medical help for fever, diarrhea and vomiting. She was treated symptomatically and not admitted to hospital. She returned five days later with chills, dry cough, pleuritis and chest pain. She was admitted to hospital where respiratory status and pleural effusions worsened.
Chief Complaint: Initial visit: fever
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