A pieviously healthy 2S yeai olu male who woiks as a high school Fiench teachei

piesents with heauaches anu a soie thioat that has giauually incieaseu ovei the last
two weeks. Be also iepoits a uiy cough that has also incieaseu in fiequency ovei
the same time peiiou. The patient uenies smoking but uoes iepoit the occasional
beei with mates. Patient histoiy is otheiwise uniemaikable. Patient has a
tempeiatuie of S9.u C. Lung exam is noimal except foi milu pleuiitic chest pain
with coughing. Chest x-iay ieveals opacities on the iight miuule anu lowei lobes.
What is the best initial tieatment foi this patient.

A. Amoxicillin
B. Penicillin u
C. Pipeicillin plus tazobactam
B. Azithiomycin
E. Cefazolin

!"# %&''#%( )*+,#' -+ ./ 01-("'&23%-*4 An otheiwise healthy young man with
a giauual onset of atypical symptoms (the heauache, soie thioat, anu uiy cough)
mixeu with classic symptoms of Pneumonia point to one of the Atypical oiganisms.
In a young peison with symptoms uispiopoitional to the x-iay, the oiganism tenus
to be Nycoplasma, which can be tieateu initially with a couise of Azithiomycin.
Amoxicillin tenus to be useu foi Stiep specific infections usually peuiatiic
patients. Penicillin u is useu in a vaiiety of cases, but Pneumonia is not typically one
of them. Pipeicillin plus tazobactam can be useu in aneiobic anu stieptococci
infections of the abuomen. Seconu geneiation cephalospoiins oi highei aie useu in
the tieatment of pneumonia, not 1
st
gens like Cefazolin.


Citation:
Baiuy RB. Chaptei 17S. Infections Bue to Nycoplasmas. In: Longo BL, Fauci AS,
Kaspei BL, Bausei SL, }ameson }L, Loscalzo }, eus. !"##$%&'(% *#$'+$,-.% &/ 0'1.#'"-
2.3$+$'.. 18th eu. New Yoik: Ncuiaw-Bill; 2u12.
http:www.accessmeuicine.comcontent.aspx.aIB=91u2612. Accesseu 0ctobei 18,
2u1S.
A 49 yeai olu male softwaie engineei piesents with uiy cough, fevei, anu heauache
giauually ovei the last week. Be is employeu by a majoi insuiance company anu
woiks in a high iise in uowntown Syuney. The patient also iepoits having
moueiateu uiaiihea ovei the last S uays. The patient uenies evei smoking, but uoes
aumit to having a glass of wine each night with uinnei. The patient has a temp of
S8.9 C. Lung exam ieveals a milu wheezing bilateially. The iemainuei of the
patient histoiy is noncontiibutoiy. A chest x-iay ieveals bilateial lowei lobe
involvement. Which of the following tests woulu be best to uiagnosis the cause of
these complaints.

A. PCR
B. 0iine antigen
C. Seium colu agglutinins
B. Seium antigen
E. Sputum staining

!"# %&''#%( )*+,#' -+ 5, 0iine antigen test. A patient that piesents with
pneumonia-like symptoms, especially if some aie atypical symptoms, plus iecent
onset uiaiihea, then Legionella is the likely oiganism. Legionella has a specific
antigen that can be easily uetecteu in the uiine of afflicteu patients. Legionella can
often be founu in encloseu enviionments with aii-conuitioning anuoi iecycleu aii,
like high iise builuings oi hospitals.
PCR anu Seium antigen testing can be useu foi uiagnosing Chlamyuia
pneumonia. Seium colu agglutinins can be helpful in uiagnosing Nycoplasma.
Sputum staining will help to ieveal offenuing oiganisms, but by itself is not specific
foi Legionella.


Citation:
Sabiia N, Yu vL. Chaptei 147. 4.5$&'.--" Infections. In: Longo BL, Fauci AS, Kaspei
BL, Bausei SL, }ameson }L, Loscalzo }, eus. !"##$%&'(% *#$'+$,-.% &/ 0'1.#'"- 2.3$+$'..
18th eu. New Yoik: Ncuiaw-Bill; 2u12.
http:www.accessmeuicine.comcontent.aspx.aIB=9121472. Accesseu 0ctobei 18,
2u1S.