CASE 11
A 21-year-old white woman developed fever, headache, and a gradually progressive dry cough. Over the next 2 days, her cough worsened, becoming productive of small amounts of clear sputum.
She was previously in good health. Her 19-year-old brother had had similar symptoms 2 weeks earlier.
LABORATORY STUDIES
Imaging
A chest x-ray revealed bilateral patchy infiltrates consistent with atypical pneumonia (Fig. 11-1).
Diagnostic Work-Up
Table 11-1 lists the likely causes of illness (differential diagnosis). Distinguishing bacterial pathogens of atypical pneumonia (e.g., M. pneumoniae) from other causes of acute respiratory infection is difficult because of a lack of reliable, widely available, rapid diagnostic tests. Investigational approach for delineating the etiology may include
TABLE 11-1 Differential Diagnosis and Rationale for Inclusion (consideration)
Rationale: There are many etiologies for atypical pneumonia, and they are often difficult to differentiate clinically. Mycoplasma is unique in that clinical pulmonary findings are often absent. Legionella often causes gastrointestinal symptoms and a severe headache. C. psittaci, Coxiella, and Legionella may have a specific history of exposure (e.g., birds, domestic animals, or environmental). Truly purulent sputum, as is seen in S. pneumoniae (a major cause of typical pneumonia), is not consistent with atypical pneumonia.
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