CASE 13
In December, a 71-year-old man from a nursing home was brought to the hospital in acute respiratory distress. He had been in his usual state of health until 10 a.m. the previous day, when he suddenly developed fever, chills, muscle aches, cough, and prostration. Several other nursing home residents had developed a similar illness during the previous week.
His past medical history was unremarkable, and he had not seen a physician in the past year.
LABORATORY STUDIES
Diagnostic Work-Up
Table 13-1 lists the likely causes of illness (differential diagnosis). Influenza was considered based on the clinical features and seasonality of the illness. Investigational approach for delineating the etiology may include
TABLE 13-1 Differential Diagnosis and Rationale for Inclusion (consideration)
Rationale: In the appropriate season, typical clinical features are usually adequate to make a diagnosis of influenza. Other viral causes are generally not as acute or severe in onset. The presence of headache and myalgias is not as common with bacterial pneumonia. Atypical causes are generally associated with a more indolent presentation. Q fever is often associated with animal exposure.
