CASE NO. 3

A 35 year alcoholic male with a history of seizures is admitted with a three week history of fever, generalized weakness, poor appetite, and cough productive of green, foul - smelling sputum. On physical examination, the temperature is 100.3 degrees P. pulse is 96 beats per minute, respiratory rate is 20 breaths per minute, and BP is 120/80 mm. There are many missing teeth with gingivitis and dental caries. He has rales and decreased breath sounds over the right base. Chest x-ray shows consolidation in the superior segment of the right lower lobe. 

1. What type of infection is suggested by his fowl smelling sputum?  Answer

2. What organisms could be responsible for this patient's pneumonia?  Answer

3. Does a normal person aspirate?  Answer

4. What then determines who gets infection?  Answer

5.  What are the other predisposing factors for aspiration? What factor/s predisposed this patient to aspirate?  Answer

6. Describe the pathogenesis of this pneumonia.  Answer

7. What are the common sites for aspiration lung abscess and why ?  Answer

8. What is the normal clinical picture of lung abscess? Does this patient fit that clinical picture?  Answer

9. Are there other routes besides aspiration by which anaerobes can reach lungs?  Answer

10. What complications are associated with this infection?  Answer

11. How would you treat this patient?  Answer

12. What organisms might be the cause of a hospital acquired aspiration pneumonia?  Answer