Question: 1.) Due To Being Homeless, What Needs To Be Ruled Out?2.) What Pathogen Is Causing The Pneumonia?3.) What Virulence Factor Aids This Organism’s Pathogenicity?4.) Is Antibiotic Resistance A Problem With This Organism?

Douglas, a 66 y.o. white male, presented with a cough, fever, night sweats and chest pain. He also noted a 12 lb. weight loss over 3 weeks. He was a homeless man who admitted to drinking 2 quarts of vodka per day. He vaguely remembers being cough- free about a month ago, and his coughs had become progressively worse since then. In the last several days, he had produced abundant, thick, tenacious, blood-tinged sputum. Upon physical examination, rales and rhonchi were present at the right lung base, and he had an enlarged liver with mild tenderness. A chest x-ray revealed a right upper lobe (RUL) infiltrate, and Douglas was admitted to the hospital. Blood work was performed. Sputum and blood cultures were collected. Hb 12g/dL Hct 36% WBC 16,300/L 72% PMN, 10% bands Alcohol 185 po, 68mm Hg Sputum and blood cultures were positive within 24 hours. Culture results were as follows: BAP: 4+ mucoid colonies that “string” when sampled CHOC: 4+ mucoid colonies MAC: 4+ mucoid pink colonies – “stringy”, indole (-) www.ldimages.org © 2009 IDS.