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Old 01-29-2015
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Default Aspirational Pneumonia in alcoholics

A 45 yo man with chronic alcohol abuse brought in to ED. Egophony +, red to rust-colored sputum. CXR shows a cavity in teh right lower lobe with an air-fluid level, sputum sample is sent to the lab, which of the following is most likely to see?
1. Aspergillus
2. Bacteroides
3. Klebsiella
4. Staph. A.
5. Strep. Pyogenes

post your answer and whyyyyyy, thanks!
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Old 01-29-2015
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Staph A. Air fluid levels with a cavity in an alcoholic patient is more likely Lung abscess. It's caused by Staph A and anaerobes( bacteroides, fusobacterium,peptostreptococcus)
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I meant staph A seems more common
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Old 01-30-2015
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Quote:
Originally Posted by mdnyc View Post
I meant staph A seems more common

Nope unfortunately...Kaplan has Bacteriodes....
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Old 01-30-2015
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Air fluid level means it's an abscess. B. Frag from stomach contents is the class ic bug. Rx: Clindamycin (above the diaphragam anaerobes)
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Old 01-30-2015
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Ans is bacteroides.ofcourse for a lung abscess leading to cavitory lesion,we can think of staph aureus first.but in alcohol intoxicated patients,klebsiella,bacteroides,streptococcus may be causes for LRT infection.Among them streptococcus usually doesnt produce cavity.klebsiella can rarely produce cavity but in an abrupt way.here pt developed cavity in an insidious onset over weeks as a result of pneumonia due to aspiration.so more chance for bacteroides i think
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Old 01-30-2015
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Correct Answer

Bacteroides is always the likely answer when talking about alcoholics or aspiration pneumonia.
Also the location of the lung lesion suggests aspiration pneumonia (right lower lobe) and lastly air fluid levels say abscess + air produced by anaerobes.
good luck everyone
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Old 02-01-2015
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Uworld classifies lung abscess as follows
-oropharngeal ** aspiration , contains a mixed organisms especially bacteroides , peptostrept , fusbactrium
Seen in loss of consicousness (alcoholics and seizure ) or dysphasia*
- bacterial pneumonia , caused by golden staph , e.coli , klabsiella or nosocomial infection in general *
Seen old age , immunosuppression , or lung diseases
-spsis often shows multiple abscesses *( gram positive cocci )



By Understanding this u will make no mistake with abscesses
Good luck
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