. Andrea, a 14 year old girl had a fever, nonproductive cough, and a headache. S

Question

. Andrea, a 14 year old girl had a fever, nonproductive cough, and a headache. She has a history of a sore throat preceding the onset of the cough, but felt well enough to walk around. Despite treatment with second generation cephalosporins (antibiotics similar to penicillin) the cough did not improve. A chest x-Ray revealed fluid in the lungs. Grams staining of Andrea’s sputum and routine blood cultures were negative. Which of the following pathogens is the most likely cause of her illness and what is the name of her illness? a. Legionella pneumophila; Legionellosis b. Streptococcus pneumophila; pneumococcal pneumonia c. Epstein Barr virus’; primary atypical pneumonia d. Mycoplasma pneumonia; primary atypical pneumonia

Explanation / Answer

Legionella pneumophila is a gram negative strain. Streptococcua, pneumococcal pneumonia and Mycoplasm pneumonia are caused by Gram-positive bacteria. Epsten Barr virus is also Gram-negative in nature and infects the aerial passage in humans and higher animals. Mycoplasm pneumonia is also unresponsive to penicillin and penicillin like infections.

Since the patient shows symptoms of:

1. Fever, headache, non-productive cough

2. Unresponsiveness to cephalosporin/penicillin

3. Fluid accumulation in lungs

4. Gram negative sputum

These set of data collectively suggest that the pateint might be suffering either from Legionella pneumophila or Epstein Barr Virus mediated pneumonia. Since lung fluid accumulation and unresponsiveness to cephalosporins, it is most likely that the patients suffers from Epstein Barr virus infection mediated primary atypical pneumonia. The infection is not likely due to Streptococcus or Mycoplasm because these bacteria are Gram positive in nature.

Thus, the most appropriate answer is choice C, Epstein Barr virus because the patient is atypical in nature, Gram-negative in staining and unresponsive to antibiotics.

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