A 23-Year-Old Woman Comes to the Emergency Department Due to 3

question 843

Multiple Choice

A 23-year-old woman comes to the emergency department due to 3 days of fever, chills, cough productive of clear sputum, and pain in her right lower chest with deep inspiration and cough.  She has had no sore throat, nasal discharge, or sick contacts.  The patient has a history of HIV and takes combination antiretroviral therapy as prescribed.  CD4 count was 300/mm³ at routine office follow-up a month ago.  She does not use tobacco, alcohol, or illicit drugs.  Temperature is 39 C (102.2 F) , blood pressure is 115/76 mm Hg, pulse is 104/min, and respirations are 22/min.  Oropharyngeal mucosa is normal and there is no cervical lymphadenopathy.  Cardiopulmonary auscultation reveals a soft midsystolic murmur at the upper left sternal border and crackles in the right lower posterior chest.  Chest x-ray is shown below. Which of the following is the most likely organism responsible for this patient's current symptoms?

• A)Aspergillus fumigatus
• B)Coccidioides immitis
• C)Klebsiella pneumoniae
• D)Mycobacterium tuberculosis
• E)Mycoplasma pneumoniae
• F)Pneumocystis jirovecii (formerly P carinii)
• G)Pseudomonas aeruginosa
• H)Staphylococcus aureus
• I)Streptococcus pneumoniae

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