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Introduction
Case1:
Vomiting
Case 2:
Cough & fever
Case 3: Bruising
Case 4: Sore
throat
Case 5: Jaundice
Case 6: Flu & fever
Case 7: Diarrhea
Case 8: Black
Robe
Case 9: Back Pain Catching the
beast
Thanks to
Quiz
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This is not your garden variety community acquired
pneumonia.
Mr. DB
has a debilitating condition.
- He's a chronic alcoholic and prone to aspiration.
- He has a Klebsellia pneumonia
- Ordinary community acquired bugs include:
- Pneumococcus
- Mycoplasma pneumoniae
- Chlamydia pneumoniae
- H. influenzae type b (especially in
children)
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- The antibiotic sensitivities are
different for Klebsiela as compared to other bugs.
- Straight beta-lactam antibiotics are of
little use with Klebsiella.
- These bugs have a beta-lactamase that
destroys the antibiotic.
- A third generation cefalosporin or
quinolone would be the way to start.
- Mr. DB was started on Ceftriaxone and did
reasonably well.
- He required oxygen initially.
- On the 6th hospital day he began to
exhibit delirium tremens.
- Things went downhill. He ripped out his
IV and tried to sign himself out.
- He had to be transferred to the
psychiatric unit to continue his care.
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Sounds a little melodramatic, but this case is
for real. Ready for the next one?
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