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Microbiology 22

An 88-year-old woman is brought to the clinic by nursing home facility personnel for follow up on a poorly healing wound on the medial side of her right fifth metatarsal-phalangeal joint. She has severe dementia and type 2 diabetes. She finds the feeling and taste of saliva in her mouth to be unpleasant and refuses to swallow it. She allows it to build up in her mouth until she spits it out or a member of the nursing home personnel wipes it out of her mouth with a tissue, as she fights back against bulb aspiration.

She is particularly susceptible to infection of her lungs by which of the following etiologic agents with what etiologic agent, with what associated characteristics?

  • A) A gram-negative, encapsulated rod that is resistant to extended spectrum beta-lactams (ESBLs) that is found with other organisms and more commonly affects the right lung
  • B) A gram-negative rod living in amoebae, with alveolar fibrinopurulent exudate
  • C) A gram-positive coccus in clusters which is resistant to methicillin and that may give rise to pneumatoceles
  • D) An acid-fast bacillus with Ghon complexes
  • E) An obligate intracellular bacterium with a biphasic life cycle that creates inflammation primarily in the interstitium


Shana Zucker


Dr. Ted O'Connell


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