A 63-year-old male is hospitalized with fever, cough, shortness of breath, and weight loss. He is coughing up thick, foul-smelling, purulent sputum. Talking with him revealed that he consumes about a quart of alcohol per day and smokes two packs of cigarettes per day. He admits he often passes out after one of his many drinking binges. His chest x-ray shows an extensive right upper lobe infiltrate consistent with pneumonia. His laboratory results indicate:
Sputum culture
Macroscopic: grossly purulent and foul smelling
Microscopic: gram-negative rod pattern (many pale, pleomorphic, bipolar
Staining gram-negative rods and many pale, thin, fusiform gram-negative
Rods)
Culture: light growth of normal upper respiratory flora
Transtracheal aspirate culture
Macroscopic: grossly purulent and foul smelling
Microscopic: gram-negative rod pattern (many pale, pleomorphic, bipolar
Staining gram-negative rods and many pale, thin, fusiform gram-negative rods)
Culture: results pending
What clinical feature(s) suggests this individual has anaerobic pneumonia?

Question

Quizplus · Accepted Answer

The clinical features suggesting anaerobic pneumonia in this individual include the foul odor of the sputum, the unique morphologies observed on direct Gram stain, and the discrepancy between organisms observed on direct Gram stain and those grown on the sputum culture. These characteristics are indicative of an infection with anaerobic bacteria, which are often not cultured under standard aerobic conditions but can be inferred from the clinical presentation and microscopic examination.

A 63-Year-Old Male Is Hospitalized with Fever, Cough, Shortness of Breath