Thread: patchy infiltrates and segmental consolidation

A Native American man is brought to a rural hospital
in New Mexico. On arrival, he is unconscious with
severe bronchopneumonia. Family members state that he
suffered the sudden onset of chills, fever, and
headache several days ago. One day later, the man
complained of chest pain and difficulty breathing, and
coughed up blood-tinged sputum. Chest x-ray reveals
patchy infiltrates and segmental consolidation. Which
of the following organisms is the most likely cause of
this man's pneumonia?

A. Brucella abortus
B. Clostridium perfringens
C. Francisella tularensis
D. Listeria monocytogenes
E. Yersinia pestis

Is it C because he is Native Indian?

i think ans is
E. Yersinia pestis not sure ..

Originally Posted by medstudent

A Native American man is brought to a rural hospital
in New Mexico. On arrival, he is unconscious with
severe bronchopneumonia. Family members state that he
suffered the sudden onset of chills, fever, and
headache several days ago. One day later, the man
complained of chest pain and difficulty breathing, and
coughed up blood-tinged sputum. Chest x-ray reveals
patchy infiltrates and segmental consolidation. Which
of the following organisms is the most likely cause of
this man's pneumonia?

A. Brucella abortus
B. Clostridium perfringens
C. Francisella tularensis
D. Listeria monocytogenes
E. Yersinia pestis

The correct answer is E. Any previously healthy person in the Southwestern United States who develops septic shock or severe pulmonary disease should be evaluated for plague. Plague is not an extinct disease, but is still encountered in sporadic cases in various places in the world, including Asia, Africa, parts of Europe, and the American Southwest. The causative organism is Yersinia pestis, which is endemic in many wild animal populations, and can be transmitted to humans either by direct contact or by arthropod bite. Human plague may take many forms, including pestis minor (mild lymphadenopathy); bubonic plague (prominent lymphadenopathy); pneumonic plague (as in this patient); and septicemic plague. The primary pneumonic form typically presents as described. Antibiotics are most effective if given within the first 24 hours, which can be problematic if medical staff do not suspect the disease. Since plague is rare in the United States, a high degree of clinical suspicion is required to make a rapid diagnosis and to institute timely treatment. If the diagnosis is missed, the mortality rate is quite high.
Brucella abortus(choice A) causes brucellosis, characterized by undulating fever, lymphadenopathy, and hepatosplenomegaly.

Clostridium perfringens(choice B) causes gas gangrene and gastroenteritis.

Francisella tularensis(choice C) causes tularemia, associated with a spectrum of manifestations from an influenza-like syndrome to adenopathy with ulceration at the site of inoculation.

Listeria monocytogenes(choice D) causes listeriosis. Infection during pregnancy may result in sepsis, abortion or premature delivery. Infection in the neonate may produce meningitis. In immunocompromised adults, either meningitis or sepsis may occur.