A 40-year-old alcoholic develops cough and fever. Chest x-ray shows an air-fluid level in the superior segment of the right lower lobe. Which of the following is the most likely etiologic agent?
- a. Streptococcus pneumoniae
- b. Haemophilus influenzae
- c. Legionella
- d. Anaerobes
- e. Mycoplasma pneumoniae
The answer is " d ".
Of the organisms listed, only anaerobic infection is likely to cause a necrotizing process. S. pneumoniae capsular type III pneumococci have been reported to cause cavitary disease, but this is unusual.
The location of the infiltrate suggests aspiration, also making anaerobic infection most likely. The superior segment of the right lower lobe is the one most likely to develop an aspiration pneumonia.
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