Question
A 25-year-old military recruit comes in with fever, headache, malaise, dyspnea, and a non-productive cough that is worse at night for the past 2 weeks. Several of his dormitory friends have also suffered from similar symptoms. He has no relevant family or past medical history. His vitals are normal except for a temperature of 101 F. Physical examination is significant only for crackles on both sides of the chest. A chest x-ray reveals diffuse reticulonodular opacities throughout bilateral lung fields. Which of the following is the next best step of management in this patient?
| A. |
Start the patient on azithromycin
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| B. |
Admit the patient for IV fluoroquinolones
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| C. |
Perform a PPD test on this patient
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| D. |
Perform a CT scan
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Show Answer
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Correct Answer � A
Explanation
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Ans. A. Start the patient on azithromycin
Mycoplasma pneumoniae is responsible for the vast majority of atypical respiratory infections. However, only about 10% of patients who acquire mycoplasma will develop pneumonia. The infection can occur all year round, and outbreaks in small communities are common (e.g., schools, homes). This patient can be managed on an outpatient basis and does not require admission.
First-line treatment is the macrolide family of antibiotics, although resistance is emerging. Azithromycin is the most common and is available in intravenous and oral formulations; the short treatment course of just 5 days increases patient compliance.
Once the organism is acquired, the symptoms may take 4-20 days to appear and include malaise, cough, myalgia, and sore throat. The cough is often dry and worse at night. Most cases of Mycoplasma pneumoniae infection are mild and resolve on their own. Mycoplasma can also cause a variety of extrapulmonary symptoms like erythema nodosum, urticaria, erythema multiforme, aseptic meningitis, Guillain Barre syndrome, and cerebral ataxia.
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