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

Question

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?
A) Organisms grown on the sputum culture do not correlate with direct Gram stain
B) Unique morphologies on direct Gram stain
C) Foul odor
D) All of the above
E) B and C

Answer 1

D