An 83-year-old man with Parkinson’s disease presents with low-grade fever and cough for several weeks. Lately, he has been experiencing more rigidity and difficulty with his walking. He is on a levodopa/carbidopa combination for treatment for the past 5 years. On examination, his gait is shuffling and slow. He has a tremor in his left hand at rest, and there is cogwheel rigidity of the forearm. There are crackles in the left lower lung field. CXR reveals a lung abscess in the left lower lobe. Which of the following is the most likely bacteriologic diagnosis for the lung abscess?
An 83-year-old man with Parkinson’s disease presents with low-grade fever and cough for several weeks. Lately, he has been experiencing more rigidity and difficulty with his walking. He is on a levodopa/carbidopa combination for treatment for the past 5 years. On examination, his gait is shuffling and slow. He has a tremor in his left hand at rest, and there is cogwheel rigidity of the forearm. There are crackles in the left lower lung field. CXR reveals a lung abscess in the left lower lobe. Which of the following is the most likely bacteriologic diagnosis for the lung abscess?
π‘ Explanation
**Core Concept**
The patient's presentation with a lung abscess and underlying Parkinson's disease suggests an aspiration pneumonia, which is a common complication in patients with neurological disorders affecting swallowing and respiratory function.
**Why the Correct Answer is Right**
Aspiration pneumonia occurs when foreign material, including saliva and food, enters the lungs. In patients with Parkinson's disease, the shuffling gait and difficulty with swallowing increase the risk of aspiration. The lung abscess is likely a result of the aspiration of oral secretions contaminated with bacteria. The most common bacteria causing aspiration pneumonia are those found in the oral cavity, such as **Anaerobic bacteria**, including **Fusobacterium** and **Peptostreptococcus**.
**Why Each Wrong Option is Incorrect**
**Option A:** **Staphylococcus aureus** is a common cause of pneumonia in hospitalized patients, but it is not the most likely cause of a lung abscess in this patient.
**Option B:** **Klebsiella pneumoniae** is a common cause of pneumonia in patients with underlying lung disease, but it is not typically associated with aspiration pneumonia.
**Option C:** **Pseudomonas aeruginosa** is a common cause of pneumonia in patients with cystic fibrosis or underlying lung disease, but it is not the most likely cause of a lung abscess in this patient.
**Clinical Pearl / High-Yield Fact**
Aspiration pneumonia is a common complication in patients with neurological disorders affecting swallowing and respiratory function. In patients with Parkinson's disease, the risk of aspiration can be reduced by using a swallowing evaluation and implementing strategies to improve swallowing function.
**Correct Answer:** **D.** **Fusobacterium**.
β Correct Answer: A. oropharyngeal flora
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