Feathers

A 58 year old man presents with a high fever, headache, sweating, arthralgia and myalgia for 9 days. He also complains of a non-productive cough and mild dyspnea for 2 days.

His medical history includes stable ischaemic heart disease and dyslipidemia for 5 years, for which he is on atenolol and simvastatin therapy.

He owns a pet shop selling parrots, parakeets, and budgerigars. There is no history of recent travel, intravenous drug use or blood transfusion.

Select Relevant Investigations
Portable Chest X-Ray

Performed

The chest X-Ray shows extensive consolidation of the right upper and left lower lobes.
Full Blood Count

Performed

WBC: 17,400/mm3 (5,000-10,500)
N: 93%
HB: 13.9 g/dL (12-18.5)
Plt: 160,000/mm3 (150,000-400,000)
Arterial Blood Gases

Performed

pH: 7.24 (7.35-7.45)
PO2: 42 mmHg on FiO2 60% (> 100)
PCO2: 38 mmHg (35-45)
HCO3-: 16 mmol/L (22-28)
Base excess: - 8.9mmol/L (-2 to +2)
Sputum Induction

Performed

Several sputum samples are collected.
ELISA for Mycoplasma pneumoniae, Klebsiella pneumoniae, Legionella pneumophila are negative.
PCR is positive for Chlamydophila psittaci.
Preliminary culture results: no growth.

Select Relevant Management
IV Fluids Stat
Isolation
IV Doxycycline
Intubation & Ventilation