Reference no: EM132704559

The patient is an 82-year-old female, Jane, who lives alone except for three cats, drives, and has an active family, community, and social life.  Lately, however, she complained to her oldest daughter, Sara, that she just felt tired and out of sorts. Sara remembered that her mother had a cold and cough about six weeks ago but had not seen the family physician and seemed mostly recovered. However, Sara noticed recently that she still had a dry (non-productive) cough and complained of a slightly sore throat. Sara suggested that her mom visit her physician and an appointment was made. 

The physical exam noted that heart and chest sounds were normal, blood pressure was slightly elevated, the throat was red, and there was no fever. The physician ordered a rapid streptococcus test and a chest x-ray, and EKG; the streptococcus test was negative, and the x-ray and EKG normal. CBC and routine chemistry panel were ordered and Jane was sent home with a prescription for amoxicillin and diagnosis of probable viral respiratory infection.  Three days later laboratory results arrived and showed that the RBC was normal, the WBC total count was slightly elevated, and the differential count showed elevated segmented neutrophils. The chemistry panel was normal.

Ten days later Jane had completed the course of amoxicillin but was not feeling better and reported to Sara that she was light-headed and "short of breath" at times, without physical exertion. Sara was alarmed and alerted the physician who suggested they go to the hospital ER. In the ER, it was determined that the patient's temperature was 99.8 0C, the blood oxygen level was low and a CT scan of the chest was ordered.  The CT scan revealed a small amount of fluid in both lungs.

1. What illness has Jane had for possibly six weeks?
2. Is this a bacterial, viral, or fungal infection?
3. Why was amoxicillin not effective?
4. What is the next course of treatment?