A 40-year-old high school teacher presents to you with 3 weeks of low-grade fever, chills, and cough. She had been visiting relatives in Bakersfield, CA, over spring break.
She saw her primary care physician 1 week ago and received 5 days of azithromycin for what she called "bronchitis." The treatment was ineffective.
Her vital signs are: temperature 99.8 °F, blood pressure 122/82 mm Hg, heart rate 120 beats/minute, and oxygen saturation 94% on room air. She is mildly tachypneic.
Findings on lung examination reveal crackles on auscultation in the left axillary area. Abdominal and extremity examination findings are unremarkable.
You order radiography of her chest (Figure 1).
You also obtain a sputum culture, and the KOH stain of the sputum is shown (Figure 2).
What organism is causing her symptoms?
This question appears in Med-Challenger Internal Medicine Review with CME.