Review Question - QID 205855

This patient is most likely suffering from aspiration pneumonia secondary to impaired consciousness due to his excessive alcohol use. Given his history of alcoholism, this patient was likely intoxicated which led to altered consciousness and aspiration of vomitus.

Aspiration is an important condition to recognize as it often leads to a lower-lobe pneumonia. These patients are often infected with gram negative organisms that are normally present in the oral flora. Patients who are chronic users of alcohol or drugs and patients with neurologic impairment are especially susceptible. Patients undergoing surgery are also at risk due to the inability to protect their airway from aspiration during anesthesia, thus the general requirement for patients to be NPO prior to a scheduled procedure.

Thibodeau and Viera review the management of elderly patients with aspiration pneumonia. They state that aspiration pneumonia should be suspected in patients with conditions that impair consciousness or swallowing. Treatment should include antibiotic coverage for organisms of the mouth as well as gram negative organisms and anaerobes (organisms of the GI tract).

Hibberd et al. attempted to create a predictive model to determine the risk of aspiration pneumonia in people with a swallowing problem. They found that poor mobility, no oral intake, age, feeding dependency, number of medications, chronic obstructive pulmonary disease, stroke and alcohol abuse were all predictors of aspiration pneumonia.

Figure A is a chest x-ray of a patient diagnosed with aspiration pneumonia. The x-ray shows a dense consolidative airspace infiltrate in the right lower lobe. Pneumonia related to aspiration commonly occurs in dependent portions of the lung.

Incorrect answers:
Answer 1: There is no indication that this patient has multiple sclerosis which is typically seen in females of reproductive age.
Answer 3: Epiglottitis is typically a result of hemophilus influenza Type B infection in younger children. These children need an airway secured urgently. It is unlikely that a college student (vaccinations are required to enter most colleges) is suffering from this condition.
Answer 4: Mycoplasma is commonly seen in college students living in college dorms however they do not present with a lower lobe consolidation (usually it is more diffuse). In addition the history does not fit the classic description of "walking pneumonia" that is seen in these patients.
Answer 5: This patients history does not make previous infection with TB and fibrosis a likely answer.