Which of the following is the most likely organism causing the symptoms?

A 74-year-old woman, who has been followed for the past 25 years for chronic obstructive pulmonary disease (COPD) comes to the emergency department complaining of 48 hours of temperatures to 38.6 C

(101.4 F) and worsening shortness of breath. She has a chronic productive cough, which has become more copious. On physical examination, she has rhonchi and increased fremitus in the posterior mid-lung field. A Gram’s stain reveals many epithelial cells and multiple gram-positive and gram-negative organisms; no neutrophils are seen.

Which of the following is the most likely organism causing the symptoms?
A . Escherichia coli
B . Haemophilus influenzae
C . Mycobacterium tuberculosis
D . Mycoplasma pneumonia
E . Klebsiella Pneumoniae

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Answer: B

Explanation:

Explanation The correct answer is B. This patient, with a long history of chronic obstructive pulmonary disease (COPD), has evidence of a community-acquired pneumonia. The common organisms causing pneumonias in patients with COPD are Streptococcus pneumonia, Haemophilus influenzae, and Moraxella catarrhalis