1. 2)What are the probable etiologic agent during this time?

2. Streptococcus pneumoniae
BACTERIAL
Streptococcus pneumoniae
The pneumococci (S pneumoniae) are gram-positive diplococci, often lancet-shaped or arranged in chains, possessing a capsule of polysaccharide that permits typing with specific antisera.
Pneumococci are readily lysed by surface-active agents such as bile salts. Surface-active agents probably remove or inactivate the inhibitors of cell wall autolysins. Pneumococci are normal inhabitants of the upper respiratory tract of 5–40% of humans and can cause pneumonia, sinusitis, otitis, bronchitis, bacteremia, meningitis, and other infectious processes.

3. Also consider… Mycoplasma pneumoniae Staphylococcus pneumoniae
Legionella pneumophila
Chlamydia psittaci
Mycobacterium tuberculosis

4. FUNGAL Histoplasma capsulatum Coccidioides immitis
Blastomyces dermatitidis
Candida species
Aspergillus species
Cryptococcus neoformans

5. VIRAL
Haemophilus influenzae
Respiratory syncytial virus (RSV)

6. What other laboratory exams would you request at this time to support your diagnosis?
Sputum gram culture
determine if pneumonia is present
Purified Protein Derivative (PPD) tuberculin test
Low sensitivity and specificity
Sputum Acid Fast Bacilli (AFB) Smear
Light microscopy of specimen (expectorated sputum) stained with Kinyoun or Ziehl-Neelsen basic fuschin dyes
in the morning for 3 consecutive days
Mycobacterial culture
Specimens inoculated onto egg or agar based medium
3 consecutive early morning sputum specimen

7. Intraperitoneal Injection of Sputum into Mice
Animals die in 18–48 hours; heart blood gives pure culture of pneumococci. This form of culture for pneumococci is very sensitive but seldom used because of the need to maintain a mouse colony.