A 55-year-old female who had a cerebral stroke and is bed-bound presents with a high fever, cough, and difficulty breathing. Chest examination reveals decreased breath sounds over the right lower lobe. What are the possible causes, and what are the next steps?
Given her history of a stroke with resultant immobility, this patient is at a higher risk for aspiration pneumonia. Aspiration of oral or gastric contents into the lower respiratory tract can cause an infection. The next step would be a chest X-ray or CT scan to confirm the presence of pneumonia. Blood tests, including a complete blood count and blood cultures, should also be obtained. This patient may require broad-spectrum antibiotics to cover both typical and atypical pathogens as well as anaerobes, which are commonly found in aspiration pneumonia.