What diagnoses should be considered in this patient, whose respiratory symptoms have failed to respond to routine antibiotic therapy? How should she now be investigated and managed?
Jiesi, a 27-year-old woman from China, presented with a cough that had been troubling her for the past fortnight. She is studying accountancy at a private college in the centre of Sydney and she lives with her husband and 18-month-old daughter. One week before presenting, she noticed shortness of breath and then developed right-sided chest pain. She was taking no regular medications and she is a nonsmoker.
The patient’s temperature was 38.6oC, so she was prescribed antibiotics (amoxycillin and roxithromycin) for suspected community-acquired pneumonia (CAP).
After a week of treatment there was no change in her condition so a chest x-ray was performed (Figure).
Why has Jiesi not improved on the prescribed antibiotics?