On 24 April 2001, nine cаses оf pneumоniа аmоng residents of a nursing home were investigated by the Department of Health of Hamilton Township, New Jersey. Illness onset among the residents occurred from 3 to 24 April. Four residents died. Pneumonia was characterized by one or more lobes filled with fluid and pleural effusions (pus in the pleural space) (Fig. 25.1). The nursing home was a 114-bed facility that employed approximately 200 staff, including nurses, restorative aides, and other administrative and support personnel. None of the employees was known to have pneumonia during this period. Seven of the residents lived in the same wing of the nursing home. All nine patients had blood cultures that grew alpha-hemolytic colonies on blood agar (Fig. 25.2). Sputum samples were Gram stained to identify the pathogen, a gram-positive streptococcus. All isolates were penicillin sensitive and resistant to erythromycin.
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