CDC Case Challenge: Four People With Cough and Dyspnea After Attending a Baseball Game

Christina A. Nelson, MD, MPH; Katharine M. Cooley, MPH; David W. McCormick, MD, MPH


October 07, 2021

Editorial Collaboration

Medscape &

Since all four patients have hypoxia and significant abnormalities on auscultation of the lungs, it is imperative to further characterize the lung findings. Figure 1 shows the chest radiograph from patient 1.

You request a manual differential and blood smear for patient 4 since she appears unwell. The laboratory calls to report the presence of bipolar staining organisms in her blood. The organisms have a safety pin appearance on Giemsa stain (Figure 2).

After discussing the situation with two of your colleagues working at other EDs in the hospital network, they report evaluating several patients today with similar symptoms of dyspnea and hemoptysis. One died of respiratory failure in the ED, and the remaining patients were hospitalized.