A 77-Year-Old Man Comes to the Physician with a 2-Week

A 77-year-old man comes to the physician with a 2-week history of fevers and generalized weakness.  His other medical history includes a hospitalization for pyelonephritis requiring intravenous antibiotics 3 months ago, an episode of rheumatic fever as a child, and Hodgkin's lymphoma treated with chemotherapy 15 years ago.  He also recently underwent cystoscopy for evaluation of persistent dysuria.  His temperature is 37.8 C (100 F) , blood pressure is 150/86 mm Hg, pulse is 98/min, and respirations are 16/min.  The patient appears slightly diaphoretic.  There is a new II/VI holosystolic murmur at the apex and tender erythematous lesions affecting several fingertips.  The remainder of the physical examination is unremarkable.  Which of the following bacteria is most likely responsible for this patient's present illness?

A) Coxiella burnetii
B) Enterococci
C) Staphylococcus epidermidis
D) Streptococcus pyogenes
E) Viridans streptococci

Correct Answer:

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