The chest x-ray shows a right upper lobe pneumonia.
In addition to streptococcus pneumoniae, other pathogens like klebsiella and legionella need to be considered while initiating antibiotic therapy. Pulmonary tuberculosis causes cavitary upper lobe infection.
Therapeutic guidelines suggests ceftriaxone and azithromycin intravenously to cover klebsiella and legionella respectively.
The above patient had legionella pneumonia which is a notifiable disease.