Ms. Ribeiro returned to the clinic as her initial symptoms have not decreased but in fact worsened. She also has developed multiple new symptoms. Her internal cough has intensified. It is now producing yellow mucus. More concerningly, the sputum is occasionally blood- streaked. Her cough has been going on for about 2 weeks, but the bloody mucus only developed in the last few days. Besides the cough her breathing feels more labored and her chest hurts when she tries to inhale deeply. She is still feeling weak and generally fatigued. Izabel complains that she can’t perform her routine physical activities for a long period of time without needing to stop to sit take a breath she has also developed a fever in the last 48 hours and reports occasional chills she has started noticing appetite loss resulting in a weight decrease. When father asked if she’s been dieting or eating differently Izabel stated that she doesn t feel hungry but is not trying to lose weight. When asked others in her town are ill Izabel remarked that someone is always sick; they live in tight quarters her vomiting ceased.