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Answer :
Final answer:
The most likely diagnosis for the presence of small gram-negative rods growing only on charcoal yeast extract agar is Legionella pneumophila, the bacterium that causes Legionnaires' disease.
Explanation:
An infection with Legionella pneumophila, a type of gram-negative rod that requires special growth conditions, such as those provided by charcoal yeast extract agar. This bacterium is associated with Legionnaires' disease, a serious type of pneumonia.
Notably, Legionella does not typically stain well with Gram stain, which could explain the 'unremarkable' result. Moreover, this bacterium is not an acid-fast bacillus like Mycobacterium tuberculosis, which is known for slow growth and distinctive staining characteristics in sputum samples.
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