What is the likely causative organism in a patient presenting with sub-conjunctival hemorrhage due to severe coughing episodes?

The presence of a sub-conjunctival hemorrhage due to severe coughing episodes is typically associated with a condition like whooping cough, which is caused by the bacterium Bordetella pertussis. In cases of pertussis, the cough is often paroxysmal and can be so severe that it leads to increased intrathoracic pressure, resulting in rupture of small blood vessels and subsequent bleeding into the conjunctiva.

This mechanism explains why pertussis is identified as the likely causative organism in this scenario. The distinctive prolonged episodes of coughing characteristic of pertussis put significant strain on the vascular system, causing such hemorrhagic manifestations. Other pathogens listed, such as the influenza virus or rhinovirus, cause respiratory illnesses but typically do not produce the same intensity of coughing or the specific vascular effects observed with pertussis. Mycobacterium, known for causing tuberculosis, would not typically lead to acute sub-conjunctival hemorrhage in the context described.