A 5-year-old boy has been irritable for the past 2 days and has complained of an earache for the past 5 days. On
physical examination, he has a temperature of 39.1°C. Laboratory examination of the CSF from a lumbar puncture shows
numerous neutrophils, slightly increased protein level, and decreased glucose concentration. On Gram staining of the
CSF, which of the following is most likely to be seen microscopically?
A. No organisms B. Gram-positive cocci C. Gram-negative diplococci D. Short Gram-positive rods E. Short Gram-positive rods
Gram-positive cocci-(b) this patient has acute bacterial meningitis. in his age group, the most common etiologic organism is now
streptococcus pneumoniae, a gram-positive coccus. the number of cns infections with haemophilus influenzae, a gramnegative
bacillus, in this age group has decreased because of widespread immunization. pneumococci also are likely to
be seen in an adult. the gram-negative diplococci of neisseria meningitidis are seen in young adults. the short, grampositive
rods of listeria monocytogenes appear sporadically or in epidemics caused by food contamination. the gramnegative
bacilli of escherichia coli are most often seen in neonates. with these clinical and csf features, it would be
unusual if bacteria were not present in the csf.
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