The CSF Gram stain showed Gram-positive diplococci, subsequently growing S. pneumoniae. A peripheral blood culture revealed the same organism.
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Clinical History: A 14-year-old girl is brought to the emergency department with a 1-day history of fevers and decreased consciousness. She had been well until the previous day when she awoke with left-sided headache, anorexia, fatigue, and subjective fevers. During the course of the day, her level of consciousness decreased. In the ED, her temperature is 38.8°C, and she is difficult to arouse. She resists neck flexion, but the remainder of her physical examination is unremarkable.
Clinical History, Part 2: Laboratory values: elevated white blood cell count of 29.3×109/L (93% neutrophils and 7% lymphocytes). Lumbar puncture results included a nucleated cell count of 7200×106/L, (92% neutrophils, 7% lymphocytes and 1% monocytes), protein level 1.79 g/L (normal 0.2 g/L to 0.40 g/L) and glucose level 2.3 mmol/L (2.2 mmol/L to 3.8 mmol/L).
Clinical History, Part 3: A sample of CSF fluid is submitted for Gram staining and blood cultures are drawn. The results of the CSF Gram stain are shown below. Image Gallery:
Clinical History, Part 4 (click here)
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