Case 31: Meningitis in a 6 year old girl

Question 1

What does CSF containing high leucocytes, low glucose and high protein suggest?

Answer 1

Bacterial meningitis

Question 2

What will a gram stain of a CSF deposit from Strep. pneumoniae show?

Answer 2

Gram +ve diplococci

Question 3

What is the colonial morphology for Strep. pneumoniae on HBA?

Answer 3

Colonies with greening

Question 4

What is the colonial morphology for Strep. pneumoniae on CHA?

Answer 4

Large green colonies

Question 5

What will a patient’s CSF isolate streaked onto HBA with optochin disc show with Strep. pneumoniae?

Answer 5

Sensitive

Question 6

What does the presence of a halo around the bacteria in the Gram stain suggest?

Answer 6

Background staining due to high level of protein present, suggesting presence of a capsule

Question 7

What does greening on HBA and CHA mean?

Answer 7

Strep. pneumoniae is able to reduce the haemoglobin present to a green product - alpha haemolysis

Question 8

Will Strep. pneumoniae be catalase positive or negative?

Answer 8

Negative

Question 9

What antimicrobial susceptibilities does Strep. pneumoniae show?

Answer 9

Penicillin and cefotaxime

Question 10

What should be added to empiric therapy when treating a patient with Strep. pneumoniae?

Answer 10

Vancomycin alongside cefotaxime

Question 11

How can infection with Strep. pneumoniae be prevented?

Answer 11

Vaccination - 88% effective

There are 90 different types of Strep. pneumoniae capsules - there are vaccines for the 13 most common