Case 100. Panel: Bacteria seen in cerebrospinal fluid
         
    S. pneumoniae, S. agalactiae, N. meningitidis, H. influenzae, K. pneumoniae, L. monocytogenes    
         
   
Key words : Gram stain, cerebrospinal fluid
   
     
 
     
Panel 1
Streptococcus pneumoniae (Gram). Gram-positive diplococci are located outside neutrophils. Penicillin-resistant S. pneumoniae makes a clinical problem.
  Panel 2
Streptococcus agalactiae (group B Streptococcus) (Gram). Gram-positive cocci are phagocytized by neutrophils, and cause neonatal meningitis. S. agalactiae is a normal flora of the vagina.
     
 
     
Panel 3
Neisseria meningitidis (Gram). Gram-negative diplococci are phagocytized by neutrophils. Fulminant meningitis is common in the African meningitis belt along the equator.
  Panel 4
Haemophilus influenzae (Gram). Gram-negative short rods are seen mainly outside neutrophils. Anti-capsule vaccine is effective, but is not yet introduced for the prophylaxis in Japan.
     
 
     
Panel 5
Klebsiella pneumoniae (Gram). Gram-negative large rods are associated with thick capsule formation, and occasionally cause meningitis in the aged.
  Panel 6
Listeria monocytogenes (Gram). Gram-positive rods are phagocytized by neutrophils, and tend to cause transplacental infection to the neonate.