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Pneumococcal Meningitis — RACP Paediatrics MCQ

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ModerateInfectious DiseasePneumococcal MeningitisRACP Paediatrics

A 4-year-old presents with fever, irritability, and a bulging fontanelle. LP shows cloudy CSF with WCC 2500 (90% neutrophils), protein 3.5 g/L, glucose 0.5 mmol/L (serum glucose 6.0 mmol/L). Gram stain shows Gram-positive diplococci. What is the most likely organism?

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Correct answer: C — Streptococcus pneumoniae

Gram-positive diplococci in CSF = Streptococcus pneumoniae, the most common cause of bacterial meningitis in children >3 months in Australia (following introduction of Hib and meningococcal vaccines). Empirical treatment is IV ceftriaxone + dexamethasone (dexamethasone before or with the first antibiotic dose).

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Bacterial Meningitis