Answer to the last #DiagnosticDilemma
Correct answer is C, S. pneumoniae

S. pneumoniae is the most common cause of bacterial meningitis between the ages of 3 months and 10 years.

The patient’s CSF and blood cultures revealed S. pneumoniae (C), which is a Gram-positive coccus that is typically found in pairs. It is catalase negative, air tolerant and encapsulated.

The capsule contributes to the pathogenesis in two different ways. One of the ways it is pathogenic is that the capsule binds complement-inhibitory factors.

The second way it contributes to the pathogenesis of the bacteria is that is secreted factors such as IgA protease, which helps to destroy IgA found in the mucin and ciliated epithelial cell, especially in the respiratory tract, as well as pPneumolysin, which activates the complement pathway and recruits inflammatory cells to the focus of infection.

Despite being on appropriate antibiotic therapy, the patient suffered severe, irreversible damage to his brain (Figures 2 and 3), with subdural fluid and multiple hemorrhagic cystic areas. His condition continued to decline, and he succumbed after 39 days in the PICU.

Upon discovering the patient’s asplenia, we also screened his siblings, revealing one other to also be asplenic, and she was started on prophylactic penicillin. Interestingly, the patient had 40 CBCs done during his hospitalization, with only one showing Howell-Jolly bodies (remnants of the nucleus in some RBCs of patients without a spleen), which was on the day after discovering the absent spleen by surgery.

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