Editor’s note: This monthly column serves to challenge pediatricians’ visual diagnosis skills on infectious diseases and provide supporting information on symptoms and treatment.
A previously healthy 19-month-old child is brought to your office with a 24-hour history of vomiting and increasing irritability. The child has not had surgery or hospitalizations, is not on any medication and all immunizations have been administered at appropriate ages. Physical exam reveals a temperature of 39 degrees Celsius (102.2 degrees Fahrenheit) and a stiff neck.
A lumbar puncture is performed, and the cerebrospinal fluid reveals 1,440 white blood cells, 11 red blood cells, protein 86 mg/dL and glucose 33 mg/dL. A cerebrospinal fluid (CSF) Gram stain is shown below.
Of the following, the most likely diagnosis is: