CSF Gram Stain Case

Case: Three years old girl baby has high fever and sepsis was detected in the morning. CSF sample was taken and sent to a laboratory for gram stain. Gram stain findings are in the image below.

What are the findings in this CSF gram stain?

Correct answer is below the image.

(Click image to enlarge)

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Correct answer: Neutrophils (PMNs) 3+, gram positive bacilli 4+

L. monocytogenes is a gram positive cocco-bacillus, but may appear as coccoid. If coccoid forms are seen in a CSF, but the predominant  form is bacilli, then the report should be gram positive coccobacilli rather than reporting gram positive bacilli and gram positive cocci.

Use of the term “diplococci” in describing gram positive organisms is reserved for those organisms with a cellular morphology resembling Streptococcus pneumoniae. If the paired cocci are not lancet shaped, then it would be most appropriate to simply describe the organisms as being “in pairs.” The organisms in this smear did not fit the traditional ‘lancet shaped’ definition (elongated with a slightly pointed outer curvature at one end). Reporting the organisms in this smear as either diplococci or lancet-shaped would be misleading to the clinician.

Source: CMPT, G131