DrVirgo
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22. An unimmunized 2 year old girl is brought to the ER after having a generalized tonic-clonic seizure. She has had fever and an upper respiratory tract infection for the past 4 days. A gram stain of cerebrospinal fluid shows numerous gram-negative coccobacilli. Which of the following vaccines would most likely have prevented this infection?
A. DTP
B. Hib
C. Miningococcal
D. Pneumococcal
E. Salmonellal
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| drkirti79
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is it B ?? HIB vaccine
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| leen
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B???
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| robin082006
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B
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| DrVirgo
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I thought C...because its a gram negative coccobacilli... why am i wrong? 
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| reet
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its B
cocco bacilli( cocoid) - H influenza.
meniengococci is only COCCI.
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| Cedrick
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2 year old "Always check vaccine History" in this case they missed one
Bug.-coccobacilli {H.influenzae}
vaccine that prevents this Hib
correct one choice B
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| DrVirgo
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Haemophilus influenzae is a gram negative rod!
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| Diego Casali
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B
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| bactitech
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Yes, H. influenzae is a gram negative rod. However, many techs sign out gram smears with this organism as gram neg coccobacilli. I personally was taught that H. influenzae were PLEOMORPHIC gram negative rods, and that is how I report out a sputum (or CSF) with this organism in it. They can be very short, almost coccobacilli. Bacteroides sp. can also stain as tiny pleomorphic gnr's but the site would probably be different. I have seen them in direct smears of abscesses.
As an aside, the organism Acinetobacter baumanii is truly a large gram negative coccobacillus. The rods are nearly square, and look totally different than H. influenzae. I'm getting so that I can pretty much recognize them right away on a gram stain; however, Acinetobacters can be big foolers on smears so you always must be careful, as they don't always stain gram negative. Indeed, I was just at a presentation on gram stains presented by my former Ph.D. boss, and he had a CSF smear from another local hospital that looked like it was gram positive cocci in pairs. The CSF ended up growing Acinetobacter baumanii. This organism tends to retain some of the crystal violet sometimes and can appear gram positive, although to be honest I've never seen one appear so much like a gram positive. This is a rare occurrence, however.
If I were reporting a smear with Neisseria meningitidis in a CSF, I would report it as gram negative diplococci - I would NOT report this as a gram negative coccobacilli EVER. We also hedge on Neisseria sometimes and call them gram negative cocci in pairs - especially in female cervical smears where we suspect GC but cannot call it, as they are not diagnostic in the female genital tract. If I were to see them in a male urethra specimen, I would call them intracellular gram negative diplococci; they are diagnostic for GC in a male. However, with the advent of molecular testing for gonorrohoeae and chlamydia, the stat gram smear on a male is a thing of the past! I haven't seen one in years.
Hope this helps to clear up the lingo.
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| mjl1717
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Thank you bactitiech, you must have been reading my mind because I was saying to myself "I know they report H. influenza as coccobaccilli, but what other organisms are reported as the same?"
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| Cedrick
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nice report there
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| jaide
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cool explanation bacitech...
thnx...
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