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A 22-year-old female school teacher was brought to the emergency room after a 2-day history
of headache and fever. On the day of admission, the patient had failed to come to school and
could not be reached by telephone. When notified of this fact, the patient ‘s mother went to her
daughter’s apartment, where she found her daughter in bed, confused and highly agitated. The
patient was rushed to the local hospital, where she was comatose on arrival. Purpuric skin
sessions were present on her trunk and legs (Figure 1). Analysis of her CSF revealed the
presence of 380 cells/mm3 (93% polymorphonuclear leucocytes), a protein concentration of
220 mg/dl, and a glucose concentration of 32 mg/dl. Gram stain of CSF showed many gramnegative diplococci, and the same organisms were isolated from the blood and CSF (Figure 2).
The patient died despite prompt initiation of therapy with penicillin.
Figure 1
Figure 2
1. What pathogen caused the disease? What is the most likely source of this organism?
How does the pathogen spread?
2. What is the morphology and staining characteristics of the pathogen?
3. What is purpuric rash, and which virulence factor plays a central role for its appearance?
4. What are the clinical symptoms of the disease?
5. How is the disease diagnosed? Discuss:
a. Specimen selection
b. Microscopic observation
c. Culture
d. Biochemical CFS evaluation
6. What is the treatment for the disease?
7. How the disease is prevented? Discuss:
a. Prophylactic strategies for large population?
b. Prophylactic strategies for exposed individuals.