Gram-Positive Diplococci in a Cerebrospinal Fluid Gram Stain.

A 5-month-old girl presented with meningitis after receiving amoxicillin for bilateral otitis media. The cerebrospinal fluid (CSF) Gram stain suggested Streptococcus pneumoniae: Gram-positive diplococci with a surrounding clear area indicative of a bacterial capsule. Her CSF and blood cultures grew penicillin-resistant S pneumoniae serotype 35B. This serotype is not included in the 13-valent pneumococcal conjugate vaccine (PCV-13) and has been identified as a cause of invasive pneumococcal disease in the post-PCV-13 era.