Microscopic examination of cerebrospinal fluid showed gram-negative diplococci
and culture documented N.
Gram stain of colony smears showed gram-negative diplococci
and the API NH system (bioMdrieux, Marcy l'Etoile, France) classified the bacterium as Neisseria gonorrhoeae (with a score of 87%).
Three of the 5 first samples were found to show gram-negative diplococci
on staining, the next 2 were negative on Pastorex rapid latex agglutination test (Bio-Rad Laboratories, Hercules, CA, USA) (during the outbreak investigation), and a subsequent 13 were sent to the African Medical and Research Foundation (AMREF) laboratory in Nairobi, Kenya, for culture and susceptibility testing.
Colonies resembling meningococci were identified by conventional tests, and oxidase-positive, gram-negative diplococci
were frozen and stored in duplicate as putative meningococci at -70[degrees]C.
meningitidis isolated from blood or cerebrospinal fluid (CSF); meningococcal antigen or DNA detected in cerebrospinal fluid by latex agglutination or polymerase chain reaction; or gram-negative diplococci
detected in cerebrospinal fluid, blood, or skin biopsy.
The next morning a chest x-ray shows infiltration in the right lower lung field, and the sputum culture shows gram-positive diplococci
Gram staining of blood-free supernatants from all positive cultures was interpreted as showing a homogeneous smear of gram-positive diplococci
and was used as the inoculum of Sceptor gram-positive Breakpoint/ID panels (Becton Dickinson, Franklin Lakes, NJ).