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Streptococcus pneumoniae (Enlarged view)​
Slide 1. Streptococcus pneumoniae meningitis​
This cerebrospinal fluid from a child with meningitis contains many neutrophils and oval gram-positive cocci singly and in pairs. Because ​the number of organisms in infected cerebrospinal fluid is small, most laboratories centrifuge the specimen to increase the concentration and ​then use the sediment for both stains and cultures. The density of microbes per milliliter of fluid cannot be estimated from a specimen ​that has been centrifuged.​

Neisseria meningitidis (Enlarged view)​
Slide 2. Neisseria meningitidis meningitis​
​This cerebrospinal fluid contains a high concentration of neutrophils and many gram-negative diplococci singly and in pairs. Although Neisseria meningitidis is the most likely organism, differentiation from N. gonorrhoeae, which can also cause meningitis, is not possible with Gram stain.​

Haemophilus influenzae (Enlarged view)​
Slide 3. Haemophilus influenzae meningitis​
​This cerebrospinal fluid contains many neutrophils and gram-negative coccobacilli, primarily in the cytoplasm of the white cells.​

Listeria monocytogenes Enlarged view​
Slide 4. Listeria monocytogenes meningitis​
​This cerebrospinal fluid contains a few neutrophils and two slender gram-positive bacilli. Although Gram stains of cerebrospinal fluid are ​positive in specimens from about 80% of all patients with bacterial meningitis, organisms are detected in the cerebrospinal fluid of only ​about 40% of patients with Listeria meningitis. Even when specimens reveal bacteria, only a small number may be visible.​

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