case_images: PMC7288222_01
case_images: Liver aspirate showing (a) brownish yellow liquid pus and (b) Gram-positive cocci (GPC) arranged in pairs, short chains, and small clusters (1000x). (c) Growth of S. pneumoniae on blood agar plate and (d) susceptibility of S. pneumoniae to various antibiotics by the disc-diffusion test.
case_images: CRIID2020-1572023.001.jpg
case_images: PMC7288222_01_CRIID2020-1572023.001.jpg
case_images: fig1
case_images: Pigtail catheterization carried out under local anaesthesia drained approximately 1000 ml of brownish yellow liquid pus, which was sent for routine microbiological investigations including Ziehl-Neelsen stain, wet-mount, and culture for bacteria and fungi (Figure 1(a)). Gram smear of the abscess drainage showed polymorphs with lanceolate-shaped Gram-positive cocci, lying in pairs, short chains, and small clusters (Figure 1(b)). The culture yielded pure growth of smooth, dome-shaped, and glistening alpha-haemolytic colonies on blood agar plates after overnight incubation at 37 C in 5-10% carbon dioxide, which on further incubation became flat with raised edges and central umbonation with carrom coin appearance (Figure 1(c)). Antimicrobial susceptibility testing using both disk diffusion and Etest (HiMedia, Mumbai, India) to determine, respectively, the zone diameter and minimum inhibitory concentrations (MICs) of various antibiotics showed the isolate to be susceptible to penicillin, ceftriaxone, levofloxacin, ertapenem, meropenem, clindamycin, chloramphenicol, vancomycin, and linezolid and resistant to erythromycin, doxycycline, and trimethoprim/sulfamethoxazole (Figure 1(d)).