Neonatal Nurse Practitioner Practice Exam

What is the most likely cause of purulent conjunctivitis in a six-day-old neonate with gram-negative intracellular diplococci?

1. Chlamydia

2. Gonorrhea

3. Herpes

4. Staphylococcus

The correct answer is: Gonorrhea

The presence of purulent conjunctivitis in a six-day-old neonate, combined with the identification of gram-negative intracellular diplococci, strongly indicates gonococcal conjunctivitis. Gonorrhea is caused by Neisseria gonorrhoeae, which presents under microscopic examination as gram-negative diplococci that may appear intracellularly within neutrophils. In neonates, this is particularly concerning due to the risk of transmission during delivery from an infected mother. Gonococcal conjunctivitis typically presents within the first week of life and often manifests as severe purulent discharge, which aligns with the symptomatology described in the question. Rapid diagnosis and treatment are critical to prevent potential complications, such as corneal scarring or perforation. Chlamydia can also cause conjunctivitis in neonates but typically presents later, around two to three weeks of life and is associated with different findings on examination. Herpes simplex virus causes conjunctivitis but presents differently and is not associated with gram-negative intracellular diplococci. Staphylococcus could lead to conjunctivitis as well, but it would not exhibit the specific intracellular diplococci finding. Thus, the identification of gram-negative intracellular diplococci directs the diagnosis to gonorrhea as the most likely