Streptococcus pneumoniae and encapsulated bacteria
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A 61-year-old develops abrupt fever, pleuritic chest pain and productive cough. Imaging shows right lower-lobe consolidation. The next day he becomes confused and has neck stiffness; cerebrospinal fluid contains predominantly neutrophils and a low glucose concentration. Blood and cerebrospinal fluid cultures yield the same gram-positive cocci, often arranged in pairs, with green discoloration around colonies on blood agar.