A 10-Month-Old Boy Is Brought to the Emergency Department Due

A 10-month-old boy is brought to the emergency department due to 2 days of fever, irritability, and vomiting.  The patient has had no prior significant medical conditions and has received all recommended vaccinations, including protein-conjugated, 13-valent pneumococcal capsular polysaccharide vaccines (PCV13) at ages 2, 4, and 6 months.  On physical examination, the patient is febrile and lethargic, with a bulging anterior fontanelle.  Lumbar puncture yields turbid fluid with an abundance of neutrophils.  Gram stain of cerebrospinal fluid reveals lancet-shaped, gram-positive diplococci.  Which of the following best explains this patient's current condition?

A) Antigenic variation of bacterial cell wall
B) Infection from capsule-lacking bacteria
C) Infection from nonvaccine serotype
D) Primary T-cell immunodeficiency
E) T-cell-independent vaccine response

Correct Answer:

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