Which gram negative bacteria is known to cause a hyperacute conjunctivitis with preauricular lymphadenopathy?

• A. Proteus mirabilis
• B. Klebsiella pneumoniae
• C. Moraxella
• D. Neisseria gonorrhoeae

Answer: (D)

Hyperacute conjunctivitis is a rapidly progressive, very purulent infection that points to a highly virulent organism. Neisseria gonorrhoeae fits this pattern best among gram-negative bacteria because it commonly causes a swift, thick purulent discharge with marked conjunctival inflammation and can rapidly involve the cornea. The regional draining lymph nodes, especially the preauricular nodes, often become enlarged due to the intense inflammatory response to this pathogen in the conjunctival surface. In contrast, Moraxella can cause conjunctivitis but typically presents less aggressively, and Proteus or Klebsiella are not classic culprits for this hyperacute, highly purulent, lymphadenopathy-associated presentation. Therefore, the organism most consistent with a hyperacute conjunctivitis with preauricular lymphadenopathy is Neisseria gonorrhoeae, which also requires urgent systemic treatment and appropriate public-health precautions.