Which of the following organisms is a gram-negative diplococcus classically causing hyperacute conjunctivitis with severe purulent discharge?

• A. Haemophilus influenzae
• B. Neisseria gonorrhoeae
• C. Moraxella catarrhalis
• D. Pseudomonas aeruginosa

Answer: (B)

Neisseria gonorrhoeae is the gram-negative diplococcus classically responsible for hyperacute conjunctivitis with a severe purulent discharge. The eye infection progresses very rapidly and produces a profuse, thick purulent discharge, often within a day or two of exposure. A key diagnostic clue is the Gram stain of conjunctival discharge showing intracellular gram-negative diplococci inside neutrophils, which points to gonococcal infection rather than other common conjunctivitis pathogens.

This situation is an ophthalmic emergency because the infection can quickly threaten the cornea and may be associated with disseminated gonococcal infection. Management requires systemic antibiotic therapy (not just topical treatment) and often evaluation for coinfection with Chlamydia trachomatis, which may require additional antibiotics. In contrast, the other choices can cause conjunctivitis with purulent discharge, but they are not gram-negative diplococci nor do they typically present with the hyperacute, purulent-onset pattern seen with gonorrhea.