A 30 year old woman with a bad obstetric history presents with fever. The blood culture from the patient grows gram–positive small to medium coccobacilli that are pleomorphic, occurring in sho chains. Direct wet mount from the culture shows tumbling motility. The most likely organism is:

**Core Concept:** Gram-positive cocci are a diverse group of bacteria that are typically divided into two categories: those that produce coagulase (staphylococci) and those that do not (streptococci). Within these categories, there are various subgroups based on their morphology, colonial characteristics, and other features.

**Why the Correct Answer is Right:** The given description matches the characteristics of group A Streptococcus (GAS), a common cause of pyogenic infections in humans. The organism exhibits gram-positive cocci, is pleomorphic (variable shape), forms chains, and has tumbling motility in the wet mount.

**Why Each Wrong Option is Incorrect:**

A. Staphylococcus: This organism is gram-positive cocci but does not form chains and does not exhibit tumbling motility.
B. Streptococcus pneumoniae: This organism is gram-positive cocci, forms chains, and has swarming motility, not tumbling.
C. Escherichia coli (E. coli): This bacterium is gram-negative bacilli, not gram-positive cocci.
D. Staphylococcus aureus: Similar to option A, this organism is gram-positive cocci but does not form chains and does not exhibit tumbling motility.

**Clinical Pearl:** The presence of chain-forming gram-positive cocci with tumbling motility in a patient with a bad obstetric history and fever strongly suggests the presence of group A Streptococcus (GAS), particularly in the context of a woman with a history of previous adverse pregnancy outcomes. Rapid streptococcal antigen test (RAST) or rapid streptococcal culture can help confirm the diagnosis, allowing for targeted antibiotic therapy and preventing complications such as toxic shock syndrome and acute rheumatic fever.

**Correct Answer:** D. Staphylococcus aureus

✓ Correct Answer: A. Listera monocytogenes