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1

Staph aureus

The Golden Staff of Moses

Staphlococcus (grape granule = bundle of grapes) aureus (golden colonies)

Gram positive (violet robe of Moses)

Catalase positive (Egyptian cat)

Coagulase positive (Moses is coagulating sea)

Beta Hemolytic (Moses' globe)

Ferments mannitol (tall man behind moses

Protein A (A on moses staph) - binds Fc and prevents complement binding

Colonizes Nose (Sphinx nose)

Pneumonia esp post viral infx (coughing man and camel w/ patchy quilt carrying icosahedral ornaments)

MCC of Septic arthritis (camel and man on knees)

Abscesses and skin infections (camel' red humps)

Rapid onset endocarditis in IV drug users. MC in Tricuspid valve (lady clutching chest on running camel w/ mortar in pestle)

MCC Osteomyelitis (smelly fish bones)

Scalded skin syndrome mediated by exfoiliative toxin ( guy w/ severe sunburn)

Toxic shock syndrome mediated by TSS supertoxin overactivating T cells = cytokine storm esp. post packing being left in (i.e. tampon or gauze) (superantigen w/ lightning bolt)

Rapid onset food poisoning (woman on running camel w/ meats and mayo)

MRSA via altered penicillin binding proteins (nubins building pyramids)

Rx: Vancomycin (caravan) or if MSSA Nafcillin/Diclocicillin (Naf for staph = pencil as staph)

2

Staph Epidermidis

Beauty and the Plumber (esp. plumber)

Gram positive

Enemy of orthopedics (plumber's pipes)

Infx of catheters (lines under sink)

MCC of endocarditis in artificial heart valves (valves under sink)

Biofilms (gunk under sink coating pipes, tubes, and valves)

Rx: Vancomycin (Van)

Must replace infected joints

MCC blood culture contaminant (dirty plumber hands w/ red dish)

Novobiocin sensitive (Navel is sensitive)

Catalase positive (cat)

Urease positive (ammonia bottle)

Coagulase negative (moses's uncoagulated gell-o)

3

Staph Saphrophyticus

Beauty and the Plumber (spec. young lady on counter)

UTI in sexually active females (sexy girl twirling her hair holding UTI yellow drink w/ ureter straws)

Catalase positive (cat)

Urease positive (ammonia bottle)

Coagulase negative (moses's uncoagulated gell-o)

4

Strep pyogenes

The Pie Genies' Bakery

AKA Group A strep

Hyaluronic Acid Capsule (glass capsule covering Hot Apple pie) same as HA in our connective tissue --> capsule can't be immunogenic

Beta Hemolytic (Heating light bulb)

Impetigo skin infection (honey crusted pie) also caused by Sa

Pharyngitis (red bow tie) think large inflamed

Cellulitis and erysipelas (red mittens)

Strep pyogenic exotxin (SPE mediated diseases:

Scarlet fever - strawberry tongue, pharyngitis, and widespread rash that spares face (tongue at strawberry; red bow tie; gingerbread man w/ red frosting not on face)

Toxic shock like syndrome (super cape w/ lightning bolt)

Necrotizing fasciitis (burnt gingebread man w/ leg broken off)

SPE A - Superantigen (TSLS)
SPE B - Nec fasc (gingebread man is Burnt)
SPE C - (TSLS)

Rheumatic fever caused by M protein (Master chef) which interferes w/ opsonization and phagocytosis (Master chef prevents others from snitching cupcakes).

M protein mimics the myosin in our heart causing autoimmune attack of our mitral valve (miter hat) causing mitral stenosis after pharyngitis

JONES Criteria for Rheumatic Fever (cupcakes)
J- Joints - polyarthritis (frosting on elbow
O - Heart shape (valve problems, myo and pericarditis)
N - Nodules on extensor surface of forearms knees and elbows (candy on cupcakes
E - Erythema marginatum - rash w/ thick red borders (red cupcake)
S - Sydenham's chorea (rapid movements of hands and face)

Post Strep Glomerulonephritis (telephone) - Type III HS w/ facial puffiness and cola colored urine (chef's puffy cheeks and bottle of cola) two weeks after infx pharyngitis or impetigo (calendar)

Rx: penicillin prevents RF not glomerulonephritis (chef on phone holding pencil)

Virulence factors:
Streptolysin O lyses RBCs (jelly filled doughnuts) - ASO antibody titers (lady w/ tongs and doughnuts)

Streptokinase (muffins w/ p's) - clot lysis

DNAse (baked twists) - depolymerize DNA

Bacitracin sensitive (Basset hound eating twists

5

Strep Agalactiae

Galactic baby

Group B strep

Serious infections in newborns (baby)

Postivie hippurate test (hippo stuffed animal)

Capsule (helmet around hippo)

CAMP test positive (Space camp) = increasing hemolysis when plated w/ SA (golden rod of tent)

Beta hemolytic (beta hemolysis lighbulb on tents)

Bacitracin resistant (bassethound w/ helmet resisting licking baby)

MCC of meningitis in neonates (space helmet on baby)

Sepsis in neonates (red clothes on baby

Pneumonia (baby is coughing)

Infection from vaginal canal (mothership w/ portal)

Mother screened at 35weeks (35wk mothership)

Give mom w/ intrapartum penicillin (pencil landing legs on mothership)



6

Strep Pneumoniae

The Alpha Knight Tournament
(#1 Alpha Knight)

Encapsulated (Knight's armor)

Optochin sensitive (exposed chin)

Lancet shaped diplocci (two lances)

Bile soluble (mud on horses legs)

MCC of CA pneumonia - esp. lobar pneumonia w/ rust colored sputum (rust spot on knights chest)

MCC (#1 fan) of MOPS (squire w/ mop)
M - Meningitis
O - Otitis media
P - Pneumonia
S - Sinusitis

IgA Protease (Cracked shield w/ IgA dimer on it)

Asplenics susceptible (Sickle on #1 knight)

Rx: Macrolides (crows watching events) or Ceftriaxone (Tri-axe flag)

Prevent w/ vaccines:
Adults = 23 valent unconjugated (IgM only) (adults on Mezzanine)
Kids = 7 valent conjugated to protein (IgG) (kids on Ground)

7

Strep Viridans

The Alpha Knight Tournament (Jester)

Alpha hemolytic (green alpha tournament)

No capsule (unarmored jester)

Optochin resistant (jester mask over chin)

Bile resistant (boots on donkey)

Common cause of dental carries (gross teeth of jester) and endocarditis of damaged valves esp. Mitral (damaged miter hat)

Dextran (deck of cards) which sticks to platelets (plate as shield)

8

Enterococcus

Protest at the Caucus

Entero (GI) Coccus (cocci is key differentiate between enterobacter which is gram negative rod)

E Faecalis is most common (many peopl at California caucus)
E Faesium is more rare, but often a super bug (Stop the Fees protester = one guy, but a super protester)

Resistant in 6.5% NaCl (Resist the 6.5% Northern California)

Bile Resistant (Protester is resistant to billy-club and wearing bile resistant boots)

Causes UTIs, endocarditis, biliary (bile soluble) tree infections (Do U heart trees sign)

VRE (Stop the fees protester resiting vanco van) must be treated by Linezolid (police tape making line or tigecycline (tigerstriped police line)


9

Bacillus anthracus

King Anthra's Axe

Forms Black Eschar (ring of fire)

ID w/ Large gram positive rods in chains (boats in background)

Poly D Glutamine protein capsule (buckles w/ D's on leather armor)

Obligate aerobe (Air Bellow)

Spore former that is highly resistant to temp and chemicals (walnuts over fire)

Lethal Factor (LF) toxin (shield w/ LF) cleaves MAP kinase and causes tissue necrosis (burning of map looking like eschar)

Edema Factor (EF) toxin (EF shield) - increases cAMP (tents) and causes edema

Pulmonary anthrax aka wool sorter's disease (sheep and wool on armor) dry cough --> hemorrhagic mediastinitis w/ 100% mortality (bloody axe which is scary). Widened mediastinum on CXR (rope around mast on ship)

Rx: Fluoroqunolones (flower on ship) or doxycycline (bicycle wheel on ship)

10

Bacillus cereus

King Anthra's Axe

Poly D Glutamine protein capsule (buckles w/ D's on leather armor)

ObligateAerobic (Bellows)

Spore former that is highly resistant to temp and chemicals (walnuts over fire)

Food poisoninig esp. w/ vomitting and diarrhea after eating fried rice (viking puking and reheating rice

11

Clostridium tetani

Rhesus Research Revolution

Gram positive

Obligate anaerobes (gas mask)

Spore former (walnuts)

Puncture wounds (rusty nails and barb wire)

Risus sardonicus - evil smile from intense contractions. Also lock jaw. (Rhesus monkey smiling)

opisthotonos - characteristic exaggerated arching of back (monkey arching back)

Tetanus toxin aka tetanospasmin - travels retrograde through motor neurons to spinal cord (scissors on pulley)

Toxin is protease of SNARE protein. Inhibits GABA and Glycine (G&G labs) inhibitory motor neurons aka Renshaw cells (Monkey w/ Wrench and Saw)

Toxoid vaccine -toxin conjugated to protein (orange injection)

12

Costridium botulinum

Robotulism

Gram positive

Transmitted by improper canning of food (torso of can robots) and eating of preformed toxin, not spores in adults

Multiple family members w/ neuro sx

Spore former (mechanical nuts)

Obligate anaerobe (gas mask)

Flaccid descending paralysis (limp robots)

Diploplia or ptosis often first sign (droopy eyes of robot)

Only affects PNS (can't cross BBB)

Toxin cleaves SNARE protein of motor neurons of Ach causing flaccid paralysis (Electrical Ach generator)

Floppy baby syndrome (flaccid baby) - babies lack robust flora --> ingested spores germinate and produce toxin --> commonly found in honey! (honey poring on floppy baby and mechanical nuts)

13

Clostridium dificile

Field Trip to the Chocolate Factory

Spore former (walnuts)

Anaerobes (gas masks of workers)

Gram positive

Nosocomial diarrhea

Clindamycin and poor hand washing are large risk (Clean sign)

Exotoxin A (Apple work station) - binds to brush border (brushing of apples) causing profuse watery diarrhea (chocolate)

Exotoxin B (Black licorice work station) destructs cell membrane via actin(black licorice structure) depolymerization (chewed by kid) causing pseudomembranous (yellowish plastic coating) colitis.

Dx by pseudomembranous visualization or toxin PCR toxin in stool (shoe in chocolate)

Rx: ORAL vancomycin w/ (vanco van w/ tongue loading ramp), or Metronidozole (metro train)

14

Clostridium perfingens

Private Ringen's Motorcycle Accident

Gram positive rod

Motorcycle accidents and military wounds (GI fell off motorcycle)

Spore former (walnuts) found in spoil (pots of soil)

Obligate anaerobe (gas masks)

Gas gangrene aka clostridial myonecrosis presents as crepitus

Necrosis formed by alpha toxin which cleaves lecithin and damages cell membranes (Alpha signs on clothes line)

Hemolysis both in vivo and double zone in vitro (double fine zone)

Rx: IV Penicillin G (pencil)

Food poisonining causing SLOW onset (slow sign) diarrhea from spore ingestion.

15

Corynbacter diptheria

Corazon de la Corrida (bullfight)

Gram positive rod

Club shape in Y or V formation w/ metachromatic granules (red and blue morracas)

Acitve (A) subunit - causes ADP ribosylation of elongation factor 2 inhibiting protein synthesis (Man playing accordian wearing bow tie)

Binding (B) subunit - binding only

Gray pseudomembranes in orohparyns (cotton candy wrapped in plastic)

Transmitted by respiratory droplets which can cause
B severe lymphadenopathy and pharyngitis w/ thickening of neck (Bull's neck)

Myocarditis w/ arrhythmias (heart shaped flag)

Neurotoxin can damage myelin (man eating sausages) causes nerve deficits starting in oropharynx

Definitive dx by growing bacteria on potassium tellulurite (jumbotron) or loeffler's (kid laughing) medium.

Elek's test for toxin (Bull's tongue licking)

Toxoid vaccine DTAP producing powerful IgG response (green syringes in bull)

Rx: Antitoxin

16

Listeria monocytogenes

Santa's List

Gram positive rod (purple ornaments)

Beta-hemolytic (light bulb atop tree)

Tumbling motility (tumbling ornaments)

Actin rockets when intracellular (rocket presents and in santa

Facultative intracellular

Catalase positive (cat)

Survive near freezing (icicles)

Unpasturized milk, soft cheeses, and packaged meat even if refrigerated (milk and cheese left for Santa)

Pregnant women (pregnant women) 20x more likely to be infected. Can cause abortion or newborn meningitis (baby w/ helmet)

Common cause of elderly meningitis (Santa is old)

Rx: Ampicillin (guitar amp gift)

17

Actinomyces israelii

Israeli Soldier

Gram positive filamentous or branching rod

Obligate anaerobe = ddx vs norcardia (gas mask)

Normal flora of oral cavity - think jaw trauma or dental work causing cervicofacial actinomycsosis (violet jaw wrap)

Draining sinus tracts (canal) w/ yellow sulfur granules (yellow granular rocks)

Rx: Penicillin G (pencil in soldier's hand) +/- surgical drainage

18

Nocardia asteroides

No Card Game for Old Men

Gram positive filamentous branching rod (picture above bar w/ tree branching)

Obligate aerobe (air bellow)

Found in soil (cactus pot)

Does NOT form spores

Lightly acid fast/carbofuschin (cowboy, but he missed once) stains mycolic acids (tassels on cowboy) in cell wall

Catalase positive (catalase positive cat w/ bartender) important for patients w/ chronic granulomatous disease

Urease positive (NH3 spray bottle)

Immunocompromised patients i.e. HIV/transplants/steroid rx (cane)

Men > women (no card game for old MEN)

Pulmonary nocardiosis = pneumonia w/ cavitation (shot in star) and abscess formation (coughing cowboy).

Brain abscesses (bullet penetrating hat)

Cutaneous nocardiosis w/ gardening/car accidents etc. w/ indurated inflammatory lesions (cow print chaps w/ red outline)

Rx: Sulfonamides (rotten eggs)

19

Neisseria species overview

Noir series

Shared features between meningitis and gonorrhea

Gram negative diplococci (red hand cuffs)

Oxidase postive (blue ring)

Grows on chocolate agar (eating chocolate bar)

Grows on VPN agar (Vice city Private Nvestigator) Vancomycin, Polymixin, Nystatin aka Thayer Martin agar (star of show)

Increased susceptibility in patients who are complement deficient esp. C5-C9 (MAC the private eye from 5pm to 9pm)

Virulence factors -

Pilus attachment w/ frequent antigenic variation (pocket watch chains)

IgA protease for mucosal survival (Ace in MAC's hat)

20

Neisseria Meningitidis

A shocking death on campus

Meningitis spread by respiratory droplets esp. on college campuses.

Common features -see other card (MAC at bar)

Frements maltose (MAC inspecting Malt liquor)

Colonizes nasopharynx (long swab)

Polysaccharide capsule which inhibits phagocytosis (glass capsules)

Vaccine for all but B (think Aho's research)

Sickle cell and asplenics are susceptible (USSR flag)

Massive inflammatory response from Lipooligosaccharides (LOS) when spreading hematogenously. Blebs fall off (envelopes that are on fire)

Extravasation of fluid and hypovolemia (sprinklers). Can lead to shock (electrical outlet when wet)

Petichial rash is key indicator of thrombocytopenia --> DIC. (wet spots on floor and spots on boxers)

Adrenal insuffiency secondary to shock and massive vasoconstriction. This causes worse shock. aka Waterhouse-Fridericson syndrome (water tower)

Mortality rate w/ abx is 15%

Early rx w/ Ceftriaxone is key (firefighter w/ three axes)

Rifampin to close contacts for ppx. (policeman at door stopping friends)

21

Neisseria Gonorrhea

The Violinist's Last Clap

Common features (MAC at bar)

STI (flirting w/ gal at bar)

Facultative intraceulluar of PMNs (trendy chairs white chairs red pillows inside)

Not encapsulated (broken glass on ground)

Urethritis in men that can cause prostatits and orchitis

Can cause Pelvic Inflammatory Disease in women --> scarring --> infertility/ectopic pregnancies (chandalier w/ candles that looks like uterus)

White purulent discharge (white wax). Thicker than chlymidia.

Can spread into peritoneum causing adhesions to liver aka Fitz-Hugh-Curtis syndrome. String adhesions to liver are called vioin string adhesions (violinist on ground)

Polyarthritis esp. unilateral knee (Crack in statue's knee) --> no gram stain due to intracellular org.

Purulent conjunctivitis in newborns w/in first five days. (mother shielding baby's eyes quickly) Chlymidia is more delayed.

Rx: Ceftriaxone (three axes on statue and signs) and macrolide/doxy to cover for chlymidial coinfection (clam shaped napkins on table)

22

Klebsiella pneumoniae

Enterodactyl, Triserratiatops, and the Kleb-Tailed Dinosaur

Often nosocomial (hospital room) so think MDR (pills on ground)

Pneumonia (oxygen mask)

UTI (catheter)

Rx: Carbapenem

Ferment lactose (milk carton) and form pink colonies on McKonkey agar (pink milk carton)

Immotile (ankylosaurus stuck to table)

Three A's (three A's on club tail) :Alcoholics
Abscesses
Aspiration

Currant jelly sputum (jelly spilled by ankylosporis)

Polysaccharide capsule (scales on back of ankylosporis)

Cavitary lesion former (CXR on wall) must ddx vs TB

Urease positive (bottle of NH3)

23

Enterobacter cloacae

Enterodactyl, Triserratiatops, and the Kleb-Tailed Dinosaur

Often nosocomial (hospital room) so think MDR (pills on ground)

Pneumonia (oxygen mask)

UTI (catheter)

Rx: Carbapenem

Ferment lactose (milk carton) and form pink colonies on McKonkey agar (pink milk carton)

Highly motile (pterodactyl is flying)

24

Serratia marcescens

Enterodactyl, Triserratiatops, and the Kleb-Tailed Dinosaur

Often nosocomial (hospital room) so think MDR (pills on ground)

Pneumonia (oxygen mask)

UTI (catheter)

Rx: Carbapenem

Ferment lactose (milk carton) and form pink colonies on McKonkey agar (pink milk carton)

Motile (charging triceratops)

Pink when cultured (red triceratops or pink around shower)

25

Salmonella typhi

The Salmon Dinner (gull)

Motile (floppy tail of salmon)

H2S positive and grows black colonies on Hektoen agar (black plate)

Encapsulated (glass dome over salmon)

Acid labile (lemon) and easily degraded in stomach thus needed large dose for infection and increased risk if on ppi or have pernicious anemia

Chronic carries harbored in gall bladder (gull)

Typhoid Mary (apron)

Rose colored macules (polka dotted apron)

#1 cause of osteomyeletis in patient w/ sickle cell (head of fish and sickle in gull's hand)

Pea-soup diarrhea (bird dropping)

Rx: floroquinolones (flower)

Vaccine (syringe)

Facultated intracellular - Invades lymphatics in colon and taken into macrophages (bird cages)

26

Salmonella enteritidis

The Salmon Dinner (chicken esp.)


Motile (floppy tail of salmon)

H2S positive and grows black colonies on Hektoen agar (black plate)

Encapsulated (glass dome over salmon)

Acid labile (lemon) and easily degraded in stomach thus needed large dose for infection and increased risk if on ppi or have pernicious anemia

MC from undercooked chicken

Causes inflammatory diarrhea (chicken holding match)

Type III secretion system that detects eukaryotic cells secretes protein that helps w/ infectivity (turkey baster)

Facultated intracellular - Invades lymphatics in colon and taken into macrophages (bird cages)

27

Shigella sonnei

She-Gorilla's Circus

Most common Shigella species in US.

Green colonies on Hektoen agar (green tutu) to ddx vs salmonella

Immotile (gorilla is chained down)

Acid stable (walking tight rope) and thus needs less organisms for infections

Induces M cells in Peyer's patches to phagocytose them and then escapes phagosome before degredation. Then makes tail from host cytoskeleton for propulsion. (she-gorilla being shot from cannon landing on M pad)

Facultative intracellular

Inflammatory and bloody diarrhea (red stool that She-gorilla is sitting on) surrounded by flames (inflammatory)



28

Shigella dysenterae

She-Gorilla's Circus

Green colonies on Hektoen agar (green tutu) to ddx vs salmonella

Immotile (gorilla is chained down)

Acid stable (walking tight rope) and thus needs less organisms for infections

Induces M cells in Peyer's patches to phagocytose them and then escapes phagosome before degredation. Then makes tail from host cytoskeleton for propulsion. (she-gorilla being shot from cannon landing on M pad)

Facultative intracellular

Inflammatory and bloody diarrhea (red stool that She-gorilla is sitting on) surrounded by flames (inflammatory)

Can precipitate HUS in patients under 10 (little boy with whip).

Shiga toxin produces endothelial damage esp. in glomerulus (whip) and a drop in platelet count (spinning plates) and hemolysis (popping baloons)

Inhibits 60s subunit (hour glass) blocking ribosomes.

Type III secretion system (turkey baster)

29

Eschericia coli (EHEC)

E. cola's Soda fountain (hamburger specifically)

Enterhemorrhagic (EHEC)

Transmitted by eating undercooked hamburgers (hamburger)

Blood diarrhea (name or ketchup spill and red stool of kid)

Only E coli that doesn't ferment sorbitol (bottle of soda that is sorbitol free)

Shiga like toxin that inhibits ribosome at 60s position (she-gorilla happy meal toy)

HUS esp. in kids under 10. Damage of endothelial cells esp in glomerulus (straw); platelet aggregation and thrombocytopenia (plates) and hemolysis (red balloon being popped)

O157H7 (Burger only $1.57)

30

Eschericia coli (ETEC)

E cola's Soda fountain (water truck)

Entertoxigenic (ETEC)

AKA traveler's diarrhea (water truck which travels)

Classic hx is recent travel to mexico (eL Agua de San Gabriel Mexico)

Heat labile toxin increases cAMP (eL Agua) --> very similar to cholera toxin

Heat stabile increases cGMP (San Gabriel)

Watery diarrhea (man standing on stool unloading water)