infectious dx UW/Sketchy Micro

Clostridium difficile

"Field trip to the chocolate factory" Two sides, two toxins. Toxin A for Apples. Apples being brushed. The toxin works on the brush border of gut. Toxin B for black licorice. Black licorice that looks like actin filaments twisted together. The licorice is eventually wrapped into a wrapper to represent toxin B causing pseudomembranous colitis. Clean handwashing sign, poor hand washing and clindamycin (C. diff infection secondary to antibiotic use) as a means of transmission. Little kid's green (green = toxin) shoe to represent that the toxin, NOT the organism, is found in the stool for diagnosis. Metro in the background = metronidazole. Van unloading in the back that has a ramp looking like a tongue = oral vancomycin.

Rubella virus

"German measles" (less contagious) Not a paramyxovirus, RNA virus More common in the spring Droplet spread via respiratory tract Most contagious when rash develops Clinical: Maculopapular rash Fever, sore throats Mild arthritis Tender cervical and auricular lymphnodes

Name of the SketchyMicro sketch for Blastomyces dermatidis

"The Blast of the Cannon"

SketchyMicro sketch for Histoplasma capsulatum

"The Historian's Cave"

(Pico) Coxsackievirus -VIRUS

(Pico) Coxsackie virus -Positive sense RNA virus (all replicate in the cytoplasm) -Picornavirus -RNA virus -naked virus -infection common in summer months -treatment is just supportive Coxsackie A virus -Hand, foot and mouth disease causing red vesicular rash -asceptic (viral) meningitis called aseptic because viruses dont show bacteria on gram stain Coxsackie B virus -causes dilated cardiomyopathy -Devil's grip; Bornholm's disease/pleurodynia extreme sharp pain in the lower chest and unilateral

Hep C

(a member of flavivirus, but it gets its own video); The Hep Sea - Hep C hippo is out at sea, Hep A hippo is stuck at the picornavirus zoo. *Hep. C hippo being discovered by explorers. Signs in front of it saying at what times it could be viewed.* Blood pool surrounding the hippo. Blood as major source of transmission. 1990s transfusion? Hep. C. Colorful tent on the right side of the sketch. Antigenic variation and reason for no vaccine. Misspelled "hippopotamus" on the sign that also says no viewing from 3-5. No proofreading capability on it's polymerase and the reason for the antigenic variation. Sign stating that 60-80% of chronically infected. 60-80% of those infected progress to a chronic state. Contrast Hep. B where 10% of infected adults progress and 90% of infected children progress. Warm hues, but snowflakes coming up on the sea-shore. Associated with cryglobulinemia. Ribs in the distance. Rib-vir as an anti Hep. C drug. See below. Interference on the woman's radio. Interferon alpha. See below. Man with his machete caught in a tree. Protease inhibitor. Simeprevir. See below. *Hep. C sketchy pharm* Plate of ribs in the corner with the wolf spider near the streamers. Ribavirin as a polymerase inhibitor and a teratogen. Man sleeping on the sofa near the streamers. Sofosbuvir as a polymerase inhibitor. Radio with interfered antenna. Interferon alpha. Recall interferon arcade and Pachtderm-man (a hippo man running away from a hairy ghost and a black ghost). The 'A' in Pachtderm is supposed to represent alpha. Treatment also for hairy cell leukemia, malignant melanoma, kaposi sarcoma, and condyloma accuminata. Also RCC with the crab in the kidney shaped claw game. Finishing out interferon arcade for completeness sake. Beta was Beta invaders, combating lesions through time and space for M.S. G was Gamma Ga and fighting the CGD asteroids. Man outside with put his machete in the tree as he is simmering a pot for dinner. Simeprevir as a protease inhibitor for Hep. C.

Gram Negative Bacilli

*Enteric* -Enterobacter cloacae -Serratia Marcescens -Klebsiella pneumoniae -Salmonella -Shigella -E Coli -Yersinia enterocolitica -Campylobacter -Vibrio -Helicobacter -Pseudomonas -Proteus mirabilis *Respiratory* -Bordatella pertussis -Haemophilus influenza -Legionella pneumophila *Zoonitic* -Bartonella henselae -Brucella -Francisella tularensis -Pasteurella multocida

Rickettsia Prowazekii (disease)

*Epidemic typhus* - widespread, rampant outbreak -HA, fever, vasculitis (rash) -Rash starts on trunk and moves outward to extremities, but spares hands, feet and head -Myalgia and arthralgia -Pneumonia -Encephalitis -Coma if really serious -Affects military camp recruits and POWs (lice)

Staph Aureus (disease)

*Inflammatory diseases* -Pneumonia: CXR with patchy infiltrate, secondary post-viral super infection -Septic arthritis: #1 cause in adults -Skin conditions: impetigo, cellulitis, faruncles/carbuncles, abscesses -Acute bacterial endocarditis: IVDUs (tricuspid) -Osteomyelitis: #1 cause in adults *Toxin mediated diseases* -Scalded skin syndrome: mediated by exfoliative protease toxin, peeling skin -Toxic shock syndrome: TSST (toxin) super-antigen causes non-specific biding of MHC II and T cell receptors --> cytokine storm -Food poisoning: pre-formed toxin, rapid onset (1-8hr), more vomiting than diarrhea, from meats and cream based foods left out for too long *MRSA* -Methicillin resistant due to altering PBPs

Klebsiella

*Kleb-tail dinosaur*, Enterodactyl, Triserratiatops *Gram-Negative Bacilli - Enteric*

Borrelia Burgdorferi (disease)

*Lyme disease* - 3 stages -Stage 1: erythema chronica migrans (bulls eye) rash within 1 month of tick bite, not painful or pruritic, accompanied by flu like illness (fever and chills) -Stage 2: heart block caused by myocarditis, bilateral facial nerve palsy -Stage 3: migratory polyarthritis of large joints and encephalopathy (memory difficulties, cognitive slowing, lymphocytic meningitis)

Mycobacterium Tuberculosis (disease)

*Primary infection* -Middle or lower lobes of lungs affected, lesion heals/becomes fibrotic and calcified with hilar lymph nodes producing Ghon complex -Prolonged fever, most likely in children in endemic regions -Can lead to... healed latent infection (most commonly heals with fibrosis), systemic infection (military TB) or reactivation TB -Caseating granulomas = activated macrophages + central area of caseating necrosis (sometimes have fibrosis or scarring --> tubercle) -Positive PPD (type IV hypersensitivity producing wheal) occurs in latent infection, active infection, or after BCG vaccine *Miliary TB* -Very serious, potentially fatal -Fulminant multi-organ failure *Reactivation of Latent Infection* -Most people with latent TB don't reactivate -Only occurs in 5-10% and is associated with immunosuppression (down-regulation of TNF release which is needed to contain the infection) -If you want to start on TNF inhibitor - need to do PPD first -Reactivation originates within macrophages -Reactivation primarily affects upper lobes -Cough, night sweats and hemoptysis -May have cachexia from TNF activation *Extra-pulmonary involvement* -Pott's disease: TB affecting vertebrae, demineralization of bone with soft tissue swelling --> spinal cord deformities, weakness, etc. -CNS involvement in 10-15% of patients with reactivation: meningitis or tuberculoma (cavitary lesion in brain)

Strep Pyogenes (disease)

*Pyrogenic infections* -Impetigo: honey-crusted skin infection -Pharyngitis: erythematous, inflamed throat -Cellulitis -Erysipelas: superficial cellulitis with well-demarcated borders (#1 cause) *Streptococcal pyrogenic exotoxin (SPE) infections* -Scarlet fever (SPEs A/C): reddening/swelling tongue (strawberry tongue), pharyngitis, widespread face-sparing rash -Toxic shock-like syndrome (SPEs A/C): super-antigen -Necrotizing fasciitis (SPE B): invades fascia and spreads rapidly, surgical emergency (amputation) *Rheumatic Fever* -M protein in cell wall is the main virulence factor responsible - interferes with opsonization (anti-phagocytic), very antigenic (elicits strong humoral response) -Humoral response likely to produces Abs against self, M protein mimics heart (type II HS) -Mitral valve (stenosis) -Only occurs after pharyngitis, and not if treated quickly -JONES criteria (joints, heart, nodules, erythema marginatum, Sydenham chorea) *Post-Infectious Strep GN* -Can occur after pharyngitis or skin infection, 2 weeks after -Early treatment of pharyngitis canNOT prevent PSGN -Circulating Ab/antigen immune complexes deposit glomerulus (type III HS) -Cola colored urine, facial swelling

Rickettsia Rickettsia (disease)

*Rocky mountain spotted fever* -HA, fever, vasculitis (rash) -Rash is not immediate (incubation period of 2-14 days), it starts on extremities and moves centrally (with no sparing in later stage disease) -Myalgia *Endemic typhus*

Treponema Pallidum (disease)

*Syphilis* - the great imitator -Primary: painless genital chancre a few weeks after inoculation (local invasion of vessels producing necrosis) -Secondary: maculopapular rash on soles and palms a few weeks after infection (and elsewhere on body), condyloma lata (flat-topped lumps) on mucous membranes -Tertiary: gummas (soft growths with firm necrotic centers) that occur anywhere, aortitis (tree-barking of ascending thoracic aorta) which can lead to aneurysm, destroys vaso vasorum of aorta, tabes dorsalis (demyelination of dorsal columns of spinal cord --> loss of DCML), neuronal damage producing Argyll-Robertson pupils (accommodate, but don't react to light) *Congenital syphilis* -Saber shins (anterior bowing of tibia) and saddle shaped nose -Hutchinson's teeth (notched incisors) and mulberry molars (with enamel outgrowths) -Congenital deafness *Jarisch Herxheimer reaction* - fever, HA, chills within hours of treatment (cytokines released by spirochetes)

Distinguishing characteristics of aspergillus fumigatus

- *A*spergillus *A*cute *a*ngle branching (stems) - Catalase + - *A*flatoxin production - some species

Common attributes of systemic mycoses

- All can cause pneumonia and disseminate - All dimorphic fungi (cold = mold, heat = yeast) Treated with fluconazole + itraconazole for local, amphotericin B for systemic

Treatment for Candida albicans

- Azoles for minor infections (pine cones) - Amphotericin B for major infections (frogs) - Nystatin for oral/esophageal candidiasis (play nyce sign) - Caspofungin for resistant candida (winter cap in immunocompromised man)

Transmission of Histoplasma capsulatum

- Bird + Bat droppings (caves) - Think farmers, spelunkers - *H*isto *H*ides within macrophages (bird in cage)

Transmission of Mucor and Rhizopus spp.

- Bread mold - Inhaled spores

Diagnosis of Cryptococcus neoformans

- Bronchopulmonary washings (soap bubbles) - Lumbar puncture and India ink stain to view wide, encapsulated halos (skull/bones on right) - Latex agglutination test that detects polysaccharide antigen (late gloves near repeating pattern)

What do dermatophytes infections cause? (include symptoms)

- Causes Tinea/ringworm (rings of rust on tin man) - Itchy rash Different types of tinea include: - Capitsus - Corpus - Cruris - Pedis - Onchomycosis (nails)

Symptoms of paracoccidioides

- Coughing (captain coughing) - Lymphadenopathy (white pearl chains on neck) - Granuloma formation (medallions hanging) - Mucosal ulcers and cutaneous lesions in upper mouth (bad teeth)

Treatment for Mucor and Rhizpus spp. infections/mucormycosis

- Debridement of necrotic tissue first - Amphotericin B (frog)

Who is susceptible to Mucormycosis?

- Diabetics due to diabetic ketoacidosis (jar of candy) - Immunocompromised (cane)

Histological features of blastomyces + Diagnostic testing

- Dimorphic (butterfly) - Blasto = *B*road *B*ased *B*udding - Roughly same size as RBCs Diagnosis: - KOH stain - Urine antigen test (yellow river)

Histoplasma capsulatum histological findings/distinguishing characteristics

- Dimorphic (butterfly) - Found within macrophages -intracellular oval bodies (bird within cage) - Smaller than RBCs - Diagnosed with KOH, rapid serum, or urine antigen test (red and yellow stalactites)

Distinguishing/histological features of candida albicans

- Dimorphic -pseudo hyphae at 25C and germ tubes at 37C (butterfly, 37 flavors sign) - Catalase positive (cat) - Diagnosed with KOH test - Normal flora of GI tract and oral cavity

Distinguishing/histological characteristics of sporothrix schenckii

- Dimorphic fungus - Branching cigar shaped hyphae at 25C (cigar)

Distinguishing characteristics of Cryptococcus neoformans?

- Encapsulated (like a mummy) - Urease + (urea bottle) - Repeating polysaccharide antigen = virulence factor (pattern on sarcophagus)

Distinguishing characteristics/Histological findings for Paracoccidioides + diagnosis

- Forms multiple buds radiating out in central pattern (captain's wheel) - Much larger than RBC

Symptoms of Mucor and Rhizopus infections

- Invades through cribriform plate (oil pan with holes) - Proliferates in blood vessels (red jumper cables) - Presents as black eschar and necrosis of nasal cavity (mechanism with dripping oil on face)

Treatment for sporotrichosis / sporothrix schenckii

- Itraconazole (pine cones) - Potassium iodine (pesticide spraying)

How is dermatophyte infection diagnosed?

- KOH prep of skin scraping - hyphae are visible (KOH salt shaker above tin man) - Woods lamp illuminates microsporum (lamps hanging in the woods)

Distinguishing characteristics/identification of Pneumocystis pneumonia

- Methenamine silver stain to identify fungus (silver discs ono table) - Disc shaped yeasts (silver discs on table) - Bronchoalveolar lavage for diagnosis (BAL watter bottle)

Histoplasma capsulatum endemic location

- Midwest/Central US - Mississippi and Ohio River Valleys

Symptoms of blastomycosis

- Patchy alveolar infiltrate (cracks in valley) - Usually subclinical Immunocompromised: - Systemic infections

Transmission of Cryptococcus neoformans

- Pigeon droppings (pigeons) - Soil - Inhaled into lungs (man coughing)

Histoplasmosis symptoms

- Pneumonia (coughing historian) - Chronic histoplasmosis resembles TB w/ granulomas (TB wild west scene) - Erythema nodosum on shins (pillars in back right) Immunocompromised: - Reticuloendothelial system targeted - hepatosplenomegaly (cane + cow drawing in back)

What does Pneumocystis jiroveci cause?

- Pneumonia w/ ground glass appearance (cracked glass ping pong tables) Associated with AIDS CD4 count below 200 (scoreboard)

Coccidioides immitis endemic location and transmission

- Southwest US (map/Presidio San Juan Valley) Earthquakes and dust storms risk factors for spore transmission (dust and cracks in ground)

Geographic Location/transmission of Paracoccidioides brasiliensis

- Southwest US, California, South America - Increased risk of spore inhalation following earthquake "*Para*coccioidio *para*sails with the *captain's wheel* all the way to Latin America

How do you treat dermatophyte infections?

- Topical azoles (pine cones) - Terbinafine - for more severe, nails - Griseofulvin (grease)

Transmission/symptoms of sporothrix schenckii

- Transmitted by cuts from rose bush (rose gardener's disease) Symptoms: - Sporotrichosis: pustule or nodules that produces ascending pattern along lymphatics causing red bumps along skin (rose bush wrapping around arm)

Clinical features of coccidioidomycosis

- Usually asymptomatic - Knee pain/arthralgias (kneeling soldier) - Pneumonia (coughing) - Fever - Erythema Nodosum (pillars) Immunocompromised: - Lung lesions (cracks in statue) - Bone lesions (cracks in statue) - Meningitis (head)

Treatment for Aspergillus fumigatus

- Voriconazole for less serious infections (pine cones, vortex) - Amphotericin B for angioinvasive disease (frogs)

Parvovirus B19- VIRUS

- classic slapped cheek fever that kids get -erythema infectiosum or fifths disease (think 5 fingers on the hand) - NAKED VIRUS - smallest DNA virus - SINGLE STRANDED DNA virus - EXCEPTION!* - respiratory droplet transmission - vertical transmission (TORCHES) hydrops fetalis in utero (severe fetal anemia, massive edema) - rash starts on face and moves downward (just like roseola HHV6) - adults: joint pain, arthritis and edema -transient aplastic anemia (depletion of the bone marrow) in sickle cell patients - will fade as the virus clears out

Cryptosporidium - parasite

- severe diarrhea in immunocompromised pts (HIV patients) -immunocompetent just have watery diarrhea -unicellular partially acid fast (look like amethyst crystals) organisms; -only parasites to stain acid fast oocysts transmit fecal orally -infectious cysts passed through stool -cysts composed of 4 motile sporozoites then attach to intestinal wall and cause diarrhea and small intestinal damage -campers, swim in dirty water, people who work with animals TREATMENT: NITAZOXANIDE (anti-protozoal used in immunocompetent hosts) -filtration can remove oocysts from infected water (highly resistant to cloronation) TREATMENT: SPIRAMYCIN (macrolide antibiotic) -mainly supportive (fluid status and electrolyte balance to monitor)

Naegleria fowleri - PARASITE

-AMOEBA -associated with fresh water -trophozoite enters CNS via cribiform plate -meningoencephalitis (primary amoeba meningoencephalitis) -rapidly fatal disease with poor prognosis -affects patients involved in water-sports -has been associated with nasal irrigation systems and contact lens solution -fever, neck stiffness and headache -diagnosis by lumbar puncture TX: amphoterecin

Mycobacterium Leprae (classification)

-Acid fast (mycolic acids take up carbol fuchsin) -Thrives in cold temperatures --> predilection for extremities -Reservoir is armadillos

Mycobacterium Tuberculosis (classification)

-Acid fast (takes up carbol fuchsin stain) because of high concentration of mycolic acids in cell wall -Cell wall also contains glycolipids which make serpentine shape required for virulence (cord factor - protects bacteria by eliciting granuloma formation by increasing TNF --> walls off bacteria) -Sulfatides prevent phago-lysosome fusion by creating incompetent secondary lysosomes -Cultures very slowly (2-6 weeks) on Lowenstein Jensen medium -Obligate aerobe -Transmitted via respiratory droplets -Primarily resides and replicates in macrophages

Gram Positive Branching Rods

-Actinomyces Israelii -Nocardia

Yersinia Pestis (treatment)

-Aminoglycosides (streptomycin + tetracycline) -Killed vaccine not routinely used

Listeria Monocytogenes (treatment)

-Ampicillin

Pseudomonas (treatment)

-Anti-pseudomonal penicillins = piperacillin + tazobactam -Aminoglycosides (in combo with beta-lactams) -Fluoroquinolones (UTIs)

Vibrio Cholerae (treatment)

-Antibiotics may reduce length of disease -Primary treatment is oral rehydration

Mycoplasma Pneumoniae (disease)

-Atypical walking pneumonia - not readily cultured -CXR may show severe pneumonia (reticulonodular or patchy infiltrate), but patients don't appear that sick clinically -Mostly affects young adults, especially in areas of close contact (military recruits)

Chlamydophila pneumoniae (disease)

-Atypical walking pneumonia in adults, more common in elderly -Similar to mycobacterial pneumonia

Strep Pneumoniae (treatment)

-Azithromycin (macrolide) -Ceftriaxone (3rd gen cephalosporin) -Vaccines: 23 valent polysaccharide for adults (T cell independent response, IgM for short-lasting protection), 7 valent conjugated to protein for kids (more robust T cell response, IgG for long-term protection)

Gram Positive Bacilli (7)

-Bacillus anthracis -Bacillus cereus -Clostridium tetani -Clostridium botulinum -Clostridium perfringens -Clostridium difficile -Listeria Monocytogenes

Gardernella Vaginalis (disease)

-Bacterial vaginosis: thin/greyish-white, malodorous/fishy discharge (pH >4.5) -Alterations in normal vaginal flora lead to infection

Bacillus Anthracis (disease)

-Black eschar (black cutaneous lesion with surrounding erythematous ring) -Weaponized -Pulmonary anthrax: via sheep's wool, starts out with non-specific finding (dry cough) but can progress to pulmonary hemorrhage and widened mediastinum

Yersinia Pestis (disease)

-Black/bubonic plague -Bubos = swollen, tender lymph nodes -Hematogenous spread causes abscesses, DIC (endotoxin), cutaneous hemorrhage -DIC causes necrosis and loss of digits

Spirochetes

-Borrelia burgdorferi -Leptospira interrogans -Treponema pallidum

Clostridium Botulinum (disease)

-Botulism: descending flaccid paralysis (opposite guillian barre), eye problems often first symptoms (ptosis, diplopia) -Same effects in babies --> floppy baby syndrome (d/t honey)

Aspergillus fumigatus - FUNGI

-CATALAST POSITIVE (exception since this is usually a bacterial quality - candida is an exception as well) -peanuts associated with aflatoxcin produced by Aspergillus flavus -aflatoxcin is associated with development of hepatocellular carcinoma -acute angle branching (<45 degrees) and septate -ASpergillus think A for acute angle branching and S for Septate -forms conidiosphores with fruiting bodies -transmitted by inhalation -3 types of infections: (1) allergic bronchopulmomary asperigillosis - type 1 hypersensitivity reaction with increased IgE, associated with asthma, wheezing,fever; (2) aspergillomas associated with TB cavities; fungus balls within cavities are gravity dependent; (3) Angioinvasive aspergillosis affects immunocompromised patients - invades blood vessels and disseminates through the body; kidney failure; endocarditis; ring enhancing brain lesions on CT; spread to paranasal sinuses may cause necrosis around the nose (this also occurs in mucor which has right angle branching) TX: less serious infections can use -azole specifically VORICONAZOLE TX: angioinvasive disease use amphoterecin B

Pseudomonas (disease)

-CGD patients at increased risk -Gram negative nosocomial pneumonia (#1 cause) -Respiratory infections and failure in CF patients (#1 cause) -Osteomyelitis (IVDUs, diabetics) -Associated with burn patients -Nosocomial UTIs -Hot tub folliculitis: pruritic, papular, pustular (underchlorinated hot tubs) -Cutaneous necrosis: ecthyma gangrenosum due to sepsis (black lesions) -Otitis externa (swimmer's ear): infection of external ear -Wounds with bluish tint

Bartonella Henselae (disease)

-Cat scratch disease: fever, regional lymphadenitis (painful and enlarged, esp in axilla), in immunocompetent patients -Bacillary angiomatosis: fever, raised red vascular lesions, also transmitted by cat scratches but in immunocompromised patients (HIV+), similar to Kaposi's sarcoma (need skin biopsy)

Neisseria Gonorrheae (treatment)

-Ceftriaxone -Plus macrolide (azithromycin) or doxycycline (assume co-infection with chlamydia)

Pasteurella Multocida (disease)

-Cellulitis at site of bite, within 24hr -Can develop into necrotizing fasciitis or osteomyelitis -Lymphadenopathy in people with liver disease, COPD

Trypanosoma cruzi - PARASITE

-Chagas disease (predominantly South America or Central America) - "kissing bug" bites (PAINLESS) around victim's mouth, and deposits feces which can later be introduced by scratching area -transmitted by Reduviid, or "kissing bug" -megacolon (may present as constipation) -dilated cardiomyopathy (what many patients die from) -mega-esophagus (makes things dilated and massive) -diagnosed by blood smear only during ACTIVE infection can see motile trypanosomes -chronic (inactive) can be diagnosed with serology and clinical symptoms -trypanosomes may be seen within cardiac myocytes on heart biopsy -burrows into endocardium TX: Nifurtimox (active); no treatment for chronic chagas

Gram Indeterminate

-Chlamydia -Coxiella burnetti -Gardernella vaginalis -Mycoplasma pneumoniae -Rickettsia

Salmonella Typhi (disease)

-Chronic carriers harbor it in gallbladder -Rose spots/red macules on abdomen (in 25%) -#1 cause of osteomyelitis in patients with sickle cell -Constipation or diarrhea resembling pea soup

Coccidioides immitis - FUNGI

-Coccidioidomycosis -distribution: Southwestern US (like California) -route of transmission: inhalation of spores in dust -earthquakes are a risk factor for spread of infection -dimorphic fungus; mold in the cold (soil and dirt) and SPHERULES OF ENDOSPORES in the heat (our bodies particularly the lungs) -cocci spherules > RBC size (cocci > blasto = RBC > histo in size) -clinical manifestation may look like an acute pneumonia: cough, fever, and arthralgia -radiographic images may show either nothing or cavities and/or nodules -cocci is associated with erythema nodosum (shows a robust immune response so only seen in healthy people) -in immunocompromised: skin and lungs are common sites of infection; may disseminated to the bone and meninges causing meningitis -diagnosis: KOH prep or culture and urine antigen test TX: -azoles for local lung infections like Ketoconazole TX: disseminated infections Amphotericin B

Yersinia Enterocolitica (disease)

-Commonly affects toddlers -Bloody, inflammatory diarrhea -Mimics appendicitis (RLQ pain) -Fever, leukocytosis, abscesses -Intestinal perforation, intussusception, necrotic bowel

Hepatitis B - VIRUS

-DNA virus -circular and partially double-stranded and becomes fully double stranded during replication -reverse transcriptase -replicates inside and outside the nucleus* unique -causes hepatitis -hepadnavirus family -ENVELOPED -transmitted via sex and sharing blood products -vertical transmission - transmitted during delivery with mixing of blood; TORCHES infection -acute goes away with time and less likely to become chronic -newborns infected with Hep B have 90% chance of developing chronic infection -polyarteritis nodosa - systemic vasculitis affects small and medium sized arteries; rash nonblanching, arthralgias, kidney damage -membraneous glomerulonephritis and membranoproliferative glomerulonephritis (tram-track appearance) -ALT>AST in viral hepatitis (unlike opposite in alcoholic hepatitis) -ALT is normal early in neonatal hepatitis serology -first marker of infection is HbSAg (Hep B surface antigen) if positive means active infection whether acute or chronic -HBeAg highly correlates with infectivity -HbSAg and HBeAg are antigens -symptomatic for the beginning of the infection -Anti-HBc (Hep B core antibody) is positive during the window period -Anti-HBe means low infectivity -Anti-HBs indicates recovery (pt no longer has infection whether acute or chronic; this is what is seen in VACCINATED PEOPLE -immunized person will not test + for any of these except Anti-HBs -cirrhosis -hepatocellular carcinoma hepatitis D -is RNA virus -enveloped -negative sense -circular genome of RNA -requires HbSAg to be infectious -co-infection is when both viruses are transmitted at the same time -superinfection is when Hep B is transmitted on top of existing Hep B infection - THIS IS WORSE TX: lamivudine -nucleoside reverse transcriptase inhibitors -interferon alpha -neonatal at risk kids need immunoglobulins

Epstein-Barr virus -VIRUS

-DNA virus - replicates in the nucleus -double stranded -member of the herpes virus family causes infectious mononucleosis -primarily transmitted through saliva -fever -tender lymphadenopathy (cervical and diffuse) -reactive cytotoxic CD8+ T cells (Downey, or atypical cells) seen on blood smear -T cells proliferate which is why splenomegaly happens -targets the B lymphocytes and EBV remains latent in B cells -EBV envelope glycoprotein binds CD21 to infect B cells -pharyngitis and tonsillar exudates -if mistakenly given amoxicillin or ampicillin can develop maculopapular rash risk factor for cancers: -Hodgkin's lymphoma - Reed sternberg cells that look like "owl's eyes" (mixed cellularity subtype) -Endemic or African Burkitt lymphoma large jaw lesion and swelling (t8;14) -nasopharyngeal carcinoma associated with Asian EBV patients oral hairy leukoplakia in HIV patients, non-cancerous lesion (you cant scrape this off the tongue) diagnose: monospot test -rapid diagnosis TX: mainly supportive, but must refrain from contact sports due to risk of splenic rupture

HSV 1 and 2 - VIRUS

-DNA virus - replicates in the nucleus -double stranded and linear -member of the herpes virus family -ENVELOPED -intranuclear inclusions bodies (Cowdry bodies) -sex and saliva, and vertical transmission TORCH infection HSV1 -gingivostomatitis is first sign of HSV1 -herpes labialis, or "cold sores" -keratoconjunctivitis -serpiginous corneal ulcers on Fluorescein slit lamp exam -causes with temporal lobe encephalitis (Hemorrhage and necrosis) -#1 cause of sporadic encephalitis in USA (change in personality etc) -HSV1 latent in trigeminal ganglia -herpes rash has "dew drops on rose petal" appearance -herpetic whitlow, more common in dentists (caused by HSV1&2) -erythema multiform may appear 1-2 weeks after infection HSV2 -herpes genitalis -painful and vesicular; painful inguinal lymphadenopathy -latent in the sacral ganglia -can cause asceptic meningitis in adolescents and adults diagnosis: Zank smear look for multinucleated giant cells, characteristic of herpes infections TX: can help prevent breakups: Acyclovir or Valcyclovir

Cytomegalovirus -VIRUS

-DNA virus - replicates in the nucleus -member of the herpes virus family -REMAIN latent in mononuclear cells (white blood cells with one nucleus; B and T cells and macrophages) -reactivated by immunosuppression -TORCHES infection -blueberry muffin rash (thrombocytopenia seen with petechial rash) -jaundice and hepatosplenomegaly -sensorineural deafness -intracranial calcifications (periventricular or parenchymal); ventriculomegaly -seizures caused by intracranial calcifications -congenital CMV is most likely to be asymptomatic 80-90% -2nd trimester has highest risk of transmission -hydrops fetalis -#1 cause of sensorineural hearing loss in children and #1 cause of congenial viral infection -organ transplant patients at risk of CMV pneumonia -AIDS patients particularly at risk with CD4 count <50 -CMV retinitis typically unilaterally -linear ulceration in esophagus (singular deep and linear) -CMV colitis with ulcerated walls -"OWLS EYE inclusions bodies" -mononucleosis but monospot test is negative tx: Ganciclovir; second line treatment is foscarnet when the virus has UL97 gene mutation against Ganciclovir

Varicella zoster virus - VIRUS

-DNA virus - replicates in the nucleus -member of the herpes virus family -ENVELOPED (all herpes viruses are enveloped) chicken pox -fever, headache -respiratory droplet transmission -"dew drop on a rose" rash vesicular (like herpes simplex virus) -lesions in different stages of healing (unlike smallpox where they are al the same stage) -Tzank smear shows multinucleated giant cells -adult presentation can get pneumonia -encephalitis especially in immunocompromised -live attenuated vaccine for children -remains latent in dorsal root ganglia -can reactivate under stress, aging or immunocompromised state -herpes zoster, or shingles is reactived form -herpes zoster or shingles, has "Dew drop on a rose" appearance with dermatomal distribution (sits on an erythematous base) -if the rash crosses the midline its a sign that the pt is immunocompromised -extremely painful rash -postherpetic neuralgia - pain after rash subsides -herpes zoster opthalmicus- vision loss possible if V1 affected -vertical transmission (TORCH) -congenital varicella syndrome; limb hypoplasia, cutaneous dermatomal scarring; blindness TX chickenpox: Acyclovir treatment for children ages 12+, adults and immunocompromised -vaccine: live attenuated zoster vaccine recommended for adults >60; can give it to HIV patients with CD4 count >200 may be given shingles vaccine TX shingles: FAMCICLOVIR treatment for shingles; also valacyclovir

Reovirus - VIRUS (ROTAVIRUS, Colorado Tick virus)

-DOUBLE STRANDED RNA* replicated in the cytoplasm (so its both positive and negative sense) -NAKED VIRUS -segmented ("BOAR" - bunyavirus, orthomyxo, arenavirus, reovirus) 11 segments ROTAVIRUS -watery diarrhea can be explosive -NSP4 viral enterotoxin that increases CHLORIDE permeability that promotes secretory diarrhea - SECRETORY DIARRHEA -seasonal virus (WINTER) where it occurs most often -children are at risk for rotavius infections -#1 leading cause of severe diarrhea in infants and children TX: ORAL rehydration Prevention: live attenuated oral vaccine (1st dose should be considered before 3 months of age to reduce risk of side effect; the vaccine increases risk of intussusception = telescoping of the bowel due to stimulation and enlargement of peyers patches which act as a lead point) Colorado Tick virus -myalgia, fevers, vomiting (BUT NO rash- so can determine form RMSF)

Papillomavirus - VIRUS 1-4, 6, 11, 16, 18, 31, 33

-DOUBLE stranded DNA virus -naked virus -HPV is the most common STD 1-4 -verruca vulgaris= cutaneous common wart 6, 11 -laryngeal papillomatosis = recurrent respiratory papillomatosis (MC seen in children & acquired at birth) -anogenital warts = condyloma acuminata (sexually transmission) -HPV shot - gardisal inactivated subunit vaccine 16, 18 -anogenital squamous cell cancers -HPV shot - gardisal inactivated subunit vaccine 31, 33 -anogenital squamous cell cancers E6 TARGETS P53 P53: cell cycle checkpoint at G1->S phase (stops transition from G1S phase) E7 TARGETS RB retinoblastoma protein = tumor suppressor post-coital bleeding (bleeding after sex) = think cervical cancer PAP smear: screening for cervical cancer from transformation zone KOILOCYTES* (look like blue sunny side up eggs) AIDS-defining illness: invasive cervical/anal/penile cancers immunosuppression increases risk of HPV related cancer

Helicobacter Pylori (treatment)

-Difficult to treat - require triple or quadruple therapy -Standard = PPI + amoxicillin + macrolide (clarithromycin)

Distinguishing characteristics/Histological findings for Coccidioides immitis + diagnosis

-Dimorphic (butterfly) - Forms spherules w/ endospores in lungs (Tumbleweeds) - Larger than RBC (RBC next to tumbleweed) - *C*occidio *C*rowds endospores Diagnostic: - KOH stain, serology

Borrelia Burgdorferi (treatment)

-Doxycycline (stage 1) -Ceftriaxone (stages 2 or 3)

Bartonella Henselae (treatment)

-Doxycycline for bacillary angiomatosis -Azithromycin (macrolides) for severe lymph node swelling in cat scratch disease

Rickettsia Prowazekii (treatment)

-Doxycycline is drug of choice

Rickettsia Rickettsia (treatment)

-Doxycycline is drug of choice

Staph Epidermidis (disease)

-Enemy of orthopedic surgeons --> infects implanted joints/hardware -Indwelling catheters -Most common cause of endocarditis in artificial heart valves -Produces biofilms that allow it to adhere and protects from immune cells/antibiotics --> resistant to many antibiotics

Brucella (disease)

-Fever (undulant), chills, anorexia -Swelling of liver, spleen and lymph nodes -Osteomyelitis

Leptospira Interrogans (disease)

-Flu like symptoms (fever, intense HAs) early on -Conjunctival suffusion (red without pus) -Weil's disease: most severe manifestation -Kidney dysfunction: fever + high creatinine -Liver dysfunction: jaundice

Salmonella Typhi (treatment)

-Fluoroquinolone (Cipro) -Osteomyelitis --> IV ceftriaxone -Live attenuated vaccine

Bacillus Anthracis (treatment)

-Fluoroquinolones -Doxycycline

Legionella Pneumophilia (treatment)

-Fluoroquinolones -Macrolides (more complications)

Bacillus Cereus (disease)

-Food poisoning: vomiting/diarrhea after re-heated fried rice

Clostridium Perfringens (disease)

-Gas gangrene: enters wound and produces gas under infected tissue (crepitus), via alpha toxin, can produce hemolysis -Food poisoning: late onset watery diarrhea from ingesting large amount of spores which must germinate in gut (not ingestion of pre-formed toxin), usually doesn't require treatment

Campylobacter Jejuni (disease)

-Gastroenteritis -Bloody diarrhea -Bacteremia (organism invades bloodstream) -Reactive arthritis (Reiter's syndrome) -Guillian barre (ascending paralysis)

Mycoplasma Pneumoniae (classification)

-Gram indeterminate -No cell wall -Special plasma membrane with cholesterols that stabilize the membrane and allow flexibility (only bacteria that have this) -Eaton's agar -Diagnosis confirmed with IgM that agglutinates erythrocytes at cold temperatures (cold agglutinins) - appears 1-2 weeks after infection in 50-75% of patients -Cold agglutinins can produce hemolysis

Rickettsia Prowazekii (classification)

-Gram indeterminate (technically classified as gram negative) coccobacilli -Best visualized with giemsa -Obligate intracellular - unable to produce NAD or CoA, get them from eukaryotic cells -Weil felix test for diagnosis - tests for cross reactivity with proteus spp. -Spread by arthropod vector (lice) -Louse defecates near bite and scratching allows organism into blood

Rickettsia Rickettsia (classification)

-Gram indeterminate (technically classified as gram negative) coccobacilli -Best visualized with giemsa -Obligate intracellular - unable to produce NAD or CoA, get them from eukaryotic cells -Weil felix test for diagnosis - tests for cross reactivity with proteus spp. -Spread by ticks (dermacenter) via direct biting

Gardernella Vaginalis (classification)

-Gram indeterminate bacilli -Vaginal flora out of whack --> increased anaerobes --> decreased lactobacilli --> more growth of this organism -10% KOH prep with fishy odor = positive whiff test -Clue cells on wet mount (epithelial cells diffusely coated with organisms)

Chlamydia trachomatis (classification)

-Gram indeterminate, but can be visualized with giemsa stain -Obligate intracellular - can't create its own ATP -Cell wall lacks muramic acid (component of peptidoglycan) -Elementary bodies = bacteria sitting outside of cell -Reticular bodies = bacteria inside cell = active form that can multiply (binary fission) -Newly replicated forms are released as elementary bodies -Inclusion bodies visible with LM in infected cells (reticular bodies) -Diagnosed with NAAT (nucleic acid amplification test/PCR)

Coxiella Burnetti (classification)

-Gram negative -Obligate intracellular organism (once classified as rickettsial) -Forms spore like structures that can survive digestive tract of animal and exist in feces -Transmitted to human via aerosol transmission (dust)

Escherichia Coli (classification)

-Gram negative bacilli -Catalase positive -Lactose fermenting (pink colonies on MacConkey agar) -Polysaccharide capsule with K antigen -Growth on EMB agar produces metallic green sheen -Fimbriae are necessary for UTIs -LPS endotoxin in outer cell membrane (not specific)

Proteus Mirabilis (classification)

-Gram negative bacilli -Facultative anaerobe -Urease positive (responsible for alkaline environment that allows calculi to form) -Swarming motility -Fishy odor

Brucella (classification)

-Gram negative bacilli -Facultative intracellular -Can survive and multiply in macrophages by preventing phago-lysosome fusion - spreads throughout reticuloendothelial system and then spreads systemically -Associated with cattle and other farm animals (think vets, ranchers or slaughterhouse workers as well as recent consumption of unpasteurized dairy products)

Shigella Sonnei (classification)

-Gram negative bacilli -Green colonies on hektoin agar -Immotile -Acid stable (smaller infective dose) -M cells in Peyer's patches phagocytose organism which escapes before degradation -In cytoplasm organism uses cytoskeleton to make tail to propel from one cell to another -Facultative intracellular -Damages tissue and release cytokines -Shigatoxin binds to 60S portion of ribosomes and inhibits translation -Type III secretion system for inflammatory cytokines

Shigella Dysenteriae (classification)

-Gram negative bacilli -Green colonies on hektoin agar -Immotile -Acid stable (smaller infective dose) -M cells in Peyer's patches phagocytose organism which escapes before degradation -In cytoplasm organism uses cytoskeleton to make tail to propel from one cell to another -Facultative intracellular -Damages tissue and release cytokines -Shigatoxin can induce endothelial damage (glomerulus) --> platelets aggregate and lyse RBCs -Shigatoxin binds to 60S portion of ribosomes and inhibits translation -Type III secretion system for inflammatory cytokines

Enterobacter cloacae (classification)

-Gram negative bacilli -Lactose fermenting - pink colonies on MacConkey agar -Motile

Klebsiella pneumoniae (classification)

-Gram negative bacilli -Lactose fermenting - pink colonies on MacConkey agar -Polysaccharide capsule -Immotile -Urease positive

Serratia Marcescens (classification)

-Gram negative bacilli -Lactose fermenting - pink colonies on MacConkey agar (but does so really slowly, and test may be negative) -Motile -Produces red pigment when cultured

Salmonella Typhi (classification)

-Gram negative bacilli -Motile -H2S positive -Encapsulated -Acid labile (easily degraded in stomach - need high dose to cause infection, PPIs predispose) -Facultative intracellular within macrophages

Salmonella Enteritidis (classification)

-Gram negative bacilli -Motile -H2S positive -Encapsulated -Acid labile (easily degraded in stomach - need high dose to cause infection, PPIs predispose) -Facultative intracellular within macrophages -Acquired by eating undercooked chicken -Type III secretion system - detects eukaryotic cells and secretes protein that helps with infection

Pseudomonas (classification)

-Gram negative bacilli -Oxidase positive -Catalase positive -Obligate aerobe -Encapsulated -Thrives in aquatic environments -Produces blue-green pigment when plated (pyocyanin and pyoverdin) -Produces fruity, grape-like odor -Exotoxin A: ribosylates its target, elongation factor 2 --> inhibition of protein synthesis and cell death

Bordatella Pertussis (classification)

-Gram negative bacilli -Spreads by respiratory droplets, very contagious -Attaches tor respiratory epithelium by pili (filamentous hemagglutinin) -Releases toxins that cause systemic effects -Pertussis toxin ribosylates (disables) Gi which increases cAMP, also disables chemokine receptors for lymphocytes so they get stuck in the bloodstream -Adenylate cyclase toxin directly increases cAMP (acts like anthracic EF toxin) -Tracheal toxin is part of the peptidoglycan wall and damages ciliated cells in the respiratory epithelium

Bartonella Henselae (classification)

-Gram negative bacilli -Warthin-starry (type of silver stain) required for visualization

Pasteurella Multocida (classification)

-Gram negative bacilli (bipolar staining, looks like safety pin) -Catalase positive -Oxidase positive -Capsule is an important virulence factor -Grows on 5% sheep blood agar -Found in the respiratory tract of small mammals, like cats and dogs -Transmitted in dog and cat bites

Yersinia Pestis (classification)

-Gram negative bacilli with bipolar staining (safety pin) -Encapsulated -Main reservoir is rats/prairie dogs, humans are incidental host via flea bites -YOPs cause neutrophil dysfunction which allows organism to replicate rapidly -YOPs come from type III secretion system

Yersinia Enterocolitica (classification)

-Gram negative bacilli with bipolar staining (safety pin) -Transmitted through puppy feces or contaminated milk products -Resistant to cold temperatures -Encapsulated

Legionella Pneumophilia (classification)

-Gram negative bacilli, but doesn't take up gram stain that well -Visualized with silver stain -Oxidase positive -Buffered charcoal yeast extract agar with cysteine and iron -Rapid urine antigen test for quick diagnosis

Vibrio Cholerae (classification)

-Gram negative bacilli, comma-shaped -Acid labile (hates stomach, needs large dose to infect intestines) -Oxidase positive -Transmitted fecal-oral (usually contaminated water/food due to poor sanitation) -Endemic in developing countries -Organism tethers to intestinal mucosal via fimbriae, but does not invade -Toxin causes symptoms by increasing cAMP (binds to and constitutively activates adenylyl cyclase, thus activates Gs pathway) -Causes water influx into intestine

Vibrio Parahaemolyticus (classification)

-Gram negative bacilli, comma-shaped -Contaminate seafood, especially oysters

Vibrio Vulnificus (classification)

-Gram negative bacilli, comma-shaped -Contaminate seafood, especially oysters

Campylobacter Jejuni (classification)

-Gram negative bacilli, curved (but not comma) -Thermophilic (prefers heat, 42 deg C) -Oxidase positive -Main reservoir is animal (poultry) intestinal tract -Fecal oral transmission (contamination during slaughtering process)

Helicobacter Pylori (classification)

-Gram negative bacilli, curved/helical shape -Urease positive (necessary for stomach invasion) -Oxidase positive -Colonies stomach near pylorus -80% of adults in developed countries have been infected as some point in life -Spins and whips flagellae for motility -Chronic infection causes increased acid production by reducing somatostatin or increasing gastrin

Haemophilus Influenzae (classification)

-Gram negative coccobacilli -Grown on chocolate agar with factor V (NAD, nicotinamide) and factor X (hematin) -Aerosol transmission -Droplets first go to respiratory tract

Francisella Tularensis (classification)

-Gram negative coccobacilli with radish shape -Facultative intracellular (recover depends on cell mediated immunity) -Bacteria enter through bite, enter macrophages and travel through lymph system to reticuloendothelial organisms -Rabbits are the main reservoir -Tick vector transfers to humans (dermacentor) -Can also be aerosolized and used in bioterrorism (must report to CDC)

Neisseria Gonorrheae (classification)

-Gram negative diplococci -Facultative intracellular (invades PMNs) -Oxidase positive -Only ferments glucose -Unable to grow in blood agar -Need heated blood (chocolate) agar -VPN (vancomycin, polymixin, nystatin) agar (aka Thayer Martin) -C5-9 complement deficiencies are predisposed (unable to form MAC complex) -Sexually transmitted *Virulence factors* -Pilli/fimbriae allow attachment to mucosal surfaces and have frequent genetic rearrangement producing antigenic variation/resistance (prevents lasting immunity) -igA protease facilitates survival on mucosal surfaces (cleaves at hinge region) -Not encapsulated

Neisseria Meningitides (classification)

-Gram negative diplococci -Oxidase positive -Ferments maltose in addition to glucose -Unable to grow in blood agar -Need heated blood (chocolate) agar -VPN (vancomycin, polymixin, nystatin) agar (aka Thayer Martin) -C5-9 complement deficiencies are predisposed (unable to form MAC complex) -Colonize the nasopharynx -Spread by respiratory droplets -Spreads hemotogenously and produces massive inflammatory response via enveloped LOS proteins -LOS proteins outgrow bacteria and bleb off -Increased permeability of capillaries and extravasation produces hypovolemia *Virulence factors* -Pilli/fimbriae allow attachment to mucosal surfaces and have frequent genetic rearrangement producing antigenic variation/resistance (prevents lasting immunity) -igA protease facilitates survival on mucosal surfaces (cleaves at hinge region) -Polysaccharide capsule inhibits phagocytosis

Staph Aureus (classification)

-Gram positive (violet) cocci in clusters (bundle of grapes) -Colonies on agar are yellow -Catalase positive -Coagulase positive -Beta hemolytic -Mannitol salt agar --> can ferment mannitol and turn it yellow -Colonizes nares *Protein A* -Main virulence factor of staph aureus -Component of cell wall -Binds Fc portion of immunoglobulins -Prevents complement from binding and prevents opsonization/phagocytosis

Bacillus Cereus (classification)

-Gram positive bacilli -Aerobic -Spore forming

Listeria Monocytogenes (classification)

-Gram positive bacilli -Catalase positive -Beta hemolytic (narrow zone of hemolysis) -Motile (tumbling outside of cell, actin rockets inside of cell) -Facultative -Survive in cold environment and can contaminate refrigerated foods (unpasteurized milk, soft cheeses)

Bacillus Anthracis (classification)

-Gram positive bacilli -Large rods and chains -Protein capsule (poly-D-glutamate) -Obligate aerobe -Can form spores resistant to temp/chemicals --> can survive for a very long time in any environment -Lethal factor (toxin) = exotoxin that acts as protease and cleaves MAP kinase (signal transduction in cell growth) --> tissue necrosis -Edema factor (toxin) = adenylate cyclase, increases cAMP, increases ECF volume, reduces host response

Clostridium Botulinum (classification)

-Gram positive bacilli -Obligate anaerobe - thrive in closed cans -Spore forming -Transmitted by improper canning of food (canned food contains pre-formed toxins) -Pre-formed toxin absorbed into gut travels to peripheral nervous system -Toxin acts as protease and cleaves SNARE protein -Attacks excitatory acetylcholine neurons which, when released, causes motor contraction -Cannot cross BBB, only affects periphery -Babies, however, have perfect anaerobic environment where botulinum can germinate and produce toxin (do not ingest pre-formed toxin) -Spores are commonly found in honey

Clostridium Tetani (classification)

-Gram positive bacilli -Obligate anaerobes (cannot survive in presence of O2) -Spore forming -Found in soil, must get under skin to cause infection -Puncture wounds caused by rusty nails or barbed wire -Spores vegetate in flesh and produce tetanus toxin -Toxin travels retrograde through motor neurons to the spinal cord -Toxin acts as protease and cleaves SNARE protein - inhibits exocytosis of NT into synapse (GABA, Gly) --> uncontrolled firing of neurons -Renshaw cells sense over-activity of nearby motor cells and fire to inhibit it

Clostridium Difficile (classification)

-Gram positive bacilli -Spore forming -Obligate anaerobe -Spores easily transferred from patient to patient -Alcohol resistant --> must hand wash -Doesn't compete well against normal flora, except when on antibiotics (clindamycin) *Exotoxins* -A: binds to brush border of intestine to cause inflammation and cell death --> watery diarrhea -B: disrupts cytoskeleton integrity by de-polymerizing actin --> enterocyte death and necrosis, yellowish grey exudate/membrane

Clostridium Perfringens

-Gram positive bacilli -Spore forming (found in dirt/soil) -Obligate anaerobe -Motorcycle accidents and puncture wounds in military combat (flesh exposed to dirt and dust) -Alpha toxin = lecithinase (cleaves phospholipids and damages cell membranes) -Forms double zone of hemolysis (must be plated in anaerobic environment)

Nocardia (classification)

-Gram positive branching (filamentous) rod -Catalase positive -Obligate aerobe -Urease positive -Found primarily in soil -Does not form spores -Weakly stains acid-fast

Actinomyces Israelii (classification)

-Gram positive branching (filamentous) rod -Obligate anaerobe -Normal flora of oral cavity

Strep Viridans (classification)

-Gram positive cocci -Alpha hemolytic (partial hemolysis with surrounding green hue) -Bile insoluble -Optochin resistant -No capsule -Produce dextrans for adherence to platelets

Staph saprophyticus (classification)

-Gram positive cocci -Catalase positive -Urease positive -Coagulase negative -Novobiocin resistant

Staph Epidermidis (classification)

-Gram positive cocci -Catalase positive -Urease positive -Coagulase negative -Novobiocin sensitive -Colonizes everywhere, normal skin flora -Contaminates blood cultures

Strep Agalactiae (classification)

-Gram positive cocci -Group B (bacitracin resistant) -Beta hemolytic -Hippurate positive (hydrolyzes Na hippurate) -CAMP test positive (increasing zone of hemolysis when plated with staph aureus, "arrowhead") -Polysaccharide capsule, lipotechoic acid glycolipid for adherence to mucosal cells -Transmitted from mom to baby during vaginal delivery (mom swabbed at 35wks to check for colonization)

Enterococcus (classification)

-Gram positive cocci -Inhabits intestinal tract -Formerly, group D strep -Grow in up to 6.5% NaCl -Bile resistant -E. faecalis (more common) and E. faecium (more dangerous)

Strep Pyogenes (classification)

-Gram positive cocci in chains -Group A (bacitracin sensitive) -Beta hemolytic -Encapsulated with hyaluronic acid (which is produced in our connective tissue, thus capsule is not immunogenic) *Virulence factors* -M protein -Streptolysin O: allows lysis of RBCs and beta-hemolytic nature, we develop Abs (ASO titer indicates recent infection) -Streptokinase: converts plasminogen to plasmin, fiibrinolytic -DNAases: depolymerize DNA

Strep Pneumoniae (classification)

-Gram positive diplococci (lancet shaped) -Alpha hemolytic (partial hemolysis with surrounding green hue) -Bile soluble (won't grow in bile) -Optochin sensitive (inhibits growth) -Polysaccharide capsule (major virulence factor) -Protease that cleaves IgA allows mucosal invasion -Sickle cell disease particularly susceptible

Mycobacterium Leprae (disease)

-Hansen's disease -Two different kinds, on a spectrum *Tuberculoid* -Th1 helper T cells involved (cell-mediated) --> bacteria contained within macrophages -Mild symptoms -Well demarcated, hairless lesions on skin (anywhere) -Diagnosed with lepromin skin test *Lepromatous* -When Th1 response fails -Th2 helper T cells involved (humoral) --> bacteria not contained to macrophages -Human to human transmission (maybe respiratory) -Symmetric, glove and stocking neuropathy -Poorly demarcated, raised lesions most notably on extensor surfaces that contain large amounts of bacteria -Profound facial deformity: skin thickening, loss of eyebrows, collapse of nose, formation of nodular earlobes (leonine/lion facies)

Clostridium Perfringens (treatment)

-IV penicillin G

Actinomyces Israelii (disease)

-Infection associated with jaw trauma (recent dental work), spreads along head and neck --> cervicofacial infection -Begins with lump, then abscess, then sinus tracks which drain thick yellow pus (sulfur granules) through the skin

Salmonella Enteritidis (disease)

-Inflammatory diarrhea

Shigella Sonnei (disease)

-Inflammatory, bloody diarrhea

Bordatella Pertussis (disease)

-Initially presents with non-specific symptoms including conjunctival infection -Paroxysmal stage can last a few weeks or months and includes whooping cough (characteristic whooping sound in inspiration) -Convalescent stage lasts up to 3 months and consists of gradual reduction in symptoms -Massive lymphocytosis

Legionella Pneumophilia (disease)

-Legionnaire's disease (atypical pneumonia): occurs in smokers, patchy infiltrate with consolidation of one lobe on CXR, hyponatremia, neurologic symptoms (HA, confusion), diarrhea, high fever (>104), serious and potentially fatal -Pontiac fever: fever + malaise, self-limiting

Listeria Monocytogenes (disease)

-Listeriosis: mostly pregnant women (early termination or disease in newborn) -Meningitis in neonates (#3 cause) -Meningitis in adults >60yo

Staph Aureus (treatment)

-MRSA: vancomycin -MSSA: nafcillin

Bordatella Pertussis (treatment)

-Macrolides -Acellular vaccine against filamentous hemagglutinin (TDaP) -Killed vaccine no longer available in US

Chlamydia trachomatis (treatment)

-Macrolides (azithromycin) for STI and trachoma -Topical macrolides are not effective for conjunctivitis in newborns (need oral form) -Tetracyclines (doxycycline) first line for pneumonia -Should also give single dose of ceftriaxone because of presumed co-infection with gonorrhea

Mycoplasma Pneumoniae (treatment)

-Macrolides (azithromycin, erythromycin)

Neisseria Gonorrheae (disease)

-Men: urethritis, prostatitis, orchitis -Women: urethritis, PID, infertility/ectopic pregnancies -White, thick, purulent discharge (chlamydia more watery) -Can spread to peritoneum --> Fitz Hugh Curtis syndrome --> adhesions to liver capsule (violin string adhesions) -Can cause polyarthritis (usually knee, asymmetric) with purulent synovial fluid that doesn't gram stain -Congenital purulent conjunctivitis in first 5 days of life (chlamydia happens >7days after birth)

Neisseria Meningitides (disease)

-Meningitis (#1 cause in college kids) -Sickle and cell and asplenic patients at higher risk -Characteristic petechial rash indicates thrombocytopenia, can progress to purpura or ecchymosis indicating DIC -Capillary leakage can lead to shock -Waterhouse Friderichsen syndrome: peripheral vasoconstriction responds to hypovolemia, adrenal glands get less blood and infarct --> further contributes to shock -Overall mortality of 15%

Strep Agalactiae (disease)

-Meningitis in neonates (#1 cause) -Sepsis in neonates -Pneumonia in neonates

Gardernella Vaginalis (treatment)

-Metronidazole

Enterobacter cloacae (treatment)

-Multi-drug resistance -Carbapenem

Klebsiella pneumoniae (treatment)

-Multi-drug resistance -Carbapenem

Serratia Marcescens (treatment)

-Multi-drug resistance -Carbapenem

Strep Viridans (disease)

-Mutans and sanguinus associated with dental caries -Sanguinus can cause subacute endocarditis in damaged heart valves (mitral valve after MVP or rheumatic fever)

Acid-Fast Organisms

-Mycobacterium tuberculosis -Mycobacterium leprae

Gram Negative Cocci (2)

-Neisseria meningitides -Neisseria gonorrheae

Borrelia burgdorferi - BACTERIA

-Northeastern US -wooden areas -transmitted by tick bite -Ixodes scapularis - tick -mouse reservoir: (host of the tick larvae) -deer obligatory host: (host of adult tick) -tick is the vector -humans are incidental host -dont gram stain -Giemsa stain and Wright stain -SPIROCHETE LYME disease -stage 1: erythema migrans (within 1 month of tick bite) "bull's eye rash" >flu like symptoms -stage 2: heart block caused by mycocarditis >Bilateral bells palsy -stage 3: arthritis of large joints (knee) - migratory polyarthritis >CNS: memory difficulty, encephalopathy TX: doxycycline in early stages ceftriaxone for more severe or lateral diseases

Clostridium Difficile (disease)

-Nosocomial diarrhea -Pseudomembranous colitis (exotoxin B) -Assay to detect toxin in stool

Enterobacter cloacae (disease)

-Nosocomial infection -Pneumonia -UTI

Serratia Marcescens (disease)

-Nosocomial infection -Pneumonia -UTI

Klebsiella pneumoniae (disease)

-Nosocomial infection -Pneumonia: currant jelly sputum, cavitary lung lesions resembling TB -UTI -Alcoholics, abscesses and aspiration

Shigella Dysenteriae (disease)

-Not common in US -Inflammatory, bloody diarrhea -Can cause hemolytic uremic syndrome in kids <10yo (ARF 7 days after diarrhea)

Salmonella Enteritidis (treatment)

-Only need fluids

Clostridium Difficile (treatment)

-Oral vancomycin -Metronidazole

Francisella Tularensis (disease)

-Painful ulcer at site of tick bite -Caseating granulomas in reticuloendothelial organs (liver, spleen, kidneys) -Regional lymphadenopathy

Strep Pyogenes (treatment)

-Penicillin

Pasteurella Multocida (treatment)

-Penicillin + beta lactamase inhibitor (clavulanic acid)

Actinomyces Israelii (treatment)

-Penicillin G -Surgical drainage for more complicated cases

Treponema Pallidum (treatment)

-Penicillin for every stage and age -If allergic --> desensitize and use penicillin

Picornavirus OVERVIEW - VIRUS

-Picornavirus family -RNA virus -positive sense (all replicate in the cytoplasm) -naked virus -large polyprotein product that is cleaved into smaller polyprotein subunits -fecal oral transmission (except rhinovirus) Hepatitis A -causes hepatosplenomegaly Enteroviruses -Polioviruses -Coxsackie A and B -Echovirus -#1 causes of aseptic meningitis -CSF glucose is normal -CSF shows no organisms (asceptic meanign without bacterium) -CSF has elevated protein -children most affected by meningitis Rhinoviruses -primary cause of the common cold -respiratory transmission -upper respiratory infection

Pneumocystis jiroveci- FUNGI

-Pneumocystis pneumonia or PCP -diffuse interstitial pneumonia, nonproductive, and wont see consolidation on xray (might not see anything at all) but if you do you will see ground glass* appearance in both lungs -AIDS defining illness CD4 count < 200 also the value when you want to start prophylaxis -transmitted through respiratory transmission -asymptomatic in healthy people -symptomatic in immunocompromised pts -diagnosis: can be confirmed with (BAL) bronchoalveolar lavage sample (obtains lung samples through fluid rinses) BAL sample is stained with methamine silver to identify PCP that will look like disc shaped* yeasts ground class appearance on PCP pneumonia X-ray can look like crushed ping pong balls prophylaxis AND TX: TMP-SMX (bactrim) can be used for both; pentamidine in case of sulfa allergy (both prophylaxis and Tx)

Haemophilus Influenzae (disease)

-Pneumonia -Epiglottitis: inflamed epiglottis, inspiratory stridor, drooling, in children (cherry red epiglottis) -Otitis media: inflammation of middle ear -Meningitis: capsular form of bacteria, type B strain -Sepsis, septic arthritis in patients without spleen

Strep Pneumoniae (disease)

-Pneumonia (#1 cause of community acquired in adults): lobar, normally lower lobes, rust colored sputum -MOPS: meningitis, otitis media, pneumonia, sinusitis (#1 case for all of these)

Chlamydophila psittaci (disease)

-Pneumonia transmitted by bird, particularly parrots

(Pico) Rhinovirus - VIRUS

-Positive sense RNA virus (all replicate in the cytoplasm) -Picornavirus -RNA virus -naked virus -ACID-labile can NOT go through GI tract (unlike rest of picornaviruses) -transmitted through fomites (hand) and inhalation -ICAM-1 is how it attaches to host cells -THE COMMON COLD -grows best in cooler temperatures around 33 degrees Celsius -affects the Upper Respiratory tract ->causing URI -113 different serotypes; thats why cant make a vaccine against common cold; no vaccines; no treatments

(Pico) Hepatitis A- VIRUS

-Positive sense RNA virus (all replicate in the cytoplasm) -Picornavirus -RNA virus -naked virus -causes HEPATITIS -ACID stable (transmitted fecal orally) like most of the picornaviruses -how to inactivate Hepatitis A: heat the water to 80 degrees Celsius for >1 minute (boiled), UV irradiated, bleach, chlorination -contaminated water is a common source in DEVELOPING countries -we can get it from water indirectly; like uncooked SHELLFISH- common source in DEVELOPED countries -commonly seen in travelers in endemic areas -commonly subclinical but can also cause acute hepatitis: jaundice, hepatomegaly, fever -common symptom: vomiting -anicteric hepatitis (no jaundice) in young children and infants -smokers with Hep A develop aversion to smoking products -one month duration of symptoms; self-limiting; no carrier state or chronic state -VACCINE -INACTIVATED VACCINE

Strep Agalactiae (treatment)

-Prevent mother-fetal transmission by treating mom with intrapartum penicillin

Nocardia (disease)

-Primarily affects immunocompromised patients (HIV, transplant patients, glucocorticoids, chronic granulomatous disease) -Tends to affect men > women -Pulmonary: pneumonia with lung abscess formation and cavitary lesions, can disseminate to any part of the body from there -CNS: brain abscesses -Cutaneous: pyogenic response, indurated lesions

Vibrio Cholerae (disease)

-Profuse watery diarrhea with rice water stools

Coxiella Burnetti (disease)

-Q fever: pneumonia, HA, fever and hepatitis -Does not cause a rash, despite other similarities to rickettsia -Immunocompromised patients or patients with preexisting valve damage can develop endocarditis

Orthomyxovirus - VIRUS influenza virus (A,B,C)

-RNA VIRUS -NEGATIVE SENSE RNA -need to be transcribed into a positive strand so RNA negatives bring their own RNA polymerases -ENVELOPED influenza virus (A,B,C) -replicates in the nucleus -8 virus segments; it is one of 4 viruses that are segmented ("BOAR" - bunyavirus, orthomyxo, arenavirus, reovirus) -antigenic drift- point mutations (epidemics disease outbreak limited to one geographical areas) this is why we get a flu shot every year -antigenic shift - reassortment (pandemics diseases that occur over multiple continents or worldwide) -antigenic variation -influenza A shift and drift -influenza B is associated with drift only -hemagluttinin (HA) determines cell tropism (which cells can get infected by the virus) -sialic acid residues are bound by HA -HA antigens: H1, H2, H3 etc. -M2 protein is needed to create proper pH for proper uncoating (amantadine/Rimantadine inhibit M2 = no uncoating) -neuraminidase (NA) it cleaves sialic acid to release the newly formed virions from the host cell -Oseltamivir(Tamiflu)/Anamivir: NA inhibitors =>inhibit virion release -transmitted by respiratory droplets -December through Feb -October is the time for vaccination -Killed injectable vaccine -Live intranasal vaccine -pneumonia = major complication -staph aureus pneumonia -aspirin is contraindicated in children with viral illness (can get encephalitis, fatty liver, liver failure = Reyes syndrome) -associated with Guillain-Barre Syndrome (ascending paralysis); would see high protein with low WBC counts = albuminocytologic dissociation)

Togavirus Group - VIRUS Arbovirus Rubella (German measles)

-RNA virus (all RNA replicate in the cytoplasm) -POSITIVE SENSE RNA virus -ENVELOPED -long polyprotein precursor cleaved by proteases (like picornavirus) Arbovirus (arthropod vector) -arthropod born virus (mosquitos are the vector) -Western, Eastern and Venezuelan -Encephalitis (HA, fever, altered mental status) Rubella (German measles) -is a childhood exanthem >BUZZ word is immigrant -congenital Rubella >ToRCHS (toxo, rubella, CMV, HIV, HSV, Sphillis; VZV and parvovirus too) >can cross the placenta and affect the child in utero >mental retardation, microcephaly, deafness, blindness, cataracts, jaundice, PDA, pulmonic stenosis, purpuric blueberry muffin rash, radiolucent bone lesions >main triad: congenital cataracts, sensory-neural deafness, patent ductus arteriosus -childhood Rubella >causes postauricular and occipital lymphadenopathy >maculopapular rash that begins on the head and moves downward ~ typically present for 3 days >transmitted by respiratory droplets -adulthood Rubella >lymphadenopathy and fever >arthritis no treatment VACCINE: live attenuated vaccines MMR (not for pregnant and immunocompromised people) -HIV positive patients should receive vaccine only with CD4 count > 200

Mycobacterium Tuberculosis (treatment)

-Rifampin + Isoniazid + Pyrazinamide + Ethambutol (RIPE) -Prophylaxis of patients with latent infection: rifampin and isoniazid for 9 months

Leptospirosis - BACTERIA

-SPIROCHETE small thin and spiral shaped -commonly associated with water sports -found in water contaminated with animal urine -fever occurs in early disease -conjunctival suffusion, redness around the eyes (without pus) -Weils disease -travels through the blood stream and affects multiple organs -renal dysfunction and jaundice from liver infection

Clostridium difficile - BACTERIA

-SPORE former like all clostridium species -obligate anaerobe and gram positive -nosocomial diarrhea -spores are removed with soap and water and cant compete well with normal flora- but antibiotics kill normal flora -antibiotics like CLINDAMYCIN can kill normal flora and poor hand washing can cause c.diff infections -exotoxin A and B -exotoxin A binds to brush border enzymes causes inflammation, cell death and WATERY diarrhea -exotoxin B causes depolymerization of actin filaments causes pseudomembrane formation, enterocyte death and necrosis -assay (like PCR) to detect TOXIN in the stool, not the actual bacterial - to see if its the cause of diarrhea -nurses can detect this by smell alone -TREATMENT: ORAL VANCOMYCIN and METRONIDAZOLE

Treponema Pallidum - BACTERIA

-SYPHILIS -SPIROCHETE. May be described as spiral shaped -STD -DARKFIELD microscopy needed for direct visualization, taken from direct sample from a lesion of a pt -VDRL is screening test (checking for antibody) -RPR rapid plasma reagent -mono, Rheumatoid factor, SLE, leprosy , IV drug user = can cause false positives -FTA-Ab (ab directly against t. pallidum) is specific test to confirm positives screening result -early stages: (first year) primary, secondary and early latent primary: PAINLESS genital chancre (bacteria damages small vessels and nerves taken out with necrosis) heals within 3-6 weeks, if not treated progresses secondary: systemic disease; maculopapulary rash occurs on palms and soles weeks to months after infection; condyloma latum on mucous membranes; visualize spirochetes within condyloma latum on darkfield microscopy -late stages: tertiary and late latent tertiary: formation of gummas- soft growths within firm necrotic center that can occur anywhere; ascending thoracic aneurysm - tree barking appearance (destroys vasa vasorum that supplies aorta with blood- weakening of the aortic wall); tabes dorsalis (damage to posterior columns of spinal cord) loss of vibration sense, proprioception and descriptive touch; Argyll Robertson pupils reacts to accommodation but NO REACTION TO LIGHT (prostitutes pupil) -congenital syphilis: saber shins (anterior bowing of the tibia), saddle shaped nose, hutchinson's teeth and mulberry molars, deafness Treatment: PENICILLIN in every stage and in everyone, desensitize and use penicillin if they are allergic, even in pregnant pts -JARISCH-HERXHEIMER reaction may occur hours after treatment- dying spirochetes release LPS releasing cytokines, causing fever and chills

Treponema Pallidum (classification)

-Spirochetes -Dark-field microscopy required for direct visualization -Usually diagnosed through blood test - main screening test is VDRL (venereal disease research laboratory, not specific for this organism, just looks for cardiolipin antigens) -RPR is another screening test -Screening tests cross-react with mono, RF, SLE, LEP, IVDUs -Confirmatory test is FTA Ab test (specific for this organism) -Sexually transmitted

Borrelia Burgdorferi (classification)

-Spirochetes (no gram stain, very thin walls) -Can be visualized on LM with special stains: wright stain, giemsa stain -Transmitted via Ixodes scapularis ticks (vector) -Northeastern US -Reservoir = white footed mouse (tick larvae feed on them) -Obligatory host = white tailed deer (adult ticks) -Humans are incidental host

Leptospira Interrogans (classification)

-Spirochetes, question mark shaped -Endemic in tropical regions (Hawaii) -Found in animals, excreted in their urine, humans swim in contaminated water (think water sports) -Travels through bloodstream (hematogenous) and can divide in many organs (most commonly affects kidneys and liver)

Gram Positive Cocci (8)

-Staph aureus -Staph epidermidis -Staph saprophyticus -Strep pyogenes (group A strep) -Strep agalactiae -Strep pneumoniae -Strep viridans -Enterococcus

Francisella Tularensis (treatment)

-Streptomycin (aminoglycoside)

Nocardia (treatment)

-Sulfonamides

Proteus Mirabilis (treatment)

-Sulfonamides

Clostridium Tetani (disease)

-Tetanus: spastic paralysis leading to rigidity, risus sardonicus (evil smile), lock jaw, opisthotonus (arched back)

Brucella (treatment)

-Tetracyclines (doxycycline) + rifampin

Mycobacterium Leprae (treatment)

-Th1 dominant/tuberculoid --> dapsone + rifampin for 6 months -Th2 dominant/lepromatous --> dapsone + rifampin + clofazamine for 2-5 years (deformities often irreversible)

Clostridium Tetani (treatment)

-Toxoid (toxin conjugated to protein) vaccine -Produces Ab response to toxin, not organism

EHEC (enterohemorrhagic)

-Transmitted by eating undercooked meat (hamburgers) -Bloody, inflammatory diarrhea -Only one that doesn't ferment sorbitol -Shiga like toxin inhibits 60S ribosomal subunit --> HUS in children <10yo -Outbreaks associated with O157:H7

ETEC (enterotoxigenic)

-Traveler's diarrhea, classically in Mexico -Transmitted via water sources -Heat labile toxin increases cAMP (similar to cholera) -Heat stabile toxin increases cGMP -Watery, not bloody, diarrhea

Enterococcus (disease)

-UTIs -Endocarditis -Biliary tree infections -E. faecium --> nosocomial infection

Proteus Mirabilis (disease)

-UTIs -Staghorn calculi (can be nidus for recurring infection)

Escherichia Coli (disease)

-UTIs (#1 cause) -Gram negative sepsis (#1 cause) -Meningitis in neonates (only with K antigen) -Diarrhea differs depending on toxin

Staph saprophyticus (disease)

-UTIs in sexually active females

Helicobacter Pylori (disease)

-Urea breath test (exhale radioactive CO2) -Biopsy during endoscopy detects urease -Ulcers, particularly duodenal (85%) -Without treatment, risk of developing adenocarcinoma of the stomach -MALT lymphoma (maltoma - goes away with treatment)

Coxiella Burnetti (treatment)

-Usually self-limiting within 2 weeks -Acellular vaccine for those at high risk (farmers, vets)

Enterococcus (treatment)

-VRE - vancomycin resistant (E. faecium) -Linezolid -Tigecycline

Haemophilus Influenzae (treatment)

-Vaccine against type B capsular antigen (prevents meningitis) should be given between 2 and 18 months, consists of polysaccharide conjugated to diptheria toxoid -Beta lactams -For meningitis or systemic disease - ceftriaxone -Rifampin for prophylaxis of meningitis in close contacts

Neisseria Meningitides (treatment)

-Vaccine contains polysaccharide capsules for all except type B -Early treatment of infection is important -Ceftriaxone (3rd generation cephalosporin that can cross BBB) -Close contacts (8hrs of contact w/in last 7 days) need prophylaxis with Rifampin

Staph Epidermidis (treatment)

-Vancomycin -Replacement of infected implants

Mycobacterium tuberculosis - BACTERIA

-acid fast stain -Mycolic acids -carbol fushon stain -TB grows on Lowenstein-Jensen medium -obligate aerobe (like nocardia) -transmission by respiratory droplets primarily residing and living in macrophages -cord factor (serpentine shape) activates immune system to activate macrophages so it can be walled off by a granuloma - VIRULENCE FACTOR -sulfatides prevent phagolysosome fusion -primary infection infects the middle or lower lobes of the lungs; hilar lymph node involvement >GHON COMPLEX = hilar lymphadenopathy + peripheral granulomatous lesion in middle or lower lung lobe -necrotic macrophages -after primary infection: 1) healed latent infection -primary TB in children often resolves and becomes latent infection and fibrosis -positive PPD skin test -BCG vaccine can cause a false positive PPD skin test 2) systemic infection (miliary TB) -miliary means it can go to multiple organs; potentially lethal 3) reactivation TB -TNFa inhibitors (neutralized TNFa) ->uncontained infection >like inflixamab -when reactivated affects the UPPER LOBES -symptoms of reactivation: cough, night sweats and hemoptysis -TNFa promotes wasting -POTTS disease (vertebrae) demineralized bones -CNS: cavitary lesion or tubulerculoma TX: R- RIFAMPIN I- ISONIAZID P- PYRAZINAMIDE E- ETHAMBUTOL prophylaxis for latent TB for 9 months: R- RIFAMPIN I- ISONIAZID

Bacillus anthracis and Bacillus cereus - BACTERIA

-black eschar -large gram positive rods in chains -encapsulated - made of proteins & poly-D -obligate aerobe- only survive in the presence of oxygen bacillus anthracis -spore forming -2 toxins = LF lethal factor and EF= edema factor -EF increases cAMP and causes edema -LF exotoxin acts as a protease and cleaves MAP kinase (signal transduction responsible for cell growth) causes tissue necrosis seen in the black eschar -wool sorter's disease causing pulmonary anthrax starting as a dry cough but can progress to pulmonary hemorrhage (hemorrhagic mediastinitis) which on xray appears as widened mediastinum -TREATMENT: Fluroquinolones and secondary doxycycline Bacillus cereus -aerobic and spore forming -food poisoning -vomiting and/or diarrhea from reheated fried rice

Pasteurella multocida - BACTERIA

-catalase positive -oxidase positive -capsule is important virulence factor -grows on 5% Sheep blood agar -demonstrates bipolar staining, described as "safety pin" staining (like yersenia) -found in the respiratory tract of small animals like cats and dogs -transmission by dog and cats bites -cellulitis may occur within first 24 hours of infection -infection may spread to bone and cause ostemyelitis TX: penicillin is empiric treatment + beta lactamase inhibitor to prevent resistance (so can use amoxicillin + clavulanic acid)

Mucormycosis- FUNGI caused by Mucor and Rhizopus

-caused by Mucor and Rhizopus -immunocompromised pts are highly susceptible to infection; diabetics are highly susceptible to infection -Rhizopus = bread mold -transmission via spore inhalation -> likes to proliferate in blood vessels in the blood where there is extra glucose and ketones -> after invading blood vessels, the fungi penetrates the cribiform plate (causes necrosis) -rhinocerebral mucormycosis -proliferation of this fungi causes necrosis of surrounding tissue -necrotic tissue presents as black escar on the nose and face -DKA is the most common predisposing factor to infection with this fungus -this fungi has hyphae that are nonseptate and branch at wide angles (90 degrees) TX: SURGICAL debridement of dead tissue amphoterecin B for medical treatment

Blastomycosis dermatitidis - FUNGI

-causes Blastomycosis -Geographic distribution BUZZ words: "Great Lakes" and Ohio River Valley and Southern US -dimorphic fungus; mold in the cold (soil and dirt) and yeast in the heat (our bodies) -transmission: inhalation of aerosolized spores -single Broad Based Budding -appear to be about the SAME size as a RBC -Chest X-ray has patchy alveolar infiltrate "haziness" -lesions or cavities in the lungs -systemic fungus only really see systemic infection in immunocompromised -> SKIN and BONE (osteomyelitis) -majority of infections are subclinical or asymptomatic -diagnosis: KOH prep or culture and urine antigen test TX: -azoles for local infections like Itraconazole TX: disseminated infections Amphotericin B

Histoplasma capsulatum - FUNGI

-causes Histoplasmosis -Geographic distribution: is endemic to midwestern and central US; along the Mississippi and Ohio river valley -transmission through respiratory tract, usually spores or bird/bat droppings are inhaled -bird/bat droppings seen in farmers or cave spelunkers -histology: macrophages with intracellular oval bodies -KOH prep and culture for diagnosis; serum and urine rapid antigen test would be faster -histoplasma is much smaller than a RBC -dimorphic: mold in the cold (soil) and yeast in the heat (in the body) -chronic histo can resemble TB in presentation; cavitary lesions in the upper lobes; granulomas; erythema nodosum -dissemination of the fungus (usually immunocompromised pts) will show up as hepatosplenomegaly and show up as calcifications TX: local infection -conazoles like fluconazoles and ketoconazole TX: disseminated infection is amphotericin B

Paracoccidioides brasiliensis - FUNGI

-causes Paracoccidioidomycosis -distributed in Brazil and other parts of South America* -dimorphic - mold in the cold, yeast in the heat -yeast form looks like "captain's wheel"* very large compared to RBC -Cocci and paracocci are roughly the same size -transmission: respiratory droplets -cervical lymphadenopathy* and can move downward to progress to lungs, causing granulomas in the lungs -mucosal ulcers in the mouth that can have small hemorrhages (mucocutaneous lesions*) TX: Itraconazole for mild infections and Amphotericin for systemic and more serious infections

Malassezia furfur / Pityriasis Versicolor - FUNGI cutaneous mycoses

-causes Pityriasis Versicolor which is hypopigmented and/or hyperpigmented patches -M. furfur resembles "spaghetti and meatballs" on KOH prep of skin scrapings -Malassezia furfur is part of normal skin flora and thrives under hot and humid conditions -produces melanocyte damaging acids via lipid degradation -remains confined to the skin, the stratum corneum of the epithelium (top layer of the skin) -mainly just a dermatologic complication of immunocompetent people -NICU neonates receiving Total Parenteral Nutrition (with liquid infusions) are at risk of M. furfur fungemia due to lipophilicity of M. furfur TX: for cutaneous infection is "Selsun Blue" (selenium sulfide)

Babesia - PARASITE protozoa

-causes babesioisis -blood related symptoms (like hemolytic anemia, hemoglobinuria and resulting jaundice) -carried by Ixodes tick (tick-borne illness), a deer tick; the longer the tick is attached the greater the chance of transmission -coinfection is common -fever, irregularly cycling fevers -higher risk of severe disease in sickle cell disease and asplenia pts (asplenic pts more likely to be symptomatic) -babesioisis diagnosed by thick blood smear -maltese cross appearance in red blood cells -predominantly in NE united states along with borellia also transferred by the Ixodes tick (co infection is common) -many healthy people with babesioisis are scarcely symptomatic and can spontaneously recover TX: atovaquone and azithroymycin (macrolide)

Cryptococcus neoformans- FUNGI

-cryptococci are heavily ENCAPSULATED -capsule is made up of repeating polysaccharide capsular antigens -capsule is the main virulence factor making it anti-phagocytic -found in soil and in pigeon droppings -enters body via inhalation and sets up primary focus in the lungs -pulmonary symptoms: cough, dyspnea and other serious lung infections -UREASE positive -is an opportunistic infection that more commonly affects immunocompromised patients (e.g. HIV patient) -can spread to the CNS and cause meningitis -symptoms: fever, pneumonia, meningitis -tissue samples can be stained with mucicarmine (red) or methanamine silver stains -diagnose: INDIA ink outlines cryptococcal capsules as "halos" - uworld says "CSF shows round or oval budding yeast" -diagnose: LATEX agglutination test detects capsular antigen and causes agglutination -diagnose: gross pathology seen in cryptococcal meningitis: "soap bubble" lesions in gray matter of brain -diagnose: bronchopulmonary washings can be used TX: JOINT therapy with amphotericin B + flucytosine followed by maintenance therapy with fluconazole

Candida albicans- FUNGI

-cutaneous and systemic fungal infections -MC cause of opportunistic mycoses -DIMORPHIC (different though because = it is a yeast in the cold and mold in the heat) -candida forms germ tubes - true hyphae(mold) at 37 degrees C -candida forms yeast at 20 degrees C in cold temperature -pseudohyphae with budding yeast -CATALASE POSITIVE, making individuals with chronic granulomatous disease susceptible to infection -part of normal flora in about 40% of individuals -candida causes diaper rash in a characteristic distribution due to the heat and humidity within a baby's diaper -oral candidiasis is seen in immunocompromised pts or those using oral steroids -oral steroid use must be followed by oral rinsing to avoid development of oral candidiasis -oral candidiasis can be scraped off the oral mucosa. This feature directly contrasts to leukoplakia, which may present in a similar manner -KOH is used to prep oral scrapings when attempting to diagnose oral candidiasis -white pseudomembranes -candida esophagitis is an AIDS defining illness, seen when CD4 count <100 -diabetes predisposes people to candida infections; candidal vulvovaginitis is common in diabetes and in people who use antibiotics and birth control pills -candida does NOT change vaginal pH -IV drug users are at increased risk of developing candidal endocarditis which commonly affects the tricuspid valve TX: azoles for minor infections and amphoterecin B for more severe and disseminated infections TX: nystatin (liquid) is used for oral or esophageal candidiasis TX: capsofungin may be used for disseminated candidial infections resistant to amphotericin

Entamoeba histolytica - parasite

-cysts form infectious when ingested from contaminated waters -associated with men who have sex with men. found be to related to anal oral transmission -right lobe of liver is most common site involved with amoebic liver abscess -right upper quadrant pain and may have enlarged and tender livers -abscess described as having "anchovy paste" consistency -intestinal amebiasis: ulcerations in the colon and bloody diarrhea (invasive) -intestinal biopsy may show flask-shaped lesions -diagnosis with stool O&P to look for cysts or trophozoites -presence of trophozoites with endocytosed RBCs under microscope -Treatment: METRONIDAZOLE, elimination of cysts in the lumen of intestine (luminal agents) PARAMYCIN & IODOQUINOL very rarely need to drain this

Dermatophytes: - FUNGI Trichophtyon Epidermophyton Microsporum

-dermatophytes are fungi that cause TINEA infections -dermatophytes live on the skin -TINEA means ring worm -TINEA capitis is on the head and scalp -TINEA corporis is on the body -TINEA cruris is on the groin -TINEA pedis is on the feet (athletes foot) -athletes commonly get tinea infections, wrestlers and swimmers etc. -animals are a common source of dermatophytes -tinea lesions are pruritic -hyphae can be seen with KOH prep of skin scrapings -woods lamp can be used to diagnose Microsporum -Onychomycosis: dermatophyte infection of the nails TX: TOPICAL azoles used to treat infections TX: Terbinafine is used to treat Onychomycosis TX: oral Griseofulvin is used to treat more serious dermatophyte infections (note it has a lot of GI side effects- "like if you eat a lot of greasy foods")

Adenovirus - VIRUS

-ds DNA NAKED VIRUS -#1 cause of tonsillitis, MC cause of infection of the adenoids or tonsils -respiratory droplets are one mode of transmission -fecal-oral transmission -children commonly affected -outbreaks can occur in military barracks -swimmers at public pools can be affected -causes hemorrhagic cystitis -is a common cause of viral conjunctivitis (pink eye) live attenuated vaccine only indicated for military recruits

Pox virus family- VIRUS smallpox (variola) cowpox molluscum contagiosum

-ds DNA virus -POX VIRUS makes their OWN ENVELOPE (unlike taking it from its host) -replicates almost entirely in the cytoplasm* exception -has its own special DNA-dependent RNA polymerase so doesn't have to go into the nucleus -forms intracytoplasmic inclusion bodies called Guarnierni bodies, are sites of viral replication in the cytoplasm -dumbbell shaped core -LARGEST known DNA virus! Smallpox (variola) -lesions are the same stage/age (unlike varicella) Cowpox is reason we dont have smallpox Molluscum contagiosum - flesh-colored, dome-shaped, unbilicated skin lesions; most commonly seen in children, unbilicated lesions on trunk in children; -diffuse Molluscum contagiosum infection in adults suggests an HIV infection

Clostridium tetani - BACTERIA

-gram POSITIVE -obligate anaerobe (cant survive in presence of oxygen) -all SPORE formers -spores found in rusty nails and in soil -SPASTIC paralysis -RISUS SARDONICUS "evil grin" or Lock Jaw symptoms -opisthotonus-exaggerated arching of the back due to spastic exaggeration of back muscles -spores are embedded in the flesh where it produces and releases tetanus toxin (which causes the symptoms) travels RETROGRADE through motor neurons from periphery to the spinal cord -tetanus toxin acts as protease which cleaves SNARE protein inhibiting release of GABA and Glycine (inhibitors) so it inhibits inhibitors ->uncontrolled firing of the neurons and spasms -GABA and Glycine released from Renshaw cells is inhibited vaccine is TOXOID (toxin conjugated to protein)

Clostridium botulinum - BACTERIA

-gram POSITIVE -obligate anaerobe (cant survive in presence of oxygen) -all SPORE formers -transmitted by improper canning of food (when you hear multiple family members developing neuro symptoms) -DESCENDING FLACCID paralysis (absence of muscle contraction) - (opposite of guillain barre syndrome which is ascending paralysis) -early symptoms included ptosis and diplopia -adults get PREFORMED toxin only effects PNS (not able to cross BBB) -toxin targets nerves that release acetylcholine (excitatory) so inhibiting excitatory causing flaccid paralysis -toxin is a protease that cleaves SNARE proteins in babies = flaccid paryalsis "floppy baby syndrome" -SPORES germinate and produce toxin in the baby -infantile botulism transmitted through injections of honey -so thats why you dont give honey to infants (spores in the honey)

Brucella - BACTERIA

-gram negative -direct contact: cow, pig, and farm animals -ingestion of unpasteurized dairy products -facultative intracellular organism (can live in both) -symptoms: fever, chills and anorexia -undulant fever -liver and spleen involvement and enlargement -osteomyelitis in chronic brucella infection TX: doxycycline, rifampin as adjunct therapy

Proteus mirabilis- BACTERIA

-gram negative -facultative anaerobe -when plated demonstrates swarming motility -staghorn calculi kidney stones -urease positive whats responsible for forming staghorn calculi and creating alkaline environment -alkaline environment can cause struvite stones formation -may cause UTI -FISHY ODOR -TREATMENT: sulfonamides

Yersinia enterocolitica - BACTERIA Yersinia pestis

-gram negative -resistant to cold temperates -SAFETY PIN, bipolar staining -encapsulated Yersinia enterocolitica -transmitted through puppy feces -commonly infects toddles -also transmitted through contaminated milk products -bloody diarrhea- invasive -CAN MIMIC appendicitis symptoms: RLQ pain Yersinia pestis -the black bubonic plaque -characteristic buboes form on the skin -causes blackening and death of tissues -Yops secreted via type 3 secretion system (yersinia associated outer protein) -prairie dogs are main reservoir in US -transmitted by flea bites Treatment: aminoglycosides (streptomycin) used in combination with tetracycline killed vaccine used to prevent infection (not typically used)

Bartonella henselae - Bacteria

-gram negative -warthin-starry silver stain -cat scratch fever transmitted by cat scratches >can also involve regional lymph nodes (painful) especially in the axilla >axillary lymphandenitis >occurs in immunoCOMPETENT patients TX: Self-limiting but can use azithrymycin (macrolides) for painful lymph nodes -bacillary angiomatosis also transmitted by cat scratches >fever, chills, HA >raised red vascular lesions in bacillary angiomatosis >affects immunocompromised patients TX: doxycycline treatment for bacillary angiomatosis; can also use macrolides

Pseudomonas - BACTERIA

-gram negative ROD -encapsulated -#1 cause of gram neg nosocomial pneumonia -MCC of respiratory failure in CF patients -osteomyelitis in IVDU and diabetics -thrives in aquatic environments -OXIDASE positive AND MOTILE (according to UWORLD) -Catalase positive -blue/green pigment when plated (pyocyanin and pyoverdin) -fruity grape like odor -obligate aerobe -BURN patients infections -nosocomial UTI -undercloronated hot tubs - hot tub fasciculitis -ECTHYMA GANGRENOSUM- black necrotic lesions on skin -otitis externa (swimmers ear) -exotoxin A (diptheria toxin have identical toxins) inactivates by ribosylation target elongation factor 2 Treatment: piperacillin (With tazobactam) and aminoglycosides (in combo with beta lactam antibiotics) and FQ (UTI)

Haemophilus influenzae - BACTERIA

-gram negative bacteria -coccobacillary shape -chocolate agar needs factor 5 (Nicotinamide=NAD) and factor 10 (hematin) -aerosol transmission -main cause of epiglottitis (inflamed epiglottis, inspiratory stridor, drooling, "cherry red epiglottitis") -otitis media -strains with type B capsule cause meningitis -increased risk of infectino in sickle cell asplenic patients -VACCINE is for type B capsule; vaccine is polysacccharide conjugated to Diptheria toxoid; between 2-18 months should get vaccine TX: beta-lactam antibiotic use ceftriaxone for meningitis or systemic disease; rifampin is used for close contact prophylaxis

Legionella - BACTERIA

-gram negative but doesn't take up gram stain well but needs SILVER STAIN to be visualized -grows on charcoal yeast extract -oxidase positive -growth requires presence of iron and cysteine -Pontiac fever, fever and malaise and usually self limited -Legonnaires' disease more common in smokers -atypical pneumonia -Xray shows patchy infiltrate with consolidation of one lobe -Legonnaires' disease may present with hyponatremia (<130) -may present with headache and confusion (neurological symptoms) -pneumonia with diarrhea* and hyponatremia think Legonnaires' disease -Legonnaires' disease present with high fever (>104F) -culture respiratory sputum but can do RAPID URINE ANTIGEN test for diagnosis TX: macrolides and flouroquinolones

Shigella sonnei - BACTERIA Shigella dysenteriae

-gram negative enteric leading to bloody diarrhea -green colonies on hektoin agar -immotile -acid stable (acid doesnt effect it)few organism to cause infection -shigella induces M cells to take it up and escapes by use of actin filaments; fecal blood and leukocytes -bloody diarrhea and inflammatory diarrhea -facultative intracellular -binds 60s subunit of ribosomes and inhibits translation -type 3 secretion system to release cytokines Shigella sonnei -most common in the US Shigella dysenteriae -infection can cause HUS in children (<10 years old) -glomerular damage activates platelets ->leading to drop in platelet count ->lyse RBCs (RBC hemolysis) ->shistocytes

Staph Aureus- BACTERIA

-gram positive cocci -grape like clusters -golden colored when plated -beta hemolytic (looks like glowing when plated on red agar) -ferments mannitol turns agar bright yellow (if not it will stay pink) -protein A is the main virulence factor for staph aureus - component of cell wall combined FC portion of immunoglobulin prevents compliment from binding same region preventing phagocytosis -coagulase positive (parting the red sea in the picture) (converts fibrinogen to fibrin) -CATALSE POSITIVE (hydrogen peroxide to water conversion) -colonizes the nose -MCC of septic arthritis in adults -pneumonia which looks like patchy infiltrates on x-ray -post-viral bacterial pneumonia -abscesses -rapid onset acute bacterial endocarditic >IV drug users endocarditis >tricupsid most likely involved -MCC of Osteomyelitis -scalded skin syndrome where skin peals off (exfoliatin toxin) -toxic shock syndrome like leaving gause on or tampon in (foreign material in the body) which is a superantigen (TSST) -staph food poisoning from performed toxin - more associated with vomitting; from meats and mayonnaise -MRSA resistance by altering PBP which constructs cell walls -treat MRSA with VANCOMYCIN -Nafcillin if its methacillin sensitive

Nocardia species - BACTERIA

-gram positive filamentous branching rod (similar to actinomyces) -obligate aerobe (UNLIKE actinomyces which is obligate anaerobe) -found in soil but does NOT form spores -weakly stains acid fast - carbol fuchsin stain used -mycolic acids (long chain FA with long tails) -catalase positive, pts with chronic granulomatous disease are susceptible to infection -urease positive -primarily infects immunocompromised patients and men more -symptoms include pulmonary nocardiosis as pneumonia like symptoms with cavitary lesions in the lungs associated; brain abscess formation; cutaneous symptoms - indurated lesions and inflammatory reaction TX: sulfonamides (unlike actinomyces you treat with penicillin)

Helicobacter pylori - BACTERIA

-helical shaped -pylori near our pylorus in the antrum of our stomach -MOTILE -curved gram negative rods (but more helical) -UREASE POSITIVE (helps reduce acidity of the environment) -urea breath test -oxidase positive (all curved are) -95% of all DUODENAL ulcer are from H.pylori -ULCERS (reducing somatostatin or increasing gastrin production) -increased risk for gastric adenocarcinoma - MALT (maltoma) mucus associated lymphoid tissues TREATMENT: TRIPLE THERAPY - Proton pump inhibitor, amoxicillin, macrolide (clarithromycin specifically)

Clostridium perfringens - BACTERIA

-infection associated with motorcycle accidents and military combat wounds -SPORE FORMING can be found in soil and dirt -obligate ANAEROBE - need to plate it in anaerobe environment -soft tissue infection GAS GANGRENE (gas is produces gas under tissue as it eats carbohydrates- crepitus) -myonecrosis involves alpha toxin or lecithinase that cleaves lecithin that is a phospholipase and causes damaged to cell membranes by damaging phospholipids -lecithinase can cause RBC hemolysis -double zone of hemolysis when plated on blood agar -TX IS IV PENICILLIN G food poisoning diarrhea -large amount of spores which germinate in the gut that produce toxin so it is slow onset -> watery diarrhea -transient and self resolves

Salmonella typhi -BACTERIA Salmonella enteritidis

-motile -H2S positive black colonies on Hektoen Agar(all enteric bacteria that are motile are H2S positive) -encapsulated -acid labile (means easily degraded in the stomach so need large dose to infect) >taking omeprazole, or prenicious anemia where you lower stomach acid= more susceptible to infection -type 3 secretion system -facultative intracellular (specifically in macrophages) Salmonella enteritidis -the reservoir is chicken; get it from undercooked chicken -inflammatory diarrhea Salmonella typhi -in gallbladder of chronic carriers -Typhoid Mary -rose-colored macules on abdomen -#1 cause of osteomyelitis in sickle cell patients -constipation and sometimes pea soup diarrhea -TREATED with FQ (Cipro) -live attenuated vaccine

Mycoplasma pneumoniae - BACTERIA

-no cell wall so cant appear on gram stain -cell membrane contains cholesterol - UNIQUE for a bacteria -atypical pneumonia "walking pneumonia" -xray shows severe pneumonia appears much worse than the patient looks; shows reticulonodular or "patchy" infiltrate -increase incidence in young adults like military recruits living in close quarters -diagnosis: IgM cold agglutination test causes agglutination of red blood cells -culture it takes a long time - Eaton agar TX: macrolides because no cell wall

Rickettsia prowazekii- BACTERIA

-obligate intracellular -poor gram stain -unable to produce CoA, gets it from eukaryotic cells -NAD+ also important for bacterial growth and replication -Rash starts at trunk, and spreads outwards towards extremities -rash SPARES hands, feet and head -affects military camp recruits and prisoners of war -spread by LOUSE (scratching usually introduces poop into blood) -illness is called epidemic typhus (wide spread rapid outbreak) -causes myalgia and arthalgia -causes pneumonia -encephalitis with dizziness and confusion -serious infections can cause coma TX: Doxycycline

Rickettsia rickettsii- BACTERIA

-obligate intracellular -poor gram stain -use Giemsa stain -unable to produce CoA, gets it from eukaryotic cells -NAD+ also important for bacterial growth and replication -transmitted by direct contact with Dermacentor Tick -rash not immediate- has incubation period between 2-14 days -rash begins at extremities (WRIST and ANKLES) -rash spreads centrally from extremities INCLUDING face and feet -symptoms include, headache, fever* and myalgia TX: Doxycycline

Rickettsia species overview - BACTERIA

-obligate intracellular -unable to produce CoA, gets it from eukaryotic cells -NAD+ also important for bacterial growth and replication -poor gram stain -weakly gram negative -coccobacillary shape -weil-felix agglutination test for Rickettsial infections -headache and fever in early Rickettsia infections -vasculitis -infection and rupture -rash may be associated with vasculitis TX: Doxycycline DOC

Chlamydia trachomatis - BACTERIA Chlamydia pneumoniae Chlamydia psittaci

-obligate intracellular bacteria -lack of staining with gram staining -lack of muramic acid in cell wall -1st stage: elementary stage -2nd stage: reticular body active form that can multiply elementary body is the infectious form "elementary enters" reticular body is active dividing form "reticular body replicates" -inclusion bodies visible within cells under microscope (a bunch of reticular bodies) -Giemsa stain to be visualized -NAAT nucleic acid amplification test to diagnose (PCR) Chlamydia trachomatis A-C: blindness -leading cause of blindness worldwide -transmitted by hand to eye contact or fomites D-K: STI -characterized by WATERY discharge -infection if left untreated can lead to pelvic inflammatory disease (PID) -newborns born to infected mothers can develop neonatal conjunctivitis and pneumonia (these babies will present later 1-2 weeks later) L1-L3: LGV >lymphogranuloma venereum characterized by tender inguinal lymphadenopathy reactive arthritis or Reiters syndrome -uveitis, urethritis, arthritis -"cant see, cant pee, cant climb a tree" Chlamydia pneumoniae -causes atypical pneumonia "walking pneumonia" in elderly Chlamydia psittaci -also causes pneumonia transmitted by bird droppings TX: macrolides such as azithromycin oral macrolides effective against trachoma tetracyclines (doxycycline) also effective coinfection with gonorrhea (treat ceftriaxone for this coverage)

Strep agalactiae (Group B Strep)- BACTERIA

-polysaccharide capasule -CAMP test positive - separates GROUP B strep from ALL the other streps (WHEN its plated with s.aureus it has an increasing zone of hemolysis; "arrowhead" zone of hemolysis) -positive hippurate (hydrolyses Na hippurate) -beta hemolytic (like group A strep) -bacitracin resistant (unlike group A strep) -CAUSES really serous infections in newborns - #1 cause of meningitis in neonates - common cause of sepsis in neonates -causes pneumonia -culture mom at 35 weeks of pregnancy to see if colonized with group B strep -prophylaxis give mother intrapartum penicillin

Calicivirus (most common is Norovirus) - VIRUS

-positive sense RNA virus (all positives replicate in the cytoplasm) -NAKED virus -produces one long polyprotein that is cleaved by viral proteases into smaller active constituents Norovirus - is the most common calicivirus - common on cruises - diarrhea breakout viral gastroenteritis that can be explosive -EXPLOSIVE WATERY DIARRHEA - outbreaks common in day care centers and schools - consumption of shellfish is associated with norovirus (or handling of food like in a buffet)

Francisella tularensis - BACTERIA

-rabbits are main reservoir (eating, handling - direct) -transmitted by dermacentor tick -MC -aerosolized -gram negative, coccobacilli -facultative intracellular organism -painful ulcer at site of inflammation -goes into macrophages and travels in the lymph system -causes granulomas with caseating necrosis in reticuloendothelial organs (i.e. lymph nodes) -regional lymphadenopathy TX: Streptomycin (aminoglycosides)

Sporothrix schenckii - FUNGI

-sporothrix is found in rose thorns, tree bark, and other plants -is a dimorphic fungus -causes "rose gardener's disease" -looks like cigar shaped yeast under a microscope -infection spreads in an ascending pattern along the path of draining lymphatics -red bumps appear on the skin following infection -culture is gold standard for diagnosis; you can also biopsy where you see granulomas consisting of histeocytes, multi-nucleated giant cells and cigar shaped budding yeasts TX: itraconazole is the drug of choice to treat lymphocutaneous sporotrichosis TX: saturated solution of potassium iodide may also be used to treat lymphocutaneous sporotrichosis

Arenavirus - VIRUS

-ss RNA (replicates in the cytoplasm) -negative sense RNA viruses -ENVELOPED -AMBISENSE* (it can encode positively and negatively) -helical shape nucleocapsid -segmented virus - 2 segments* ("BOAR" - bunyavirus, orthomyxo, arenavirus, reovirus) -grainy appearance on electron microscopy -roden transmission Lymphocytic choriomeningitis virus (LCV) -meningoencephalitis -fever TX: inactivated by heating, low pH, irradiation and detergents

Rhabdovirus (Rabies)- VIRUS

-ss RNA (replicates in the cytoplasm) -negative sense RNA viruses -ENVELOPED -capsule "looks bullet shaped" -helical capsid -zoonotic virus (carried by animals and transferred to humans) -bats are #1 carriers in US -foxes, skunks and other rodents are also common carriers -binds to nicotinic ACh receptors -initially infects neurons at the post-synaptic motor endplate -virus travels in a retrograde transmission along peripheral nerves -replicates in motor neurons -travels to dorsal root ganglia before spreading to the brain -fever, rabies encephalitis, drooling and foaming of the mouth are symptoms -eosinophilic Negri bodies in neurons found on biopsy -Negri bodies in the hippocampus cytoplasm (hippocampal pyramidal cells) -Negri bodies in purkinje cells TX: passive immunization after exposure to rabies (preformed antibodies) and give killed vaccine to have active immunization -once symptoms appear prophylaxis is ineffective

Bunyavirus family- VIRUS Hantavirus California encephalitis Rift Valley Fever

-ss RNA (replicates in the cytoplasm) -negative sense RNA viruses -ENVELOPED -golgi in its envelope -segmented - 3 circular segmented ("BOAR" - bunyavirus, orthomyxo, arenavirus, reovirus) -ARBOVIRUS -reservoir: deer mouse -transmitted via rodent urine/feces Hantavirus -pulmonary edema via pulmonary capillary leak - pre-renal azotemia -hemorrhagic fever California encephalitis and Rift Valley Fever -seizures -encephalitis -transmitted by Aedes mosquito

Paramyxovirus -VIRUS Measles (Rubeola) Mumps RSV respiratory syncytial virus Croup

-ss RNA (replicates in the cytoplasm) -negative sense RNA viruses -ENVELOPED -transmitted by respiratory droplets -MMR: live attenuated vaccine (CI in pregnancy) Measles (Rubeola) -4 C's: Cough, Coryza (runny/stuffy nose), Conjunctivitis, Koplik spots) Koplik spots - pathognomonic = small, bluish white spots on a red background found on the buccal mucosa in the cheek near the second molars) -fever can be very high -rash starts on the face and moves downwards -pneumonia is a complication of measles infection -SSPE subacute sclerosing pan encephalitis is another complication -Hemagluttinin (HA) -fusion protein: multinucleated giant cells -vitamin A reduces measles morbidity and mortality Mumps -parotitis replicates there and in the testes (unilateral orchitis) -meningitis -Hemagluttinin (HA) -Neuraminidase (NA) -fusion protein: multinucleated giant cells RSV respiratory syncytial virus <6 months of age -attaches to G protein to infect respiratory epithelial cells -RSV is the #1 cause of pneumonia and bronchiolitis in infants -fusion protein: multinucleated giant cells -ribaviron can be used in adults to treat RSV -prevent fusion protein with Palivizumab Croup "laryngotracheobronchitis" -seal bark cough -has all 3 virulence factors: fusion protein, HA, NA -x-ray: "steeple sign" narrowing of the sub glottis region -mainly infects children -buzz word: inspiratory stridor

Filovirus - VIRUS Ebola Marburg

-ss RNA (replicates in the cytoplasm) -negative sense RNA viruses -helical capsid -ENVELOPED Marburg Ebola -fever -petechial rash (micro hemorrhages) -hemorrhagic fever -end organ failure -hemorrhagic (hypovolemic) shock -possibly transmitted via primates -monkeys or bats in endemic areas like Africa -health care works taking care of infected individuals -very dangerous infections

Gardnerella vaginalis- BACTERIA

-the cause of BACTERIAL VAGINOSIS -gram variable rod staining- can stain both -normal vaginal flora contains majority lactobacilli; bacterial overgrowth that disrupts the normal flora -grayish-white discharge -FISHY ODOR -KOH wiff test -infection occurs when pH >4.5 -CLUE CELLS - epithelial cells diffusely coated with bacteria - are characteristic* on wet mount -TREATMENT: metronidazole (also used to treat c.diff)

Mycobacterium leprae - BACTERIA

-thrives in cool temperatures explaining predilection for extremities -acid fast bacteria -Mycolic acids -carbol fushon stain -armadillo is main reservoir in US -leprosy also known as Hansen's disease Tuberculoid -Tuberculin response -TH1 response with cell mediated immunity -can contain bacteria within macrophages -symptom: include well demarcated hairless lesion on skin -positive Lepromin skin test demonstrates good cell mediated response -generally well controlled Lepromatous -Lepromatous response -TH2 response humoral response -bacteria unable to be contained by macrophages -human to human transmission -symptoms: symmetric glove and stocking neuropathy -poorly demarcated raised lesions on extensor surfaces of extremities -profound facial deformity described as "Leonine facies" tx: Tuberculoid needs Dapsone and Rifampin for 6 months Lepromatous needs Dapsone and Rifampin + Clofazimine FOR 2-5 YEARS

Bordatella pertussis - BACTERIA

-transmission: respiratory droplets -filamentous hemagglutinin -(1)pertussis toxin acts by ADP ribosylation and toxin inhibits Gi (toxin inhibits inhibitor and thus increases cAMP) and causes lymphocytosis -(2)adenylate cyclase toxin acts like the anthracis EF toxin and increase in cAMP -(3) tracheal toxin damages respiratory epithelium -catarrhal stage (nonspecific symptom stage) -paroxysmal stage: whooping cough -convalescent stage can last for months can have gradual reduction of symptoms -treatment: treat early with macrolides -prevention: killed vaccine no longer available; acellular vaccine = DTaP (aP is for acellular pertussis antigens)

Giardia Lamblia - parasite

-transmitted through unfiltered or poorly purified drinking water associated with campers -transmitted by fecal oral transmission of CYSTS -bloating, flatulance and foul smelling diarrhea -causes steatorrhea, or "fatty diarrhea" -distinct trophozoite shape, they attach but do not invade the intestinal wall (thus wont cause bloody diarrhea) -trophozoites in stool is diagnostic -Stool O&P is diagnostic test -ELISA stool antigen test can also make diagnosis -Treatment: Metronidazole

What does aspergillus fumigatus cause? (3 types of infection)

1) *Allergic Bronchopulmonary Aspergillosis - ABPA (plane)* - Type I hypersensitivity reactions, IgE 2) *Aspergillomas - fungus balls in lungs (crop duster w/ sweaty, running farmer below)* - gravity dependent fungus calls) 3) *Angioinvasive Aspergillosis (farmer on right w/ immunocompromised cane)* - Invades blood vessels and surrounding tissue, kidney failure, endocarditis, ring enhancing lesions in brain, nasal sinus invasion (scare crow)

what vitamin prevents measles complications

A

Adenovirus

A Den of Lions *dsDNA*

Adenovirus

A Den-O Lions where the den looks like tonsils - the virus first isolated from adenoids Blue cave. DNA virus. Red hues in the back of the cave. #1 cause of tonsilitis. Lions yawning. Most common cause of infection in the adenoids and tonsils. Could it also cause a pharyngitis? Naked David carved into the the cave wall. Drippings from the cave. Respiratory droplets. Lion poop. Fecal-oral. Those who are at risk: children who are gross, military recruits, and those who frequent public pools (fecal-oral) Kids in camo shirts observing the lions. Children commonly affected and military recruits. Kid drowning. Swimmers at public pools often affected. David peeing a pool of blood that a kid is drowning in. Causes hemorrhagic cystitis. Affects swimmers at public pools. Red eyes in the back. Common cause of viral conjunctivitis. Pink eye. Farting on pillow. Kid in camo shirt holding the vaccine. Vaccine available and only administered to military recruits because we do not want them to have pink eye and pee blood.

Neisseria meningitidis

A Shocking Death on Campus *Gram-Negative Cocci*

Reovirus

A race on the rio (Rotavirus, CO tick virus in the family) *Majority of sketch about rotavirus.* CO sign on the very left hand side, everything else about rotavirus. Warm hues. RNA. See below. No sun or moon in the sketch. DS RNA virus. Also reinforced with the floating divider in the race. *DS DNA dividers.* David carved into the mountain. Naked. 11 boats in the race. 10-12 segmented virus. One of the BOAR viruses. 3, 8, 2, 10-12. Propeller on the back of one of the contestants boats. Rotavirus. Do not confuse with the propeller on the back of the Cali-Sea-Cruise, although they both signify explosive diarrhea. Propeller says Nine SPeed 4 stroke and the boat says chlo-rider. NSP4 toxin increases chloride permeability. Snowcaps in the mountain off into the distance. Wintertime as a prime rotavirus season. Recall Coxsackie infections more prevalent in summertime. Child fan holding the number 1 sign. Rotavirus is the number one cause of severe diarrhea in young children. Waterbottle being held by the kid in the speedboat. Tx for rotavirus is oral rehydration. TV crew filming the race with the sign saying LIVE and the anchor holding up a syringe. He is holding up the syringe to his mouth, like you'd do with a microphone. Oral live attenuated rotavirus vaccine part of the vaccination schedule for children. Must know a few things about when to give them. Man next to the TV crew with a large telescope camera. The vaccine sometimes causes intussception, or telescoping of the bowels. The vaccines causes an increase in the size of peyer's patches which are thought to act as a lead point. Welcome to colorado sign and someone puking and with sweat droplets. CO tick virus causing myalgia, fever, vomiting and no rash. Can be differentiated by RMSF by the lack of rash.

Klebsiella pneumoniae, Enterobacter cloacae, Serratia marcescens- BACTERIA

ALL -nosocomial infections -pneumonia and UTI -multi-drug resistant -ferment lactose (e.coli also does) form pink colonies on MacConkey agar Enterobacter cloacae -motile Serratia marcescens -motile -produces red pigment when cultured Klebsiella pneumoniae -immotile -Alcoholics, Abscesses and Aspiration -polysaccharide CAPSULE -BUZZ WORD "currant jelly sputum" -cavitary lesion originally makes people think its TB -UREASE POSITIVE

HLA-B*57:01

Abacavir hypersensitivity

-Carbol fuchsin is taken up by bacteria with mycolic acid (carbohydrates with two long tails) in the cell wall

Acid Fast Staining

Strep viridans

Actually a group of strep species that include mutans and mitis (oropharynx species that cause dental caries) and sanguinis (species that infects damaged heart valves) The jester with the facial jaw armor in the alpha knight tournament (alpha hemolytic, alpha means partial hemolysis and green). Damaged miter hat. Dextrans (deck of cards) binds platelet aggregates on damaged heart valves and cause subacute bacterial endocarditis. Jester jaw mask. Optochin resistant (contrast Strep pneumoniae) A deck of cards. Dextrans binds platelet aggregates on damaged heart valves and cause subacute bacterial endocarditis. His donkey has green booties on and donkey teeth. Bile insoluble (contrast strep pneumoniae). Viridans are normal flora of the oropharynx and cause dental caries.

Treatment for Cryptococcosis neoformans

Amphotericin B (frogs) + Flucytosine (flute player) followed by fluconazole (pine cones)

Arenavirus

Arenavirus gladiators. Gladiators fighting inside of two circles. 2 segments. One of the BOAR viruses. 3, 8, 2, 10-12. Rodents on the floor of the arena. Transmitted by rodents. Spiral banners going up the arena columns. Helical. LCV roman numerals in the back for lymphocytic choriomeningitis. One of the fighters with a red shawl that covers his head and neck. Meningioencephalitis of LCV. Night-time fight. RNA negative sense.

Name of the SketchyMicro sketch for Aspergillus fumigatus

Asparagus Farm

Aspergillus fumigatus

Asparagus Farm *Opportunistic Fungi*

Aspergillus fumigatus

Asparagus farm with a peanut plant (aflatoxins are a family of toxins found on peanut plants among others) that has acute angles and farmers that represent different diseases. Cat on the scarecrow. Catalase positive. Tracker with a crab on it, behind a cow with a liver spot. Aspergillus flavus (not fumigatus) in certain conditions can grow on peanuts and produce aflatoxins, a carcinogen that is strongly associated with hepatocellular carcinoma. Peanut plant is growing at 45 degree angles. Acute angle septations (contrast mucor, which is wide angle). The first two letters of aspergillus are A.S. which stand for acute septate. Within peanut plan are the yellow flowers (aspergillus's conidiophores) that look like an aspergillum, a device used to sprinkle holy water and where aspergillus gets its name. These bud off and then float through the air. Transmission by inhalation. Migratory worker sweating and with an inhaler. ABPA (allergic bronchopulmonary aspergillosis). Wheezing, fever, migratory pulmonary infiltrate. Associated with asthma, wheezing and CF patients. IgE written on the inhaler. Type I HSR. Worker coughing next to the TB cactus. Aspergillomas. Fungus balls in the lungs. People who are susceptible are those who already have cavitations in the lungs. TB. Worker with cane on the right next to the red sprinklers and the scarecrow showing what organs are affected. Angioinvasive aspergillosis affects immunocompromised patients (particularly chemotherapy patients who are neutropenic). Fever, cough and hemoptysis. Kidney spots for kidney failure. Heart spot for endocarditis. Straw protruding through the head with white rings around it. Ring enhancing brain lesions (recall toxo and recall JC virus with non-enhancing lesions). Scarecrow without a nose. May spread to paranasal sinuses and cause necrosis. Paranasal necrosis occurs in mucor as well. Question stem. Seizures, focal neuro deficits. Has a cough, symptoms of pneumonia and has a past of TB, you may want to jump to TB, but also keep aspergillosis in the the back of your mind and the way you'd differentiate is by seeing ring enhancing lesions on CT. Vortex. Voriconazole. Amphotericin B for angioinvasive aspergillosis.

Aspergillus flavus

Aspergillus fumigatus *Produces the aflatoxins, which are carcinogenic and can cause hepatocellular carcinoma *Opportunistic Fungi*

M. avium prophylaxis

Azithromycin

Treatment for blastomycosis

Azoles for local (pine cones) Amphotericin B for systemic (frogs)

Treatment for coccidioidomycosis

Azoles for local (pine cones) Amphotericin B for systemic (frogs)

Treatment for paracoccidioides

Azoles for local (pine cones) Amphotericin B for systemic (frogs)

Parovirus B19

B19 Bomber *ssDNA (SINGLE STRAND)*

Strep. pneumoniae / Strep viridans- BACTERIA

BOTH: alpha hemolytic = partial hemolysis giving a green hue (group A and B are beta hemolytic) strep pneumoniae - polysaccharide capsule (main virulence factor) -optochin sensitive -lancet shaped diplococci -bile soluble (cant grow in bile) - #1 cause of CA pneumonia (lobular) -rust colored sputum -"MOPS", Meningitis, Otitis media, Pneumonia, Sinusitis (MC bacterial cause of all of these) -IgA protease -encapsulated -sickle cell disease (Asplenia) particularly susceptible - Treatment: macrolide (erythromycin), 3rd gen cephalosporin (ceftriaxone) -prophylaxis (adult) 23 valent IgM response; (child) is 7 conjugated to protein - IgG generates a more robust T cell response Strep viridans -optochin resistance -NO CAPSULE -bile insoluble (bile resistant) -strep mutans causes dental caries ->subacute endocarditis in damaged heart valves (mitral valve) -adheres to platelets -dextrans that makes them stick to platelets

vibro cholerae -BACTERIA vibro parahaemolyticus vibrio vulnificus

BUZZ WORD: "COMMA SHAPED" gram negative vibro cholerae -perfuse watery diarrhea - RICE WATER stools -fimbraie attachment then releases cholerae toxin but does NOT invade -grows on alkaline media - its ACID LABILE (hate acidic environment of the stomach) -oxidase positive -activates Gs pathway, increases cAMP secretion of water into intestinal lumen hence watery diarrhea -Treatment: oral rehydration with electrolytes vibro parahaemolyticus & vibrio vulnificus -they can contaminate sea food particularly oysters

ring shaped intraerythroytic parasite

Babesia

Bartonella henselae

Bart the Leopard *Gram-Positive Rod - Zoonotics*

Bartonella henselae

Bart the leopard Cause of two diseases. Cat scratch disease and bacillary angiomatosis. Woman on the left with puffy sleeves. Cat scratch disease and axillary lymphadenitis (usually regional and unilateral). Man on right with cane and dots all over him represents bacillary angiomatosis. Raised red vascular lesions. Can be confused with Kaposi sarcoma, but differentiated base on the their infiltrates. Bartonella will have a neutrophilic infiltrate because its bacterial and HHV-8/Kaposi will have a lymphocytic infiltrate because it is viral. Not in FA: Starry night backdrop to represent the Warthin-Starry stain Red pillow. Gram negative. Bike tire in front. Doxy. Crow in the sky. Macrolides, ezithromycin.

Arenavirus

Battle at the Arena *(-)-sense ssRNA*

Lymphocytic Choriomeningitis Virus (LCV)

Battle at the Arena -Roman Numerals LCV *(-)-sense ssRNA - Arenavirus*

Staphylococcus epidermidis

Beauty and the Beast *Plumber* *Gram-Positive Cocci*

Staphylococcus saprophyticus

Beauty and the Beast *Woman* *Gram-Positive Cocci*

Bordetella pertussis

Board and Care *Gram Negative Rods - Respiratory*

Bordatella pertussis

Board and Care of disabled GI with a bowtie Disabled GI. Pertussis toxin disables Gi through ADP-ribosylation. Tractor in the midline. Tracheal (trachea midline) toxin damages respiratory epithelium. DTaP vaccine for children. Tdap for adolescents and adults. Also called whooping cough or 100-day cough.

Parvovirus

Bombs away playroom B19 bomber's mission to bomb the small town. Smallest DNA virus. B19 on a runway. Runways only have one lane. Single stranded DNA virus. This is unique. Statue of liberty and and a statue of David. TORCH infection and naked. Sketch is around parvovirus infection in 4 populations. Fetus to the left, child to the right, adult in the middle and sickle cell patients in the cupboard. Kid getting slapped. Slapped cheek fever a.k.a. fifth disease (also known as exanthem infectiosum). Fever for about a week and then a rash develops on their face. Similar to roseola except roseola has a rash that spares the face. Flame design on the plane. Flames start at the nose of the plane and moves downward. Rash starts at the face and moves downward. Adult who is kneeling on a lego. Joint pain, arthritis and edema in adults. Communist plane with a sickle and a bone underneath it. Aplastic anemia in sickle cell patients. Red balloon baby. Hydrops fetalis in those who contract parvovirus in the 1st or 2nd trimester. Recall CMV hydrops fetalis in those who contract CMV in the 2nd trimester.

lyme

Borrelia burgdorferi

blocks release of ach

Botulinum toxin

Brucella

Bruce Farms *Gram-Negative Rod - Zoonotics*

Brucella

Bruce's farm Undulating hills in the back of Bruce's farm with cows and pigs. Causes undulant fever. Unpasteurized milk, direct contact with cows and pigs. Not in FA: Fish bones being fed to pig. Osteomyelitis. Tire looking windmill. Doxy. Rifle on Bruce's back. Rifampin as adjunctive *treatment* in addition to doxy. Do not confuse rifampin prophylaxis with rifampin treatment. In Neiserria and H. flu, the rifle was on a healthy person and that is to represent prophylaxis in close contacts.

cytotoxin B

C difficile

Why should you suspect C. tetani infections after puncture wounds?

C. tetani spores found on rusty nails and puncture wounds will close off air. Clostridium species are obligate anaerobes.

maraviroc

CCR5 antagonist

immune mechanisms vs giardia

CD4+ T helper cells secretory IgA production

Colonic mucosal erythema/ulcerations

CMV

intracytoplasmic basophilic inclusions

CMV

Trypanosoma cruzi

CRUIZin' through Che's Gas *Protozoa/Parasite of the Blood*

predisposition to develop chronic giardiasis

CVID, XLA, IgA def

Calicivirus

Cali Sea Cruise *(+)-sense ssRNA*

(Norwalk) Calicivirus

Cali Sea Cruise Narwhal in the background. Norovirus. David sand statue. Naked. Man handing out long admission tickets. Cleavage of a long polypeptide. Cruise ship with a propeller that is kicking up mud. Explosive watery diarrhea. Viral gastroenteritis. Going onto the ship are day-care children and they are eating shellfish. Day-care children/close quarters are a risk factor. Shellfish are a source. Cruise ship and cruise-goers. Close quarters. Buffett. Anyone who is infected and touches food.

Norovirus

Cali Sea Cruise -NARWHAL (most common type of calicivirus) *(+)-sense ssRNA*

Norovirus

Calicivirus , "winter vomiting bug" LEADING CAUSE OF GASTROENTERITIS Virus changes rapidly "shape shifter" so prior formed antibodies are usually not effective Transmission: Very potent Person to person (fecal-oral) Contaminated food Aerosolized vomit or toilet flushing Rapid onset and short clinical course: - Low grade fever, anorexia - Explosive watery diarrhea - Nausea and forceful vomiting - Some times kids have respiratory symptoms

Campylobacter jejuni

Camping Guy and the Bears (Guillen Barre is a big symptom) *Gram-Negative Bacilli - Enteric*

What is the name of the SketchyMicro sketch for Candida albicans?

Candid Canadians

Candida albicans

Candid Canadians *Opportunistic Fungi*

List the common opportunistic fungal infections

Candida albicans Aspergillus fumigatus Cryptococcus neoformans Mucar and Rhizopus spp.

List 2 catalase positive fungi

Candida, Aspergillus

Toxoplasmosis gondii

Cat lady scene Three ways to transmit Toxo: oocysts in raw or undercooked meat, oocysts in shed animal feces, or through the placenta of an infected woman as a torch infection. Organization of the sketch: Statue of liberty torch cat overlooking classic triad plus one symptom of congenital toxo, and then gandi (HIV/AIDS), and Ben Franklin cat for prophylaxis (with certain parameters) in HIV/AIDS patients. Gandi cat with turban, needle through the turban and multiple lenses to his hipster glasses. Encephalitis, *biopsy to differentiate from CNS lymphoma (which also causes ring enhancement and can also happen in AIDS/immunocompromised patients)* Compare JC virus, which causes non enhancing lesions on CT. Gandi cat kicking over the bowl of meat in a hunger strike. Cysts in undercooked meat. When thinking about the classic triad plus one symptom of congenital toxo, it is important to recall that toxo is a CNS parasite. Classic triad: chorioretinitis, hydrocephalus, and intracranial calcifications. Added symptom: deafness. Camera that looks like a retina held by the pregnant lady. Chorioretinitis. Cat shaking with a fish bowl on his head. Hydrocephalus and seizures secondary to hydrocephalus and intracranial calcifications. Kitten drinking milk and getting it all over it's head. Intracranial calcifications. Compare congenital CMV that has periventricular calcifications. Beethoven cat. Deafness that is not part of the classic triad of congenital toxo, but a frequent finding. Dyed eggs with pyramids on them. Sulfadiazine and pyrimethamine for treatment. Ben Franklin cat with the positive sign kite and the IgG keys dangling from it. Ben Franklin cat is also holding a $100 bill. Egg next to Ben Franklin cat that does not have any dye or pyramids on it. In HIV patients with CD4 count <100 and who also are IgG positive for toxo, begin TMP-SMX prophylaxis.

-Converts hydrogen peroxide to water -Present in all gram pos cocci except strep -Present in nocardia -Patient with chronic granulomatous disease have an increased risk of infection

Catalase

What does Candida albicans cause? (include symptoms)

Causes both cutaneous and systemic infections Immunocompetent: - Diaper rash (baby swinging) - Vaginal candidiasis (woman clutching crotch) - Endocarditis in IV drug users, tricuspid (three humps) Immunocompromised: - Oral candidiasis (thrush) - Candidal esophagitis (cartoon tube slide w/ white patches)

What does Malassezia furfur cause? Symptoms?

Causes: Pityriasis (tinea) versicolor (Versi di colore sauce) Symptoms: - Lipid degradation builds up acid that damages melanocytes causing loss of pigmentation (broken bottle of oil) - light and dark colored patches on chest and back (patches of sauce on chef) - usually occurs in hot and humid climates (sweating chef)

Echinococcus granulosus

Cestode County Carnival -COCKER Spaniel Stage *Cestodes/Tapeworms (Helminth)*

Diphyllobothrium latum

Cestode County Carnival -Man Running to BATHROOM *Cestodes/Tapeworms (Helminth)*

Tinea saginata

Cestode County Carnival -SAGgy Tent *Cestodes/Tapeworms (Helminth)*

Tinea solium

Cestode County Carnival -Sun (SOL) Tent *Cestodes/Tapeworms (Helminth)*

taenia solium, taenia saginata, diphyllobothrium latum, echinococcus

Cestodes a.ka. tapeworms Cestode County Carnival. Tents. Taenia. Sun and Sold tent with the pig. Taenia solium. Sagging tent with cow. Taenia saginata. Hooks on the pigs tent. Proglottid heads of T. solium seen on O and P. Circus merry go round that flung off the girl with the cheese head next to the eggs in feces water. Ingestion of taenia eggs that leads to cysticercosis or neurocysticercosis. Brain said to have a swiss cheese appearance on CT. Seizure are a symptom. Important distinction. Ingestion of the cysts or larvae of the Taenia species will lead to taeniasis, which is usually asymptomatic, but could cause GI problems or malabsorption. Ingestion of eggs in feces contaminated water may cause neurocysticercosis. Pretzel stand. Treat taenia with praziquantel. Strong man bending a bar on the merry go round. If patient has neurocysticercosis, additional treatment with albendazole is necessary. Man throwing away his fish running to the bathroom. Bathroom sounds like bothrium. Diphyllobothrium latum, the fish tapeworm. Bathroom located next to the fireworks stand that says, "must B12 to buy fireworks." This tapeworm is associated with B12 deficiency and megaloblastic anemia. Cobalt firework going off in the background. Cobalamin is another name for B12. Man walking out of the bathroom with a long piece of toilet paper stuck to his foot. D. latum is the longest tapeworm (can grow up to 10 feet). Toilet paper segments in the brown puddle. Proglottid segments in stool as diagnostic for D. latum. Man with toilet paper stuck to foot eating a pretzel. Praziquantal for treatment of D. latum. Nickel donation thing on the front of the bathroom. Niclosamide for treatment of D. latum. Cockerspaniel winning first place. Liver spot and a ribbon on that liver spot. For winning first place he received a cracked egg in an egg cup. Echinococcus granulosus. Causes hyatid cysts in the liver. Eggshell calcification of the liver on CT. Flushed, red man removing the second place pin from the sheepdog. Anaphylaxis and an acute abdomen that results if the hyatid cysts rupture. Sheep are intermediate host and dogs are definitive host. Surgeons will inject the cells with ethanol or hypertonic saline to kill the cells before attempting to remove the cysts. If cysts were in the lungs, you'd see hooks in the patients sputum. Contrast how you would treat the liver abscesses of entamoeba histolytica with medicine. Cockerspaniel that pooped. Dog feces that contaminate human food or water.

Sporothrix schenckii

Cigar-smoking rose gardener who has potassium iodide pesticide (KI is one tx along with pine cone) Cigar. Sporothrix look like cigar shaped yeast under a microscope. Roses going up the walls and up her arms. Ascending lymphadenitis. Pinecones. Itraconazole is the drug of choice to treat lymphocutaneous sporotrichosis. Potassium iodide on her back. Saturated solution of potassium iodide may also be used to treat lymphocutaneous sporotrichosis. Do not confuse with KOH. KI is for treatment, KOH is for diagnosis of many other fungi, not including sporothrix.

-Converts fibrinogen to fibrin -Present in staph aureus

Coagulase

Neisseria meningitidis

College kid in red spotted boxers who OD'ed on malt liquor and vaccines. MAC swabbing the malt liquor bottle and placing drug (vaccine) syringes underneath capsules. No capsule for B. This is to represent that N. meningitis ferments maltose (N. gonorrhoeae does not) and that the type B vaccine is not widely available and the reason for outbreaks. Burning envelopes to represent the envelopes of LOS proteins blebbing off and creating the inflammatory response (FA says Neisseria's LOS has strong endotoxin activity). 1st step of the pathogenesis. Sprinklers creating purple wet spots on the floor and the kid who overdosed with red spotted boxers to represent leaky capillaries (caused by LOS virulence factor) and consumption of platelets that cause hypovolemia and a petechial rash. Petechia can progress to purpura which can progress to DIC. Menigitis with a petechial rash? Think Neiserria. Sparked outlet to represent shock. Waterhouse in the background to represent Waterhouse-Friderichsen syndrome. Peripheral vasoconstriction goes to a maximum in order to preserve blood flow and as a result some organs become poorly perfused. Adrenals are one of them. Waterhouse-Friederichsen syndrome is characterized by adrenal insufficiency, fever, DIC, shock. Pathogenesis: encapsulated Neiserria transmitted by respiratory droplets, LOS proteins bleb off and cause a massive inflammatory response, leakage of capillaries and consumption of platelets. Petchial rash and shock. Waterhouse-Friderichsen syndrome. Mortality rate even with antibiotics is 15%. Treatment is ceftriaxone (firefighter with axe). Prophylaxis for anyone who was in contact with the individual is rifampin (FA also says ceftriaxone). Represented by the policeman with the rifle fencing off the crime scene to the college kids 'close contacts.' Recall the rifle tooting close contact is also in phyllis's chocolate covered cherries for H. flu meningitis.

Vibrio cholera

Colonel Cholera's Base cAMP *Gram-Negative Bacilli - Enteric*

Vibrio vulnificus

Colonel Cholera's Base cAMP plus causes Acute gastroenteritis *Gram-Negative Bacilli*

Vibrio paraliticus

Colonel Cholera's Base cAMP plus causes fulminating septicemia *Gram-Negative Bacilli*

State whether each of the following will cause blindness or deafness Congenital gonorrhea Congenital chlamydia Congenital syphilis

Congenital gonorrhea. Blindness. The mother quickly shielding the baby's eyes from the violinist dying. Congenital chlamydia. Blindness. The mermaid idol on the front of the pirate ship shielding the baby's eyes. Note that this neonatal conjunctivitis is later in time course than gonorrhea's. Congenital syphilis. Deafness. Kids in the cold with earmuffs on outside the Pallidum observatory.

Adenoviruses

Contain DNA, capsid and noneveloped Can cause lytic infection, latent/chronic infections, or oncogenic transformation Clinical manifestations: -respiratory (pharyngitis or tracheitis) -Pharyngoconjuntival fever Occurs in small "outbreaks" with kids at daycare or pool -epidemic kerato conjunctivitis -hemorrhagic cystitis Common cause blood in urine for kids -infantile diarrhea

Corynebacterium diptheria

Corazon de la Corrida *Gram-Positive Bacilli*

Corynebacterium diphtheriae

Corazon de la corrida "Heart of the bullfight" *Gray cotton candy being eaten by the kids wrapped in wrappers. Gray pseudomembrane formation in the oropharynx.* Heart shaped matador cape. Heart problems. Diptheriae can lead to life threatening myocarditis, heart block and arrhythmias. Bull with large neck. Bull's neck lymphadenopathy Man with bowtie playing the accordian. ADP-ribosylation of elongation factor 2 (EF-2). Old guy shaking the maracas in the stand. Maracas represent club shaped, or V/Y shaped metachromatic granules. "Tele" labeled megatron. Cystine-tellurite agar in order to colonize for a diagnosis. FA says Black colonies on cystine-tellurite agar. Kid pointing and laughing in the stands. Loeffler's medium in order to colonize for a diagnosis. Bull tongue sticking out. Elek test to differentiate between toxic and non-toxic strains of diptheriae. Bull being stabbed by vaccines = TDaP vaccine.

SARS (severe acute respiratory syndrome)

Coronavirus, RNA Bats and palmcivits Respiratory droplets or fomites Clinical: -early= fever, myalgia, chills, dry cough -late: persistent fever, worsening pneumonia, watery diarrhea Isolation is key! Diagnosis = PCR

Coxsackievirus A & B

Coxsackie Cockatoos *(+)-sense SS Picornavirus*

Corona-virus

Crown = kingdom Kingdom of SARS King is coughing next to his helical kingdom. Cause of a common cold. Helical shaped. FA: Helical, SARS, MERS (middle eastern respiratory syndrome), common cold.

Trypanosoma cruzi

Cruzin' through Che's Gas (Che's gas = Chagas, for Chagas disease) Protozoa of the blood. Causes chagas disease. Colon gas line. Big red heart bag. Snake with giant throat. Megacolon, DCM, and megaesophagus. Che kissing his gf. Transmitted by the kissing bug, reduviidae insects that are vectors for the parasite. Blood leaking from the gasoline pump. Acute infections diagnosed on peripheral blood smear. Chronic infections diagnosed with serology. Red bug on the DCM heart bag. Reinforcement of bug name and trypanosomes seen within cardiac myocytes on heart biospy. Knee high, furry mocassins of Che's gf. Nifurtimox. This is for the acute infection. No treatment for chronic infection. Romana sign not in sketch. Romana sign is periorbital swelling.

Cryptococcus neoformans

Crypt (for Cryptococcus *Opportunistic Fungi*

What is the name of the SketchyMicro sketch for Cryptococcus neoformans?

Crypt for Cryptococcus

yeast with capsule

Cryptococcus neoformans

Coxiella burnetii

Curly Q the Ram *Gram-Negative Rod - Zoonotics*

Coxiella burnetii

Curly Q the Ram. Horn on the ram is in the shape of a Q. Cause of Q fever. White ram. No rash. Common to confuse Borrellia, Ricketsii and Coxiella, but you will not do this. This is the only one out of those without a rash. Walnuts and animal poop. Spores are in animal poop. Ram kicking up a dust cloud. Aerosol transmission (or amniotic fluid from a farmer delivering a baby sheep). Farmer knocking his head, sweating, coughing and standing in front of a cow. HA, fever, pneumonia and hepatitis. This could be confused with Brucella because both around farm animals, but with Brucella the undulating fever will be emphasized. Ram is inside the barn with a lock on. Obligate intracellular. Compare Chlamydia and Ricketsii species. (From sketchy pharm): Treatment is doxycycline.

removal of RNA primers

DNA poly I

Microsporum, Epidermophyton, Trichophyton

Dermatophytes Tinea tin man Tin man wearing a headband and toto. Athletes are a population at risk and pets are a source of these fungi. Crura is the structure that attaches the base of the penis to the ischiopubic rami. Tinea crura is jock itch. Woodlamps up with microsporum. Woodlamp used to diagnose microsporum. Tx: Pinecone. Azole. Wizard of Oz biting his nails. Terbinafine as treatment for nail dermatophytes. Wizard of Oz holding a grease can. Griseofulvin for most severe infections.

Leishmania donovani

Desert Mania -Donovan (the character) *Protozoa/Parasite of the Blood*

Leishmania baziliensis

Desert Mania -Zombie w/ BRAZILIAN flag *Protozoa/Parasite of the Blood*

Gardnerella vaginalis

Detective at the Fish Garden Graffiti all over the fish garden. Gram variable rod. Detective. Clue cells. Detective dog sniffing. Amine whiff test that enhances the fishy odor. Venus flytraps with gray white drool. Venus flytraps represent the imbalance in normal flora and the overgrowth that leads to bacterial vaginosis. If it's part of the normal flora, likely why it cannot be transmitted sexually. Metro in the background. Metronidazole. Price 4.5 and up. Changes pH to 4.5. *pH, microscope, D/C comparison of vaginal infections.* Gardnerella vaginalis. Grows at pH 4.5 and up. Plants at price 4.5 and up. Candida albicans. Grows at pH 4 (does NOT change pH. Canadian playground open until 4pm (does not go higher/past 4). Trichomonas vaginalis. Grows at pH 4.5 and up. Street art next to the magician on the green street corner sold at price 4.5 and up. Thus, pH of 4.5 can narrow it down to Trichomonas and Gardnerella. Under the microscope this is what each would show... Gardnerella vaginalis. Clue cells. Candida albicans. Pseudohyphae. Trichomonas vaginalis. The distinct looking trophozoite (but they may not be that obvious and in that case *motile* is the buzzword). Discharge of each... Chlamydia. Watery. Gonnorhea. Thicker than Chlamydia. Gardnerella vaginalis. Gray-White. Candida albicans. Vaginal thrush. Trichomonas vaginalis. Malodorous yellow green.

Klebsiella, Enterobacter, Serratia

Dinosaurs hovering around the hospitalized patient with a non-rebreather mask and a urinary catheter in to represent causes of nosocomial pneumonia and UTIs. Hospital setting and pills on the ground should clue you in to multi-drug resistance and use of a carbapenem when treating (because resistance isn't an issue with carbapenems). Pterodactyl and Triceratops are motile. Klebsiella is not motile because it knocked over the red currant jelly and has it's foot caught in it. 3 A's of Klebsiella on it's tail = alcoholics, aspiration, abscesses (abscesses also represented by the CXR in the back). FA A's of Klebsiella: aspiration pneumonia, abscesses in lungs and liver, alcoholics, di-A-betics, curr-A-nt jelly sputum. *X-ray = cavitary lesion to remind that it causes abscesses and that it may get confused with TB* *MacConkey caveat: serratia ferments at a slow rate. Can show up negative on a lactose fermentation test.*

HHV6 - Roseola -VIRUS exanthema subitem

Double stranded DNA virus is in the HERPES VIRUS FAMILY -6th disease -infects CD4+ cell helper T cell has the ability to cause immunosuppression -occurs primarily in children 6 m to 2 y.o and is usually self limiting -high grade temperature fever >104 degrees lasts 4 days -> can cause febrile seizures -AFTER fever, appears diffuse lacy body rash that spares the face -TREATMENT: SUPPORTIVE

HHV-8 Kaposi's Sarcoma - VIRUS

Double stranded DNA virus is in the HERPES VIRUS FAMILY -immunosuppression and AIDS associated with Kaposi Sarcoma -causes violacious lesions on the nose, extremities and mucous membranes -angiogenesis causes proliferation of vasculature and gives it its violet color -causes dysregulation of VEG-F -lesions can be found within the GI tract -kaposi's lesions most commonly occur on the hard palate -infection of B cells can cause Primary Effusion Lymphoma (B-cell lymphoma) -sexual active including kissing -higher incidence in elderly russian men and African populations -can be confused with bartonella henslea (cause of bacillary angiomatosis- which has a neutrophilic infiltrate & bacterial etiology); must be distinguished lesion by microscope; karposi is characterized by lymphocytic infiltrate & viral etiology -Treatment - antiretroviral therapy and the lesions should shrink

Treatment of Rocky Mountain Spotted Fever

Doxycycline

Tissue Nematodes- PARASITE Dracunculus medinensis, Onchocerca volvulus, Wuchereria bancrofti, Toxocara canis, Loa loa

Dracunculus medinensis -drinking contaminated water with copepods containing larvae (intermediate hosts) -adult females emerge from PAINFUL ulcers in the skin -eosinophilia Onchocerca volvulus -hyper and hypo-pigmented spots occur with onchodermatitis -microfilariae in eye causes blindness also called RIVER BLINDNESS -eosinophilia -microfilariae seen in skin biopsy under microscope TX: ivermectin Wuchereria bancrofti -causes elephantiasis: long standing lymphedema in the lower extremities -lymphadenopathy -cough from microfilariae in lungs causes hypersensitivity reaction making someone cough -transmitted by mosquitos (intermediate host) -diagnosis by organisms seen on thick blood smear -eosinophilia TX: diethylcarbamazine Toxocara canis -contamination from food by dog or cat feces -visceral larvae migrans name of disease -ocular larva migrans leads to blindness -eosinophilia TX: Albendazole Loa loa -causes transient angioedema -local subcutaneous swellings -adult worms can migrates across conjunctiva also called african eye worm -microfilariae seen on blood smear -transmitted by deer flies -eosinophilia TX: diethylcarbamazine and Albendazole

mulberry shaped intraleukocytic inclusions

E chaffeensis

Escherichia coli (EHEC)

E. Cola's Soda Fountain *Inside the Shop*

Escherichia coli (ETEC)

E. Cola's Soda Fountain *Outside the Shop w/ the truck - Enteric*

E. coli

E. Cola's Soda Fountain and $1.57 Hamburger Joint Left = EHEC, middle = shared features, right = ETEC Hamburgers. EHEC found in undercooked hamburgers. $1.57 hamburgers to represent that the O157:H7 is the serotype strain that causes EHEC (and the most common serotype in the US). EHEC stands for Enterohemorrhagic E. coli. Soda fountain that uses milk in it's milkshakes. Lactose fermenter that would produce pink colonies on MacConkey agar. Only lactose fermenters are the dinosaurs and E. coli. Sorbitol-FREE glomerulus soda straw that is popping the red balloon of the kid with the She-gorilla toy. EHEC does not ferment sorbitol (contrast other strains of E. Coli) and E. coli produces Shiga-like toxin which produces HUS and schistocytes. Sorbitol is a new sweetener and this is an old-school Soda fountain. Ketchup over the burger to represent bloody stool. Gentlemen capping the cake with a K on it from the neonate with the space helmet on. K capsule as a virulence factor and K capsule being the virulence factor necessary for causing neonatal mengitis. E. coli also encapsulated. Girl with red bows in her hair. Fimbriae as a virulence factor. Fimbriae cause cystitis and pyelonephritis. #1 on a yellow drink with two straws facing outwards to represent that E. coli is the number 1 cause of UTIs. The strawberry milkshake with the strawberry atop the whipcream. Supposed to represent E. coli being the leading cause of gram negative sepsis. Virulence factor responsible for this is LPS. LPS not illustrated because LPS is a virulence factor for all gram negative bugs and not just E. coli. Green coasters underneath drinks on the bar counter. E. coli forms green colonies on EMG (Eosin-methylene blue) agar. Water guy delivering water from the company eL Agua de San Gabriel. Labile increases cAMP, stable increases cGMP. Water also a symbol that ETEC produces watery diarrhea (contrast EHEC which produces bloody diarrhea.

heterophile IgM antibodies

EBV

Cryptococcus neoformans

Egyptian crypt and the crypt cleaner with the tx hieroglyphics in the background (frog for amphotericin with the pharaoh playing the flute, for flucytosine, and then the pillar with the pinecone for fluconazole). Latex gloves. Latex agglutination of polysaccharide antigen. Coughing. Pneumonia. Neck brace. Meningitis. Red and silver color of the coffins. Mucicarmine (red) and methenamine silver stain. Methenamine silver stain is also used for diagnosis of pneumocystis jiroveci. Cleaning and soap bubbles. Soap bubble bronchopulmonary washing and soap bubble lesions on brain scan. Pigeons flying everywhere. Bird dropping as a source. Vat of black ink. India ink diagnosis. Frog and flute hieroglyphics and then a pine cone pillar. Tx for cryptococcal meningitis. Amphotericin B and flucytosine and then maintenance with a conazole.

-Following splenectomy or auto-splenectomy (i.e., sickle cell patients), there is a greater risk of infection with _______________ organisms

Encapsulated

Entamoeba histolytica

Entering the Historical Drug *Protozoa/Parasite of the Intestinal Tract*

Entamoeba histolytica

Entering the historical digsite for Queen Iodo's tomb. Pool with bubbles. Cysts are infectious. Man drinking water holding another mans hand. Associated with men who have sex with men. Anal-oral. Drinking contaminated water. Digging in the right lobe of the digsite. Right lobe of the liver most commonly affected (abscess formation). Anchovy truck in the background. Pus inside liver abscess described as having anchovy paste consistency. Colon sewage pipe with brown lesions. Causes intestinal amebiasis and ulcerations in the colon. Specifically, flask shaped lesions (intestinal biopsy would show flask shaped lesions). O and P written on the side of the sewage pipe. O and P as diagnostic test. Red cups floating around in the amoeba/trophozoite puddle. Endocytosed RBCs within a trophozoite. Metro in the sketch. Metronidazole. Pair of mice. Paramycin that is a luminal agent that works by eliminating cysts in the lumen of the intestine, a spot where some drugs have a hard time reaching. Queen iodo's dig site. Iodoquinol as another luminal agent. Important to know that you do not operate on these liver abscesses. Treat medically. Contrast to enchinococcus, surgeons inject hydatid cysts with ethanol or hypertonic saline before attempting to remove. Testmakers will give you a question stem about a liver mass and then make you determine if it is echinococcus or entamoeba. Recall echinococcus hydatid cysts, eggshell calcifications and risk of anaphylactic shock.

Enterococcus - BACTERIA

Enterococcus Faecalis (more common) Enterococcus Faecium (more dangerous) Both: -inhabits the INTESTINAL tract -gram + cocci -can grow in 6.5% NaCl -bile resistant -UTI, endocarditis, biliary tree infections (hence bile resistant) -VRE - vancomycin resistant TREATMENT: Linezolid (antibiotic); Tigecycline

Poliovirus

Enterovirus 3 serotypes. (PV1 (paralytic one) , PV2,PV3) Replicates in gut and can disseminate to lymphonodes and sometimes other organs after Types: Abortive poliomyelitis 2-3 days of fever, HA, sore throat, anorexia Nonparalytic poliomyelitis Aseptic meningitis similar to other enteroviruses Paralytic poliomyelitis - Flaccid paralysis -biphasic illness (see notes_ CNS poliomyelitis

6 Intestinal Nematodes (Helminth)

Enterovius vermicularis -VERMINE lady Ancyclostoma duodenale -American DAD Necator americanus -AMERICAN dad Ascaris lumbricoides -LUMBERIN Tree Man Strongyloides stercoralis -STRONG Guy Trichinella spiralis -Pig w/ SPIRAL

Influenza

Enveloped RNA virus with 8 segments that can reassortment when more than one virus infects a single cell Surface proteins: Hemaglutinin and Neuramindase are used to subtype (H, N) Pathogenesis: enters respiratory tract, penetrates columnar epithelial cells and causes cell death---> reduced bacterial clearance from lungs Symptoms: -Fever, rigors, myalgia, headache -followed by sore throat, dry cough, nasal obstruction/discharge Can progress to viral pneumonia or Guillain-Barré syndrome Diagnosis: Rapid test is okay but not sensitive, PCR is better at distinguishing between A and B

Escherichia coli - BACTERIA (ETEC, EHEC)

Escherichia coli -lactose fermenter -Pink on MacConkey Agar -encapsulated -K antigen present on capsule -green on EMB agar -catalase postiive -fimbriae necessary for UTI -#1 cause of UTI -leading cause of gram negative sepsis -LPS endotoxin located in outer cell membrane (virulence factor for all gram negatives) -neonatal meningitis - only if it has the K antigen Enterohemorrhagic E.coli (EHEC) -transmitted by eating undercooked meat/hamburgers -bloody diarrhea -only e.coli that DOESNT ferment sorbitol -inhibits ribosomes at 60s subunit - like SHIGA LIKE TOXIN -hemolytic uremic syndrome in <10 y.o. patients (damages endothelial cells in glomerulus; platelet aggregation and decrease in platelet count; hemolysis of RBCs) -O157:H7 associated with outbreaks enterotoxigenic E.coli (ETEC) -"travelers diarrhea" -"montezuma's revenge" -transmitted via water -recent travel to Mexico -heat labile toxin increases cAMP -heat stable toxin increases cGMP (similar to cholera) -watery diarrhea

BK Virus

Et Tu, BK? *dsDNA virus - Herpes Family*

JC Virus

Et Tu, BK? *dsDNA virus - Herpes Family*

inactivates EF-2, inhibits protein synthesis

Exotoxin A (Pseudomonas aeruginosa) Diptheria toxin

Strep bovis

FA only. Gram positive cocci, colonizes the gut. S. galloyticus (S. bovis biotype 1) can cause bacteremia and subacute endocarditis and is associated with colon cancer. Bovis in the blood = cancer in the colon.

Clostridium difficile

Field Trip to the Chocolate Factory *Gram-Positive Bacilli*

(Pico) Poliovirus

Flamingo breeding pool (flamingos were chosen to represent polio because polio is said to result in asymmetric paralysis, the posture of the flamingo leg bent is supposed to represent that). Baby counterpart. Picornavirus. David statue. Naked. Toucan. Anterior horn cells. Yellow pool and flamingo standing. Acid stable. Sign reading Peyer's flamingo, caution, patches of eggs, breeding season 2-3 weeks. Peyer's patches in the gut is a site of replication. There are two sites of replication and the other is not represented. The other is the tonsils. Paralysis by disabling lower motor neuron cell bodies in the anterior horn of the spinal cord. Sulking teenager with the skull and cross vaccines shirt. Salk vaccine. Skull represents that this is the killed vaccine. Also called IPV, or inactivated polio vaccine. IgG response. Savin' a life donation next to the sulking teenager with the skull and cross vaccines shirt. Sabin vaccine. 'Life' on the donation post is meant to represent that this is the live vaccine. Also called OPV, or oral polio vaccine. Unique IgA response. Refer back to picornavirus overview.

Yellow fever

Flavirus, mosquito born Two phase: 1= abrupt high fever, extreme myalgias (esp back), conjunctival suffision ----symptoms resolve for a day---- 2= can cause severe illness and death (viremia is clear and antibodies appear) -fever, hepatitis, jaundice, renal failure, SEVERE hemorrhaging (vomiting blood, bleeding from eyes and other orfaces) Diagnose with serology IgM while symptomatic

West Nile Virus

Flavivirus Reservoir= birds. Vector= mosquitos Human= dead end host (from mosquito bites) High risk if deletion in CCR5 gene! Clinical manifestations: -west nile fever -Abrupt onset of fever, headache, fatigue, myalgias -Neck pain and stiffness -Maculopapular rash trunk> extremities Recovery= 3-6 days Post illness fatigue can last for week/months -west nile neuroinvasive disease -meningitis (recover without permanent damage) -encephalitis - polio like flaccid paralysis Diagnosis = IgM spinal Tap of CSF

Dengue virus

Flavivirus, 4 serotypes that all can cause severe disease and aren't cross protective Mosquitos= vector humans= main reservoir Primary infection--->develope antibodies to that serotype Subsequent infection---> more severe due to antibody dependent enhancement Clinical: in sequence (condensed) -____fever syndrome Unique= retro-orbital pain Diffuse maculopapular rash Have petechiae and bruising but NO hemorrhage -_____ hemorrhagic fever Need presence of preexisting antibody -fever -hemorrhagic manifestations -thrombocytopenia -plasma leakage -_____ shock syndrome -DHF + circulatory failure Deadly if not treated right away!

Zika Virus

Flavivirus, vector= mosquitos Vertical and sexual transmission (can stay in semen for 2months) Symptoms: Fever, rash, joint pain, conjunctivitis, guillain barre syndrome -microencephaly of fetus of effect mother during first trimester Diagnosis: PCR <14 days >14 days--> serology IgM

Chikungunya

Flaviviruse, mosquito borne 2 stages of disease: -acute: intense joint pain (arthralgias), fever, headache, backpain, myalgia, maculopapular rash with edema of face and extremities Chronic: debilitating polyarthralgias in peripheral joints diagnosis= PCR during viremic phase, serology after 2 days of symptoms

West Nile Virus

Flavor Packed Flavi -Birds *(+)-sense ssRNA Flavivirus*

Dengue Fever Virus

Flavor Packed Flavi -DINGY *(+)-sense ssRNA Flavivirus*

Flavivirus & 4 Types

Flavor Packed Flavi -Dengue Fever Virus (DINGY) -Yellow Fever (YELLOW African Buffalo) -West Nile Virus (Birds) -Hepatitis C (Hep Sea Hippo) *(+)-sense ssRNA*

Yellow Fever Virus

Flavor Packed Flavi -Yellow Water Buffalo *(+)-sense ssRNA Flavivirus*

Flavivirus

Flavor Packed Flavi, party along the Nile Hooded party-goers. Enveloped. Straw of the Hep. C is not bendy. Flaviviruses are non-segmented. Hep. C (play on High C drink). Man on a dinghy adrift with a brown white oar. Dinghy fever. Dengue fever. Also known as breakbone fever. Dinghy oar is in two pieces. Type 2 of dengue fever. Red tubes surrounding the kidney shaped dinghy. Compare dinghy with that in leptospirosis. Dengue fever is a type of hemorrhagic fever. Acute renal failure. Yellow waterbuffalo. Yellow fever. Do not mistake for general jaundice of Hep. C. This is it's own flavivirus. Waterbuffalo has mosquitoes buzzing around it. Liver spot and a hump on it's back. Aedes egypti. Jaundice. Backache. A man climbing on a red stool poking a vaccine into the yellow water buffaloes back. Yellow fever can cause red stool (can also cause bloody vomit) and a live attenuated vaccine. Swans floating in the river. Mosquitoes buzzing around them. Birds are the reservoir for West Nile virus. Mosquitoes are the vector. Culex mosquito. Turban, neck brace, and floppy neck of the swans. Encephalitis, meninigitis, flaccid paralysis.

Francisella tularensis

Francis the Rabbit *Gram-Negative Coccobacilli - Zoonotics*

Francisella tularensis

Francis the rabbit eating radishes and scratching off ticks Ticks and a rabbit. Cause of tularemia, also known as rabbit fever. *Kaplan Qbank: begin as a rupturing pustule followed by an ulcer, with involvement of regional lymph nodes.* Not in FA: Radishes. Gram negative, coccobacilli Psis gardening tools. Streptomycin as treatment.

Corynebacterium diphtheriae- BACTERIA

GRAM POSITIVE -CLUB shaped -metachromatic granules -V or Y formation -exotoxin A (active) and B (binding) -toxin causes ADP ribosylation of elongation factor 2 (EF2) which inhibits ribosome function and inhibit protein synthesis ->cell death -pseudomembranes formation (throat and tonsils) -RESPIRATORY DROPLET spread -"bulls neck" due to lymphadenopathy -cardiotoxic effects (myocarditis, arrhythmia, heart block) -damages myelin of nerve fibers -plated on tellurite agar and Loeffler's medium to culture -Elek's test -often immigrants get this because can be vaccinated (toxoid- inactivated exotoxin bound to protein) -passive immunization by administrating anti-toxoid if pt presents with symptoms

Strep pyogenes (Group A Strep) - BACTERIA

GRAM POSITIVE COCCI -form long chains or pairs - encapsulated -hyaluronic acid what the capsule is made up (we produce this in our CT) -beta hemolytic -impetigo honey crusted! (skin rash also caused by s.aureus) - pharnygitis - MCC of cellulitis and erysipeias (inflammation of the skin) STREP PYOGENIC EXOTOXIN SPE causes the following 3: 1) scarlet fever (strawberry tongue, pharyngitis, diffuse rash that spares the face) 2) TSLS- toxic shock like syndrome by a superantigen 3) necrotizing fasciitis (surgical emergency) SpeA- superantigen (TSLS) SpeB- protease (Nec. fasc) SpeC- superantigen (TSLS) -Rheumatic fever >type 2 hypersensitivity reaction >M protein main virulence factor responsible for RF (antiphagocytic) >M protein mimics myosin in our heart causing antibodies to attack our mitral valve (damaged causing mitral stenosis in RF) >pharyngitis precipitates RF >jones criteria (joints (polyarthritis), o (heart problems), n (subcutaneous nodules), erythema marginatum, sydenham's chorea) > can occur only after pharyngitis >>TREATMENT: penicillin WILL help -post streptoccocal glomerularnephritis PSGN >type 3 hypersensitivity reaction > glomerulonephritis (cola colored urine, facial edema) >2 weeks post infection >can occur after pharyngitis or impetigo >TREATMENT: penicillin will not help VIRULENCE FACTORS: -streptolysin O - lyse red blood cells and be beta hemolytic (we generate ASO antibodies) -streptokinase (lyses clots) -DNase (depolymerize DNA) -BACATRACIN sensitive (group b strep is resistant) -antistreptolysin O titer tell us if we have a had a recent infection with group A strep

Streptococcus agalactiae

Galactic Baby *Gram-Positive Cocci*

Strep agalactiae

Galactic baby Mainly problematic in babies to mothers with vaginas infected by Group B strep. The baby is seen coughing and has a space cadet helmet to signify that this causes meningitis and pneumonia in babies. He is holding a stuffed hippo to represent hippurate positive (do not get confused with hepatitis). He is facing a basset hound who cannot lick him through his helmet (bacitracin resistant and this is how you will differentiate between Group A Strep). CAMP tents in the backgound with beta hemolytic light bulbs to signify CAMP factor production (not cyclic AMP, but named after those who discovered it). The spaceship that the baby arrives in: Has "35 wks." painted on the top half of it and then the bottom half looks like a vaginal canal and that canal is being stabbed by pencils. Screen pregnant women vagina and rectum at 35 weeks to see if colonized by Group B strep. If they are, patient is given intrapartum penicillin. The pencils stabbing the canal is to represent that the medication is given intrapartum, or during birth.

treatment of CMV

Ganciclovir

Toxoplasma gondii

Ghandi the Cat *Protozoa/Parasite of the CNS*

Giardia lambia

Giardia Jungla Ride *Protozoa/Parasite of the Intestinal Tract*

Giardia lambda

Giardia jungle ride with the metro. Kid sitting on a yellow stool. Steatorrhea. Kids with backpacks. Associated with campers and hikers who drink poorly purified water. Think about lakes and streams. Bubbles in the water. Transmitted by cysts. Decorative shields on the side of the boat. Distinct looking trophozoites. Monorail in the background. Metronidazole. Kid with OP shirt. Stool O and P is diagnostic. Boat called ELISA. ELISA for stool antigen also diagnostic.

Neisseria gonorrhoeae

Gonzo's bar and the violinist's last clap (Fitz Hugh Curtis band) Trendy white cell looking chair with multiple white spots = PMN (polymorphonuclear cells also called granulocytes, FA has a picture of Neisseria facultative intracellular in a neutrophil). Broken glass on the ground at Gonzo's bar represents that N. gonorrhoeae does not have a capsule. Contrast N. meningitidis, which does have a capsule (recall the crime scene of the college kid where vaccines are put under capsules). Statue with the cracked knee that has crushed the violinist. Septic arthritis. Sexually active female who comes in with unilateral arthritis? N. gonorrhoeae Clam shell napkins on the table. Assumption of chlamydia co-infection in those with gonorrhoeae. Ceftriaxone for gonorrhoeae and doxy (bicycle tire wheel as a captain's wheel) or azithromycin (crow in the bird's nest of the pirate ship) for chlamydia. Mother quickly shielding her babies eyes to represent neonatal conjunctivitis. Gonorrhoeae conjunctivitis comes quicker than chlamydia conjunctivitis. Chandelier dropping hot wax onto the table. Neisseria gonorrhoeae discharge is thicker than Chlamydia's discharge. Difference in neonatal conjunctivitis with chlamydia and gonnorhea. *Timecourse* (gonnorhea earlier, recall quickly shielding eyes from the scene of the violinist's death) and presence of *pneumonia* (buzzword staccato cough, recall clam shell bra on the newborn in the mermaids arms).

Mycobacterium leprae

Good, Bad, Lion-cloth faced. Jail cell #1. Prisoner is behind bars and the deputy is pointing his rifle at him. TH1 response to the disease that is well contained a.k.a. tuberculoid. Dapsone and rifampin as treatment. Jail cell #2. Prisoner is escaping with the lion-cloth faced bandit while the deputy is being held at gunpoint and his rifle is by his side. TH2 response to the disease that is not well contained a.k.a. lepromatous. Clofazamine added to the dapsone/rifampin regimen. Cold setting. Infects skin and extremities due to lower temperature creating the glove and stocking loss of sensation. Armadillo. Armadillo are the reservoir in the US.

North American Encephalitic Arboviruses

Group of arboviruses that infect the CNS Mosquitos= vectors Symptoms: ◊ Asymptomatic infection ◊ Flu like syndrome ◊ Encephalitis-meningitis syndrome ◊ Acute flaccid paralysis / myelitis Diagnosis: CSF IgM

-All enteric bacteria that are motile are _____ positive, meaning they grow black colonies on Hektoen agar

H2S

Retrovirus - HIV/AIDs - VIRUS

HIV -immunocompromised -RNA postive virus -ENVELOPED -diploid RNA positive virus -gag = p24, which is the capsule for RNA strands -Env = gp 41 and 120 -gp41 is transmembrane protein -gp120 is outer glyocprotein that eventually comes in contact with host receptors -pol = reverse transcriptase (creating DNA from RNA) -TORCHES infection -HIV initially infects macrophages and targets helper T cells progression of the disease -prodrome consists of flu or mono-like symptoms and cervical LAD, fever can last for several weeks but generally gets better on its own, CD4+ cells are infected -latent for up to 10 years where the virus is replicating in the lymph nodes -steep decline in CD4+ cells -AIDS diagnosed when CD4+ cells <200 or if AIDS defining illness with a higher count (diffuse large b cell lymphoma is an AIDS defining illness) gains entry via CCR5 receptor in early stages or gains entry via CXCR4 receptor in late stages diagnosis: screening done with ELISA looking for antibodies (tested early can be false negative) confirmation done with a Western Blot use PCR to check viral load and CD4 count once diagnosed with HIV HIV RNA and DNA amplification test in neonates to check for virus itself because they will have antibodies passed down from the mom TX: HAART -combination therapy is BETTER than monotherapy -NRTI are the backbone of antiretroviral therapy (nucleotide analog halting further elongation); inhibits reverse transcriptase -Zidovudine for pregnant patients -NNRTI (doesnt incorporate itself but still inhibits reverse transcriptase) -protease inhibitors to cleave proteins necessary for viral replication -CCR5 inhibitor (early stage) = Maraviroc EVERYONE GETS TREATMENT esp pregnant people, high viral load patients or those with low CD4 counts

Cryptosporidium

HIV man with a poncho in the crypt filtering the water for purple gems. Severe diarrhea in HIV patients. Cane. Old man. Poncho. HIV. Stains acid fast (only parasite to do so). Bubbles and amethyst crystals. Infectious cysts and purple circular things found underneath the microscope. Purple crystals are composed of 4 motile sporozoites. Sewage draining pipe that is narrow and without hofstra. Diarrhea and small intestine damage. Question stem: patient with diarrhea and oocytes with acid fast staining on stool O and P and asked how to treat it (or given picture). Knitted sock that is draining water. Nitazoxanide as treatment. Filtration can remove oocysts from infected water. Cryptosporidium is highly resistant to chlorination. Spirit crows. Spiramycin, a macrolide (does not follow the -thromycin rule in FA). Not FDA approved in the US.

multimucleated giant cell with intracytoplasmnic ground glass opacities

HSV

Hepatitis B Virus

Hep B Love *dsDNA virus*

Hepatitis D Virus

Hep B Love -Kids in orange w/ dad *(-)-RNA virus*

Hepatitis B

Hep B Love, the hippie scene. *See pathoma p. 120 for better explanation of serologic markers of Hep. B.* Hippie Pad. Hepadna virus. He*pad*na. Hippies inside the dome and outside the dome. Replicates in the nucleus and in the cytoplasm. Kum ba yah circle of hippies. The circle is almost double, but it's not. Partially double stranded. Hippie reading reverso-transcriptum. Has a reverse transcriptase. Hippie holding sex, drugs and rock and roll sign with the baby wearing the red splattered dress. In front of torches. Hep. B is a large virus and does not cross the placenta during pregnancy, but can be transmitted during childbirth where there is a lot of blood. Woman with 10% of the cookie and her newborn with 90% of the cookie. Adults will progress to the chronic stage 10% of the time. Newborns infected with Hep. B will progress 90% of the time. Hippie lady who is beading. She represents the extrahepatic manifestations of Hep. B. Prodromal serum like sickness with rash and arthralgias. Glomerular nephritis and polyarteritis nodosa. See below. Beads that the hippie lady is holding up. Polyarteritis nodosa is a systemic vasculitis that affects small to medium sized vessels and the aneurysms it forms is said to have beads on a string appearance. PAD can affect the blood vessels going to the kidney. Would manifest as a reduced GFR and HTN. She is covered in henna. Knees have lightning bolts. Rash. Purpuric rash with nonblanching dark macules. Arthralgias. Two other kidney problems unrelated to PAD. Membranous glomerulonephritis and membranoproliferative glomerulonephritis. Knot above has two strings associated with it. Extra thick glomerular membrane look. Membranous glomerulonephritis. Three strings associated with it. Represents the deposits in the mesangium expanding into the glomerular basement membrane causing a tramtrack appearance. Viral hepatitis and hepatitis from alcohol cause an increase in liver enzymes so how do you tell the difference? Alcoholic, AST greater than ALT. Viral, ALT is usually greater. Hippie and son playing volleyball. Hippie has the volleyball labeled ALT in the air. In acute viral infection, ALT rises and then after symptomatic phase is over, ALT drops. Baby playing with a deflated ALT volleyball. Acute *early* neonatal infection can show normal ALT despite active replication of HBV. We are all one SPECIES. Serology. Focus on the colored ones. S. HBsAg. Surface antigen. Represents current infection. E. HBeAg. E antigen. Marker of infectivitity. Tire flat underneath S and E. This is when people would be symptomatic. Definition of window period. Antibodies towards the surface have been made and are binding surface antigens. Both may be undetectable. If one were to just look at the antibodies to surface or the surface antigens, it may give false reassurance that the patient is not infected. This is known as the window period. Thus, we must check antibodies to the core. For an infected individual, antibodies to the core will be positive during the window period. Second E. Antibody to E antigen. Second S. Antibody to surface antigen. Indicates recovery. If somebody has this then they are over the illness. Syringe wrapped around the blue line which corresponds to the second S, the blue S. Vaccines are given to the surface and that's what immunized people will have. How would one tell the difference between immunized people and those that have had the disease? Immunized would only have antibodies to S. Those that have had the disease would have antibodies to E antigen or Core antigen. Liver made out of a rock (or something hard or coral in other sketches). Liver cirrhosis or carcinoma. Father hippie with orange hippies sons. Hep. D. Orange because Hep. D is an RNA virus. Moon necklaces. Negative sense. Circular headbands. Circular genome. Stickers over their body. Hep. D requires the surface antigen of Hep. B to cause infection. Orange kid cooperating holding his dad's hand. There are two ways Hep. D can be infectious. Co-infection or Hep. D infection AFTER a Hep. B infection. Co-infection has better outcomes. Father hippie grimacing under the weight of his second orange child. Superior position of the kid represents superinfection, or Hep. D infection after a Hep. B infection already occured. This is associated with worse outcomes and why the father is grimacing. Who gets treatments? Acute cases will resolve, but you should treat pregnant women and those who have progressed to the chronic stage. Make peace, lamb, not war, elf queen with a nucleotide mace stomping on a book. Lamivudine as treatment. NRTIs as treatment. Antenna on the van. Interferon alpha. Baby with deflated volleyball holding IgG keys. If mother is Hep. B positive, you must give neonate vaccinations and IgG antibodies for both passive and active immunity. HBV behavior once inside cell (courtesy firecracker): Once inside hepatocytes, the partially dsDNA viral genome is completed via a viral DNA polymerase. Newly complete dsDNA generates mRNA transcripts that can be used to generate viral proteins or to make more partially dsDNA via a RNA-dependent DNA polymerase.

Cryoglobulins

Hep C

Hepatitis C Virus

Hep Sea *(+)-RNA virus*

Herpes Simplex Virus 1

Hermes, the God of Herpes *dsDNA virus - Herpes Family*

Herpes Simplex Virus 2

Hermes, the God of Herpes *dsDNA virus - Herpes Family*

HSV1 + HSV2

Hermes, the God of Herpes Cowhide robe. Intranuclear cowdry bodies. These are also present in CMV and VZV. Poxvirus has similar inclusions, but they are in the cytoplasm. The torch is he is carrying. Torch infection. Upper half of the body is HSV-1. Lower half is HSV-2. Inflammed mouth. You'll want to think cold sores when you think of HSV-1, but the first thing that happens is gingivostomatitis. Then cold sores ensue. The snakes wrapped around his torch. Serpiginous corneal ulcers on fluorescein slit lamp exam. Keratoconjunctivitis. Helmet with red wings on it. Temporal lobe encephalitis. Black helmet represents necrosis and red wings represent hemorrhage. Hemorrhage and necrosis of the inferior and medial temporal lobes. #1 cause of sporadic encephalitis in USA. Three gems on the side of his helmet. HSV-1 latent in the trigeminal ganglia. He is tripping only to show the dew drops have been dislodged from the rose petals. Herpes vesicles are said to have dew drops on a rose petal appearance. Also seen in VZV. Dew drops on his finger. Herpetic whitlow, more common in dentists. HSV-1 and 2. Hermes is a postal worker and has red stamps going up and down his arm. This occurs more often with HSV-1 and represents erythema multiform that may appear 1-2 weeks after infection. Tufting around the skirt. Painful inguinal lymphadenopathy with HSV-2. Metal cup in front of his genitals. HSV-2 lies dormant in sacral ganglia. Neck brace. HSV-2 a cause of aseptic meningitis in adults and adolescents. Keep straight which strain causes temporal lobe encephalitis and which strain causes aseptic meningitis. Tank with large multinucleated giant cells as the camouflage. Tzanck smear of a lanced ulcer shows large multinucleated giant cells (old way of doing it). Also seen in VZV. PCR of skin lesions or CSF PCR for herpes encephalitis. Violet trash can. Valacyclovir.

Tzanck test

Herpes, VZV

(Pico) Hepatitis A

Hippo exhibit USA Shellfish stand. Says three things on it. One month only. Limit one per customer. No carrying out of food. One month duration of infection. Self-limiting. No carrier/chronic state. Hippos on the rocks above the yellow pool. Acid stable. Person putting out their cigarette. Infected smokers have aversions to smoking. FA: No HCC risk. Monocyte infiltrate on biopsy. Council bodies (not specific?) Refer to picornavirus overview for general characteristics. Naked statue in the front of the Peak Animal Nursery. Long tickets for admission. Long polypeptide that is cleaved. Sun and warm hues. RNA positive sense.

small oval yeast in macrophages

Histoplasma

List the common systemic fungal infections

Histoplasmosis Blastomycosis Coccidioidomycosis Paracoccidioidomycosis

Hepatitis A

Hungry Hep A Hippos *(+)-sense SS Picornavirus*

congenital rubella syndrome

Infants born with rubella that shed it for many months Caused by infection in mother in 1st/2nd trimester Symptoms: -low birthweight -deafness, cataracts, cognitive impairment -heart disease -microcephaly Diagnose with serology or PCR of amniotic fluid

Enterobius vermicularis, ancylostoma duodenale, necator americanus, ascaris lumbricoides, strongyloides stercoralis, trichinella spiralis

Intestinal nematodes, the "Super Worms!" scene Enterobius vermicularis (pin-worm), ancylostoma duodenale, necator americanus, ascaris lumbricoides, strongyloides stercoralis, trichinella spiralis. All intestinal nematodes in this scene can be treated by bendazoles. Vermin lady crawling out of a round hole. Pinworms lay eggs at the anus (round hole) at night. Fecal-oral. Vermin lady with a long tape cape. Scotch tape test. American dude with the neck and ankle brace swinging in from a hook (other side iron) kicking the vermin lady "PAM!" Hookworms found in rural southern United States. Suckers that feed on capillaries. Iron-deficiency anemia. Pyrantel pamoate for treatment of American dude and vermin lady. Red boots of american dude. Hookworm penetrate skin of soles of feet. Arrow on american dude. Circuitous route throughout the body to the intestines. Blood, lungs, intestines (goes to lungs, coughed up and swallowed and is then in the GI tract). American dudes grenades in the puddle. American dudes eggs in stool. Groot. Lumbercoides. Groot with rubble behind him. T-shirt design with the arrow and a tree. Intestinal obstruction as the main complication of ascaris. Respiratory symptoms. With albendazole (MT inhibitor), you run the risk of causing the worms to die and then obstruct as well. Also, do not give albendazoles to pregnant women. Strong guy. Red boots and circuitous T-shirt design. Strong guy kicking into the wall. Autoinfection. Strongyloides larvae hatch from eggs laid in intestinal wall, repentrate wall, enter blood stream. Larvae at the base of strong guy. Since the eggs are laid into the intestinal wall, they are not passed into the stool. This is important for diagnosis. Instead you will see larvae. No dumping, drains to the river sign next to strong guy. Ivermectin (or albendazole) for strong guy. Porky trickster with sweats, red glasses, and green drool. Standing in front of a striated brick wall. Fever, vomiting, periorbital edema, and myalgias. Pig because you can get it from eating undercooked pork. Red pipes. Larvae enter blood stream (ingestion of cysts in undercooked meat). Striated brick. Larvae travel to striated muscle. Fire behind him. Muscle inflammation.

Actinomyces israelii

Israeli Soldier *Gram-Positive Branching Filamentous Rods*

Actinomyces Israeli

Israeli soldier The Israeli solider with a jaw bandage (to represent jaw trauma and association with dental caries) and the gas mask (anaerobic, contrast nocardia) who is writing a letter to his family with his pencil. The bandage around his face is purple. Banzai looking tree in the background. Purple jaw bandage + banzai looking tree = gram positive filamentous rod (one of two gram positive filamentous rods, the other is nocardia - actinomyces can be differentiated from nocardia based on the fact that actinomyces is anaerobic). Yellow rocks scattered about and a draining sewer tract represents the buzz phrase 'formation of sinus tracts that drain yellow sulfur pus.' Known as cervicofacial actinomyces. Google search of cervicofacial actinomyces shows the yellow pus in sinus tracts along the jawline and neck region. Pencil = penicillin G as treatment.

Polyomavirus JC and BK

Julius Caesar and the Senators (Brutus kills Julius Caesar with a knife) Takes place in a circular government room with a statue of David. DS, circular, naked DNA virus. Robe falling off JC. Reinforcing naked virus. Focus on Julius Caesar, the bust, senator count 200 and his cane for JC virus and the rest of the sketch belongs to BK virus. JC with a cane. HIV patients. Causes disease specifically in HIV patients with CD4+ count <200. 'PML' bust with the white roman crown. JC virus causes PML in HIV patients with CD4+ count <200. White crown is supposed to be non-enhancing brain lesions on CT. Contrast toxoplasma which causes ring enhancing brain lesions on CT. Senator count 200. JC virus causes PML in HIV patients with a CD4 count <200. Fountain of baby peeing bright red water. BK virus causes hemorrhagic cystitis. Also seen in adenovirus and cyclophosphamide sketch. Prevented in cyclophosphamide with co-administration of MESNA (2-mercaptoeethanesulfonate). Meats falling (should be on the left side of the sketch. The workbook is wrong). Baby peeing blood. BK virus causes hemorrhagic cystitis in transplant patients.

Bacillus anthracis

King Anthra's (the Viking) Axe. Entire sketch minus the bottom left corner represents Bacillus anthracis. The guy vomiting while holding rice represents Bacillus cereus and reheated rice syndrome. No play-on words for B. cereus and rice. King Anthra seen standing in a black circle with a fire around it holding his lung shaped bloody axe to represent cutaneous and pulmonary anthrax. Ulcer with black eschar. Pulmonary anthrax that causes hemorrhagic shock. Sheep being tended to by one of King Anthrax's soldier. Pulmonary anthrax also known as woolsorter's disease. All solider and kings representing B. anthracis are wearing armor with multiple belts with "D-shaped" buckles around their chest to represent polypeptide D-glutamate capsule. Walnuts in sketch = spore forming.

Bacillus anthracis

King Anthra's Axe *All besides the guy cooking* *Gram-Positive Bacilli*

Bacillus cereus

King Anthra's Axe *Guy Cooking Rice on the Left*

Coronavirus

Kingdom of SARS *(+)-sense ssRNA*

Enterobacter

Kleb-tail dinosaur, *Enterodactyl*, Triserratiatops *Gram-Negative Bacilli - Enteric*

Serratia

Kleb-tail dinosaur, Enterodactyl, *Triserratiatops* *Gram-Negative Bacilli - Enteric*

Hydatid cyst

Larval stage of echinococcus tapeworm

Leishmaniasis donovani - PARASITE Leishmaniasis baziliensis

Leishmaniasis donovani -visceral leishmaniasis caused by Leishmaniasis donovani -black fever, or kala-azar -bone marrow affected causing pancytopenia -hepatosplenomegaly (so fevers, hepatosplenomegaly, pancytopenia) -100% fatal if left untreated TX: Amphoterecin B for visceral leishmaniasis Leishmaniasis baziliensis -mucocutaneous Leishmaniasis (cutaneous leishmaniasis) -consuming the flesh of the victim -vertebrates are the host -sandflies are the vector -AMASTIGOTE is intracellular form, seen within macrophages TX: stibugluconate treatment for cutaneous leishmaniasis

responsible for sepsis and shock in E Coli infection

Lipid A

organisms resistant to cephalosporins

Listeria MRSA ehterococci atypicals

Treatment for histoplasmosis

Local - Azoles (pine cones) Systemic: Amphotericin B (amphibian)

Pasteurella multocida

Louis Pasteur's Lab *Gram-Negative Rod - Zoonotics*

Pasteurella multicoida

Louis Pasteur's lab (lab = labrador retriever). Louis Pasteur is holding out a fishbone tempting his dog who has bitten him. Osteomyelitis. Cellulitis where his dog has bitten him and dog/animal bites as the mode of transmission. Not in FA: Cat. Catalase positive. Helps reinforce animal bites. Capsule over the swan neck flask (actual invention). Encapsulated. Blue ring. Oxidase positive. Sheep's blood. Grows on sheep blood agar. Safety pin on his lab coat. Bipolar staining. Recall Yersinia. Pencil. Penicillin as treatment.

CD4 less than 50 infection

M avium

Ehrlichiosis vs. Anaplasmosis

MEGA berry for where the morulae (mulberry-like) inclusions are. Monocytes = Ehrlichiosis Granulocytes = Anaplasmosis

What is the name of the SketchyMicro sketch for Malassezia Furfur?

Malassezia Italian Restaurant

Malassezia furfur

Malassezia's Italian Restaurant *Cutaneous mycoses fungi*

Malassezia furfur

Malassezia's Italian Restaurant, Malassezia furfur causes tinea/pityriasis versicolor, entrance of the restaurant has a sun blue glass stain for "selsun blue" Chef sprinkling KOH onto the plate of spaghetti and meatballs. M. furfur resembles spaghetti and meatballs on KOH prep of skin scrapings. Heat lamps. Thrives in hot and humid conditions. Light and dark colored spots on the chefs back. Causes pityriasis versicolor, which manifests as hypo- and/or hyperpigmented patches. Merely a dermatological annoyance. Broken olive oil bottle. M. furfur produces melanocyte damaging acids via lipid degradation. Lasagna with a side of corn. M. furfur generally stays confined to the stratum corneum of the epithelium. Baby slurping up the spaghetti. NICU neonates recieving total parenteral nutrition are at risk of M. furfur fungemia due to lipophilicity of M. furfur. Stained glass window of a blue sun. Selsun blue as treatment a.k.a. selenium sulfide.

Cytomegalovirus

Mega-Lo Grocery Store *dsDNA virus - Herpes Family*

What species the Dermatophytes include?

Microsporum Trichophyton Epidermophyton (TEM on the munchkins' chests)

Staph aureus

Moses and the Golden Staff ("naf for staph") Purple robes. Gram positive. Coagulated red sea. Coagulase positive. Compare Staph epidermidis and sapro. Egyptian cat. Catalase positive. Tall man behind moses. Ability to ferment mannitol. Some agar. He is wearing yellow because mannitol fermenters turn the agar yellow. Beta hemolytic light bulb. Staff with the letter A at the end and the A binding the Fc region of the antibody. Protein A as the virulence factor binds Fc region of IgG, inhibiting complement and phagocytosis. Sphinx's nose. Colonizes the nares. Man coughing next to the camel with patchy quilts. Pneumonia and patchy infiltrates seen on X-ray. Icosahedron shaped balls dangling from the camels back. Icosahedron shape of viruses. Staph aureus usually causes a post-viral pneumonia when our immune system has been weakened. Man kneeling with camel and camel kneeling. Staph aureus is the most common cause of septic arthritis in adults. Large red mounds on the camels back. Large erythematous abscesses. Mortar and pestle with weird medication vials dangling from the side. IVDU. Woman clutching her chest and the camel getting spooked and sprinting towards the edge of the cliff. Hearts over the camel and three pyramids in the background. *Acute* bacterial endocarditis. Fish bones. Most common cause of osteomyelitis. Man roasting in the sun. Scalded skin syndrome. Mediated by exfoliative toxin, a protease. Cape on the man. Toxic shock syndrome. Gauze after a rhinoplasty or a tampon left in for too long. Woman looking like shes about to vomit with meats and a jar of mayonnaise. Rapid onset food poisoning that is most associated with vomiting instead of diarrhea. Ingestion of the preformed toxin. Meats and creams that have been left out for too long. Merciless pharoah and the anubis jackels. MRSA. MRSA comes about by altering it's cell wall. In history, it was slaves (PBCs) that built the pyramids (walls of the bacteria), but this pyramid is using altered humans to represent the altered PBCs that are now constructing the cell wall. Caravan. Vancomycin as treatment for MRSA. However, if the bug is found to be methicillin sensitive, nafcillin will kill better than vanocmycin. Naf for staph. MRSA = vancomycin

What is the SketchyMicro sketch for Mucor spp.

Mu Car Auto Shop

Mucormycoses

Mu Car Autoshop *Opportunistic Fungi*

Rhizopus

Mu Car Autoshop -Rides 'R' Us *Opportunistic Fungi*

Mucormycosis and Rhizopus

Mu car auto shop "Rides R us" Old man with bread reaching his hand into a jar of candy. Immunocompromised people (specifically those with leukemia and neutropenia) and diabetics (the bug likes ketone bodies). Bread to represent rhizopus as a bread mold. Ketone auto parts. DKA is the most common predisposing factor to infection with this fungus. Red jumper cables. The fungus like to proliferate in blood vessel walls where there are high amounts of glucose and ketones. Tire irons on the wall and with the mechanic. Hyphae that are nonseptate and branch at wide angles. Oil pan with holes in it. After invasion into the blood vessels this fungi penetrates the cribiform plate. Recall Naegleria fowleri penetrates through the cribiform plate as well. Mechanic under the car with oil dripping onto his face. Rhinocerebral mucormycoses with frontal lobe abscesses. Necrosis of nasal and paranasal tissue also seen in aspergillosis. Car that looks like a frog. Amphotericin B as treatment. Don't forget surgical debridement.

Vibrio cholera

Mustache Colonel Cholera's baSe cAMP The colonel has a mustache. Comma shaped (Helicobacter, Campylobacter and Vibrio are all comma shaped, but Helicobacter and campylobacter and more helical/spiral shaped). baSe cAMP map. Activates Gs to increase cAMP. Soldier outhouse dumping into a river where rice-field workers are. Fecal-oral. Rice water diarrhea. Colonel drinking water and enjoying oysters and lemon. Oral rehydration and seafood as a source of parahaemolyticus and vulnificus.

Campylobacter jejuni

Mustache guy on the red stool and the bears around a campfire cooking a chicken. Guy and the bears. Guillan Barre. Guy has a mustache and a ring. Comma shaped (however, comma shaped is more of a buzzword for Vibrio. Helicobacter, Campylobacter and Cholera are all comma shaped, but Helicobacter and Campylobacter and slightly more helical/spiral) and oxidase positive. Red stool. Blood diarrhea. Campfire. Likes hot temperatures. Grows at 42 degrees celcius. Cooking the chicken. Uncooked chicken as a source. Guy slapping knee. Reactive arthritis. Also in Chlamydia with the pirate slapping his knee at the monkey who is falling off the tree. Reactive arthritis is also known as Reiter's syndrome. Represented by the monkeys in the chlamydia sketch. Can't see (uveitis), can't pee (urethritis), can't climb a tree (arthritis).

Polyomavirus- VIRUS JC BK

NAKED (non enveloped) circular double stranded DNA virus JC virus (john cunningham) -progressive multifocal leukoencephalopathy PML -immunocompromised people -HIV patients with CD4+ <200 -DEMYELINATING disease -non-enhancing multifocal brain lesions in the white matter (brain lesions that light up on brain imaging) -example: 40 y.o HIV patient complains of weakness, visual changes and difficulty with speech getting worse over the past couple of weeks, CD4+ count is 150, get brain scan CT or MRI which shows multiple non-enhancing lesions around the brain BK virus - nephropathy and other problems with the urinary tract including hemorrhagic cystitis in kidney and bone marrow transplant patients (adenovirus causes this in young patients who go swimming) -example: 50 y.o renal transplant patient taking immunosuppressions that presents with fever and gross hematuria

Naegleria fowleri

NIAGRA Falls *Protozoa/Parasite of the CNS*

allosteric RT inh

NNRTI

efavirenz

NNRTI

nevirapine

NNRTI

abacavir

NRTI

competitive RT inh

NRTI

emtricitabine

NRTI

lamuvidine

NRTI

tenofovir

NRTI

zidovudine

NRTI

Naegleria fowleri

Naegleria Falls Protozoa of the CNS. Also called brain eating amoeba. Annie Edson Taylor. 63 year old woman during the civil war era who survived a drop in Niagara falls in a wooden barrel. Annie opening a bottle of champagne to celebrate. Champagne tap is a colloquial term that means not getting any blood in a spinal tap. *Amoebas seen in CSF on spinal tap.* Niagara falls setting. Transmission via swimming in fresh water lakes. Watersports. Cribs going down the falls. Parasite entrance via the cribiform plate. Turbans on the men a the bottom of the falls, one dead, one alive and with frogs crawling on him. Causes a rapidly fatal meningoencephalitis. Give amphotericin B to the survivors.

-Gram _____________ organisms -Appear pink

Negative

Neisseria - BACTERIA Neisseria meningitidis Neisseria gonorrheae

Neisseria -gram negative diploccoci -oxidase positive -heat blood agar = chocolate agar allows neisseria to grow because it inhibits enzymes that would prevent growth -VPN agar (vancomysin, polymixin and nystatin) -thayer martin agar another name for VPN agar -C5-C9 deficiency (complement deficiency) are unable to form MAC complex leading to increased infections -pili (fimbriae) demonstrate antigenic variation -IgA protease - cleaves IgA at hinge region Neisseria meningitidis -colonizes nasopharynx first and transmitted by respiratory secretions and then spreads hematogenously -LOS envelope proteins cause inflammatory response -inflammation leads to leaky capillaries -characterized by petechial rash (indicator of thrombocytopenia) -capillary leakage can lead to hypovolemia and shock -Waterhouse-Friderichsen syndrome, characterized by hemorrhage of adrenals -only meningitis ferments maltose but both ferment glucose -polysaccharide capsule inhibits phagocytosis -vaccine contains polysaccharide capsule - except type b not included in vaccine -sickle cell and asplenic pts at higher risk of infection because its encapsulated -TX: CEFTRIAXONE; close contacts prophylaxis RIFAMPIN Neisseria gonorrheae -STD -facultative intracellular likes to invade PMNs -NO capsule -in men -> urethritis and prostatitis -in women -> PID can cause scarring leading to infertility or ectopic pregnancies -PID can spread to peritoneum - Fitz Huge Curtis Syndrome; "violin string" adhesions form to capsule of liver -both men and women characteristic white purulent discharge (thick) -asymmetric arthritis commonly at knee -purulent synovial fluid that doesnt gram stain (because its intracellular) -early purulent neonatal conjunctivitis can happen within days TX: CEFTRIAXONE for gonorrheae (coinfection with chlamydia is with azithromycin or doxycycline)

oseltamivir

Neuraminidase inhibitor (inh release of virus)

Orthomyxovirus

Night Shift at the Orthodontists *(-)-sense ssRNA - Only one to replicate IN NUCLEUS*

Nocardia

No Card Games for Old Men *Gram-Positive Branching Filamentous Rods*

Nocardia

No card games for old men Gun fight in a bar. The gentleman shooting the gun hits a planted cactus. Soil spilling from the cactus pot represents that this bacteria is found in soil. The man on the right being shot has a cane (infections occur in the immunocompromised) and represents the 3 infections that nocardia can cause: CNS, pulmonary, and cutaneous. CNS and lung abscesses are represented by the bullets hitting his chest and cowboy hat. Cutaneous nocardia is represented by the redness around his cow-spots on his cow-hide outfit. The gentleman shooting also has on the acid fast mycolic garb and is sporting a fuschia colored pistol to represent that this bacteria stains acid fast (weakly). Above the bar is a picture of the actinomyces isreali desert banzai tree to represent that it is one of the two gram positive filamentous rods along with nocardia. We can differentiate this bacteria from nocardia based on the fact that nocardia is anaerobic (recall the gas mask in the actinomyces israeli scene). Air bellow on the counter of the bar to represent that nocardia is aerobic Jar of rotten eggs on the bar top represents TMP-SMX as a treatment for nocardia infections. Cat on the top of the bar counter = catalase positive. CGD.

Neisseria species

Noir Series *Gram-Negative Cocci*

Neisseria species overview

Noir TV series (the detective with red handcuffs). Starring Thayer-Martin as "MAC" the private eye. A Noir series is a dramatized hollywood crime show. Detective is eating a chocolate bar to represent growth on a chocolate agar. Vice City Private Nvestigator = VPN agar, which is vancomycin, polymyxin E (also known as colistin), nystatin. VPN agar has some chocolate in it's agar, but can be thought of as a special, selective type of chocolate agar. Starring Thayer Martin as MAC the Private Eye. Thayer Martin is another name for the VPN agar. Taken together, VPN, chocolate bar and Thayer-Martin represent the agars that Neisseria can be grown on. MAC the private eye to represent that people with MAC attack complex deficiency are more prone to Neisseria infections. (C5-C9, represented by the show's air time). Ace card in MAC's hat to represent IgA protease as Neisseria's virulence factor. IgA protease is what allows it to survive in mucousal surfaces (recall mucosal surfaces have IgA's secreted into them).

Enterovirus

Non enveloped RNA Stable at low ph so can survive transit through stomach Shed from GI tract Mainly kids Types: poliovirus

Calicviridae

Non enveloped RNA virus Associated with epidemic outbreaks of waterborne, food born, shellfish associated gastroenteritis Example; norovirus

Distinguishing features of Mucor and Rhizopus spp.

Non-septate hyphae with 90 degree angle branching (tire iron)

Zika virus

Not in sketchy, but in FA. A flavivirus. conjunctivitis, low-grade fever, itchy rash in 20%, congential microcephaly diagnose RT-PCR or with serology sexual and vertical transmission possible outbreaks more common in tropical/subtropical tx = supportive

Retrovirus

One Cane to Rule Them All -HIV!!! *(+)-sense ssRNA, but diploid*

HIV

One Cane to Rule them all (most powerful immunocompromised cane to rule them all) HIV wizard garb. Sundial around the hat. gp24 that acts as a capsid protein. Cap = a type of hat. Two dragon design on the wizard cap. Two RNA strands within the cap. These are positive sense RNA strands. Notice that HIV is in the RNA positive video folder of sketchy micro. Also notice that warm hues with the sun. Do not confuse with the dragons in the calicivirus sketch that was a GOT reference. Pipe in his mouth and robe pockets. Env gene (of env, gag, and pol) encodes for the proteins gp41 and 120 which sketchy decided to combine into 4/20 and his pipe. 41 and 120 pipes are associated with the env protein and so they are sticking out of his robe. Reading 4/20 left to right you will remember that 41 is the part closest to his mouth and 120 the part that is farthest away. 41 etched into the middle of one of his pipes. gp41 as the transmembrane protein and gp120 as the outer protein. Busting out of a cage with the carving CCR5. First infects macrophages through the CCR5 receptor. Casting a spell on squires with the banner CXCR4. Then infects CD4+ cells through the CXCR4 receptor. Following the spell follows the course of the disease. Primary infection includes flu-like, mono-like syndrome. Lymphadenopathy and fever. Fall 200 ft. to their death. CD4+ count less than 200 as the definition for AIDS. Caution. AIDS can also be defined when there is a count above 200 AND an AIDs defining illness. Archers congregated into a stronghold shooting at the giant crab. HIV can cause a large (large crab) diffuse, B-cell lymphoma (archers congregated into the stronghold). CCR5 banner holder blocking the bucking mare. Maraviroc as use in addition to HAART (NNRTIs, NRTIs) Elf with a shield that says ELISA in front of a wall markings that look like a Western blot. ELISA screen, Western blot to confirm diagnosis. Why you have to wait a few months before using an ELISA is that it test antibodies. *Neonate testing!* If you are wanting to know if the mother passed down HIV you should not use ELISA. HIV positive mother will pass down the antibodies to the baby and cause ELISA and western blot of the baby to read positive. You must use nucleic acid amplification for neonates.

Orthomyxovirus

Orthodontist Night Shift at the Orthodontist's (flu scene) Doktor Drift's Night Shift. Drift is a point mutation. Shift is recombination with another species like bird flu or swine flu. Drift cause of epidemics. Shift cause of pandemics. Octopus hoarding the RBCs. Hemagglutinin. Hemagglutinin (HA) envelope protein binds sialic acid on cells, facilitating endocytosis. Octopus with 8 legs. 8 segments. One of the four segmented viruses, BOAR. 3, 8, 2, 10-12. Octopus grabbing one of the nurse assistant's scalpels and using it to cut the lights from the diver's helmet. N and A of nurse assistant stand for neuraminidase and the scalpel cleaving the lights represents sialic acid being cleaved by NA to release virions. Diver's helmet and octopus babies inside to represent that orthomyxovirus is an exception to the rule that RNA viruses replicate in the cytoplasm. NA is a virulence factor that cleaves sialic acid to release virions from the cell (not necessarily the nucleus, which the diver's helmet is supposed to represent). Amantadine manatee with utensils looking for the baby octopus hiding in the shell that has M2 carved into the lip of the shell. Amantadine is an M2 inhibitor. M2 is a proton channel that is required to make the proper pH that is required for viral uncoating. Air bubbles going into the nose and a syringe stabbing the skeleton represent the two administration routes for vaccines. Live intranasal or killed intramuscular. Nurse assistant is named Tammy V. Osel*tamivir*. Tammy V capping the scalpels. NA inhibitor. Anamivir is the same as oseltamivir. Trade name tamiflu. Only works within the first 72 hours.

ALL RNA virsuses replicate in the cytoplasm EXCEPT which one replicates in the nucleus?

Orthomyxovirus

Paramyxovirus and 4 Types

PARAnormal MIXer -Measles -Mumps -RRespiratory Syncitial Virus (RSV) -Parainfluenza *(-)-sense ssRNA*

What is the name of the SketchyMicro sketch for Pneumocystis jiroveci?

PCP Ping Pong

Pneumocystis jiroveci

PCP Ping Pong -PCP = pneumocystis pneumonia (which it causes) *Opportunistic Fungi*

Pneumocystis jiroveci

PCP ping pong of the old man beating the young man 20 - 0 for <200 cell count (PCP = pneumocystis pneumonia). Old man versus the young kid. Symptoms are evident in immunocompromised individuals and infection is usually asymptomatic in healthy individuals. Cracked glass tables. Ground glass infiltrate on CXR. Player squirting a bottle of BAL into his mouth. PCP diagnosis can be confirmed with a bronchoalveolar lavage. Silver discs in the middle of the table. BAL sample is stained with methenamine silver to identify PCP that will look disc shaped yeast. Methenamine silver stain also in cryptococcus neoformans. ^biopsy would also reveal "spherical bodies with sharply outlined walls" Crushed ping pong balls. Ground glass appearance on PCP pneumonia X-ray can look like crushed ping pong balls. Backhand. Bactrim as prophylaxis once CD count is <200 and for treatment if the disease is contracted. Jar of ping pong balls that look like eggs. Sulfamethoxazole and trimethoprim are the components of bactrim. Pentagon shaped paddles. Pentamidine use for individuals allergic to sulfa drugs. Recall that Sketchy micro has prophylaxis for one other bug. Toxo. For toxoplasmosis, we begin prophylaxis when that patient was IgG positive for toxoplasma and had a CD count <100. We also give bactrim (recall this egg was not dyed and did not have any pyramids drawn on it). Sulfadiazine and pyrimethamine were for treatment of toxoplasma, not prophylaxis. *Pneumocystis is an atypical, extracellular fungi*

Treponema pallidum

Pallidum Observatory *Spirochete*

Metapneumovirus (MPV)

Paramyxovirus : RNA virus All age groups Winter Attaches to G-proteins Clinical: -fever, cough, rhinorrhea Diagnosis=PCR

Pneumovirus : respiratory syncytial virus (RSV)

Paramyxovirus: RNA virus Common lower respiratory tract infection in kids (most infected within first few years of life) Winter and spring Inoculation through nose or eyes Manifestations: -bronchiolitis: -endothelial sloughing and mucus secretions-- >obstruct bronchioles and create lymphocytic infiltrate - pneumonia from cell infiltrate Complications: Acute= apnea and aspiration Chronic= recurrent wheezing Immunocompromised = pneumonia Diagnose with PCR

Mumps virus

Paramyxovirus: RNA virus Endemic throughout world Humans only host Droplets and direct contact Incubation= 2-4 weeks, lasts 3-10 days Symptoms: -Prodromal low grade fever, malaise, headache -Bilateral parotid enlargement and earache -post puberty---> epididymo-orchitis Complications: Meningitis Encephalitis

Measles (Rubeola)

Paramyxovirus: RNA virus Highly contagious droplet spread Hemagluttin H proteins attach to cell surface molecule Disease manifestation caused by T-cell reponse to virus infected cells lining capilaries Symptoms: -Kopliks spots in mouth -2 weeks after infected maculopapular rash (face--->trunk and limbs) ---->rash starts to fade within 72 hrs Complications: viral pneumonia, superinfection in lungs, encephalitis Treatment: vitamin A and supportive

Paramyxovirus

Paranormal Mixer *Measles Weasles* Male weasle with 4 C's going down his tuxedo. Cough, Coryza, Conjuncitivis, Koplik spots. Woman weasle with a red latin flowy dress. Rubeola sounds more latin. Also known as rubeola. Do not confuse with roseola or rubella. Woman weasle with rubies that are going down her face. Rash that starts at the head and moves down. Compare rubella. Son weasle with a turban on and hands fused together. Standing next to a sign that says Tales of SSPEence. Fusion protein. Subacute sclerosing panencephalitis. Woman weasle next to octopus hors d'oeuvres and the weasle son with his hands fused together. Only HA and fusion protein as virulence factors for measles. Compare croup (3 wolves) and the mumps mummy (3 represented visually). *Mumps mummy.* Holding an orchid and a plate of octopus hors d'oeuvres with a scalpel. Orchiditis, haemagluttin (HA), and NA. Big cheeks on the mummy. Parotidis. Child mummy with hands fused together. Fusion protein in mumps. Scalpel, octopus, and fusion protein. Mumps has all 3 virulence factors. *RSV R.I.P. tombstone.* Little children and one really pale ghost. Palivizumab as prophylaxis for RSV premies. Ribs around the tombstone. Ribavirin for adults infected with RSV. *Seal howling at the steeple with the wolves* Seal-like bark. Croup. Also called parainfluenza. Seal wants to be part of the croup. Croup. Howling at the steeple. Steeple sign on X-ray. 3 wolves in his wolf pack to represent that parainfluenza has all 3 virulence factors as well. HA, NA, fusion protein. MMR live puppet show with one puppet defending the pregnant puppet. Live vaccine, do not give to pregnant women. Ghosts with envelopes. Enveloped.

Mumps Virus

Paranormal Mixer -MUMmies *(-)-sense ssRNA - Paramyxovirus*

Respiratory Syncitial Virus (RSV)

Paranormal Mixer -RSV and Baby Ghosts (RIP) *(-)-sense ssRNA - Paramyxovirus*

Parainfluenza

Paranormal Mixer -Seals in Background *(-)-sense ssRNA - Paramyxovirus*

Measles Virus

Paranormal Mixer -WEASELS *(-)-sense ssRNA - Paramyxovirus*

ssDNA virus

Parvovirus

Bunyavirus

Paul Bunya *(-)-sense ssRNA*

California Encephalitis Virus

Paul Bunya -CALIFORNIA Rift Vallet Elementary *(-)-sense ssRNA - Bunyavirus*

Rift Valley Fever Virus

Paul Bunya -California RIFT VALLEY Elementary *(-)-sense ssRNA - Bunyavirus*

Hantavirus

Paul Bunya -HAUNTED Ghost Mice *(-)-sense ssRNA - Bunyavirus*

Bunyavirus

Paul Bunyavirus in CA rift valley Paul Bunyan chopping down 3 trees. 3 segments. Part of the BOAR viruses that are segmented. 3, 8, 2, 10-12. Arbor in the background. Arbovirus. Most viruses in the bunyavirus family are arboviruses with the exception of Hantavirus. Hantavirus takes up 4 and a half minutes of the 6 minute sketch. Walking in front of him are haunted mice. Two of the mice have spirits leaving their bodies. Hantavirus. Hantavirus is NOT an arbovirus and is a robovirus (rodent transmitted virus). Hantavirus outbreak in yosemite from people who swept up rodent feces. Paul's sweaty shirt and renal shaped canteen represent the symptoms of Hantavirus. Capillary leak causing pulmonary edema and pre-renal azotemia. Paul's bloody axe. Hemorrhagic fever that can also occur in Hantavirus. Kids shaking and the teacher with a turban outside of the California Rift Valley Elementary. On the same side as the arbor. CA encephalitis and Rift Valley fever caused by an arbovirus of bunyavirus. Seizures and encephalitis.

Picornavirus Overview

Peak animal nursery. Volcano peak in the background. Exhibit A for hep. A Exhibit B for birds Exhibit C for cold Admission has a long ticket being ripped into many pieces. Long polypeptide that is cleaved. Statue of David. Naked Poop everywhere. Fecal-Oral. All animals have a baby animal next to them. Baby hippo, baby birds, baby rhino. Represents pico in picornavirus. Hippo with armband A exhibit on the left. Human head shaped bird cage in the middle that says ENTER aviary. Inside are flamingos, cockatoos, and birds that are echo-ing each other. Enteroviruses that include poliovirus, coxsackie, and echo virus. #1 cause of aseptic meningitis. Bird feed with no added sugar, no organisms and source of protein. CSF findings in viral meningitis. Rhino exhibit on the right. Mud on the nose. Not transmitted fecal orally.

Haemophilus influenzae

Phyllis's (HaemoPHYLLIS) Chocolate Covered Cherries. Chocolate covered cherries. Plated on chocolate agar (recall Neiserria) 5 cents. Factor V - nicotinamide or nickel-tin-amide. Factor added to chocolate agar. 10 cents. Factor X - hematin or hem-a-ten. Factor added to chocolate agar. Spraying pesticide on a bee hovering around a case of chocolate covered cherries. See below. $2.18 special on sugar DIPped items. Vaccine to H. flu given to children from 2-18 months and vaccine contains the the type b capsular polysaccharide conjugated to diptheria. Kids represent the diseases. One kid *screaming*, drooling, crying and with a cherry red epiglottis. Cherry red epiglottis. Drooling and inspiratory stridor are physical exam findings in epiglottitis. As far as STEP 1 is concerned, epiglottitis is caused by H. flu. Other kid is plugging his ears because the epiglottitis kid is screaming. Otitis *media.* Kid with space cadet helmet pointing at the capsule with the bee floating around it. H. flu only causes meningitis when it is the type B strain. Sickles with the two kids dressed as knights. Three axes also in their costume. Sickle cell patients because encapsulated. Ceftriaxone as a treatment for meningitis or systemic infection. Use augmentin for mucosal infections (not represented). Rifle tooting close contact of the kids in the store. Rifampin prophylaxis for close contacts. Recall Neiserria meningitis rifampin rifle on the police officer holding back the close contacts.

Haemophilus influenzae

Phyllis's Chocolate Covered Cherries *Gram-Negative Coccobacilli - Respiratory*

Papilloma virus

Pill-oma bugs (pill looking bugs) Blue table. Statue of David. Naked DNA virus. 6 people in the sketch ages 1, 4, 6, 11, 16, 18. Seperate warts and cancers. Kids outside holding up their fingers (1 and 4) to show how old they are. They are covered in skin bugs. Strains 1-4 cause verruca vulgaris the cutaneous common wart. *Can also think of the children being covered in multiple bugs to remember the high-yield fact that laryngeal papillomas in children are multiple as opposed to singular in adults.* 6 and 11 year old's eating one and then dropping it down his pants. Laryngeal papillomatosis a.k.a. recurrent respiratory papillomatosis. Condyloma acuminata a.k.a. anogential warts from HPV 6, 11. Teens with a 15 year promise sharing a crab dinner. The guy is about to sit on one of the bugs. HPV 16, 18, 31, 33 associated with anogenital cancers. Vaccine fence with the kids outside. Guardasil covers 6, 11, 16, 18. The 31 and 33 year old selfs of the teens are not within the fence. Fork with shrimp shaped like a 6. E6 targets p53. Root beer with a straw that is shaped like a seven. E7 targets RB. Blue sunny side up eggs next to the woman. HPV infected cells on pap smear are called koilocytes and look like blue sunny side up eggs. Ribbon on the woman. AIDS-defining illness. Invasive cervical/anal/penile cancers. Immunosuppression increases risk of HPV-related cancer. Casted leg and cane. Because she wasn't old enough to represent HIV/AIDS. Car keys. 16 year old. I voted sticker. 18 year old.

Human Papilloma Virus

Pilloma Bugs *dsDNA virus*

Name of SketchyMicro sketch for Paracoccidioides brasiliensis

Piratas del Sur

Paracoccidiodes brasilensis

Piratas del Sur *Systemic Mycoses*

Paracoccidioidomycosis

Piratas del Sur "captain's wheel" South America map in the back. Geographic distribution. Red thing in front of the much bigger captain's wheel. Captain's wheel yeast that is much bigger than an RBC. Earrings. Cervical lymphadenopathy. Gold medallions. Potential for granulomas in the lung. Poor dentition. Mucocutaneous lesions.

Chlamydia

Pirates of Chlam Island. Marooned on an island. Obligate intracellular. Think of the sand as being the limits of the cell. Other sketches depict obligate intracellular as an indoor theme. Obligate intracellular because chlamydia cannot make their own ATP. Ghostbusters sign with mermaid. Lack of muramic acid and thus why penicillins cannot be used to treat. Life cycle with pearls and clams. Pearls. Elementary form. Clam with two pearls inside of it. Reticular Form. Elementary form enters a cell and then replicates inside of the cell via binary fission. Release outside of the cell to become 2 elementary forms again. *Elementary = infectious, reticular = replicating* Treasure chest full of gems and knats flying around the chest. Diagnosis. Gems to represent giemsa stain (recall borrellia) 3 types of chlamydia - trachomatis, pneumoniae and psittaci. Parrot dropping on mermaid with clam shell bra - psittaci (parrot) and pneumoniae cause an atypical pneumonia. Think pet store workers for psittaci. 3 types of trachomatis. A-C: Blindness. D-K: STI. L1-L3: LGV. Hole through the side of the ship. Watery D/C. Recall candle wax (thicker) in gonnorhea. Difference in neonatal conjunctivitis with chlamydia and gonnorhea. *Timecourse* (gonnorhea earlier, recall quickly shielding eyes from the scene of the violinist's death) and presence of *pneumonia* (buzzword staccato cough, recall clam shell bra on the newborn in the mermaids arms). Mermaid with barnacles around her waist. Lymphogranuloma venereum. Small, painless ulcers on genitals that progress to swollen, painful inguinal lymph nodes that ulcerate. Treat with doxy. Captain with the shades on. Blindness and the representation of subtypes A-C (as in, you *SEE* with your eyes). He is the leader and this is the leading cause of blindness worldwide. His hand up to his world represents hand to eye contact as transmission. Pirate slapping his knee. Reactive arthritis. Reactive arthritis is also known as Reiter's syndrome. Represented by the monkeys in the chlamydia sketch. Can't see (uveitis), can't pee (urethritis), can't climb a tree (arthritis). This same syndrome can be seen in the Campylobacter sketch and Guillan Barre. Reither's syndrome is common to trachomatis. Crow in the birds nest. Marcolides, specially azithromycin. Topical macrolides not effective for treatment of neonatal conjunctivitis, you must give an oral macrolide. Bicycle wheel tire. Doxy. Captain with 'MAC the private eye's' hat. Frequently tested concept that you must treat as a co-infection with gonnorhea. Add ceftriaxone (3 axes in the logo for Gonzo's bar).

methenamine silver stain of bronchial secretions

Pneumocystis

Proteus mirabilis

Poseidon god with a spray bottle throwing a stone at a urinal in a public restroom. Tentacles. Swarming motility. Spray bottle. Urease positive. Breakdown of urea to basic NH3 creates an alkaline environment that is conducive for formation of struvite stones. Fish and eggs on the ground. Fishy odor and sulfonamides as tx.

-Gram ______________ organisms take up crystal violet and stay purple after safranin rinse -Appear violet

Positive

(Pico) Poliovirus- VIRUS

Positive sense RNA virus (all replicate in the cytoplasm) -Picornavirus -RNA virus -naked virus -fecal oral transmission -acid stable virus -replication occurs in Peyer's patches (submucosal of the gut) takes 2-3 weeks -anterior horn of the spinal cord (lower motor cell bodies) -> paralysis -asymmetric paralysis concentrating in the lower legs, myalgias and decreased deep tendon reflexes, respiratory insufficiency from paralysis of the diaphragm, asceptic viral meningitis (remember enteroviruses are the #1 causes of aseptic meningitis) -no treatment -prevention with vaccines SALK vaccine = killed vaccine -injection (since it bypasses the GI tract) only forms IgG SABIN vaccine = live attenuated vaccine given orally -forms IgA* and IgG response

Pox Virus: 3 Types?

Pox in a Box -Small Pox Virus (Small Box) -Cow Pox Virus (Udder) -Molluscum Contageosum Virus (Snail) *dsDNA*

Small Pox Virus

Pox in a Box -Small Boxes *dsDNA*

Molluscum Contagiosum Virus

Pox in a Box -Snail *dsDNA*

Cow Pox Virus

Pox in a Box -Udder *dsDNA*

Poxvirus

Pox in a box (Poxvirus packs everything into itself when it infects, over-preparer into ever virion), the box shipping warehouse Employees making own envelopes. Only virus that makes it's own envelope. Boxes full of things. Poxvirus has everything it needs and is the only DNA virus that replicates in the cytoplasm. Guarnieri's shipping. Intracytoplasmic guarnieri inclusion bodies when looking at cells infected with poxvirus on biopsy. Because it has everything it needs and doesn't need to go into the nucleus we can derive that the inclusion bodies are intracytoplasmic. Dumbbells. Dumbbell shaped core. World's largest shipping center. Largest DNA virus. Smallboxes sign with same day shipping. Smallpox is a pox virus. Also called variola. Blisters look similar to varicella. Can be differentiated by the fact that varicella's blisters are in different stages of development. Smallpox's blisters are all in the same stage of development. Utter shaped styrofoam dispencing unit. Cowpox. Snail mail. Molluscum contagiosum. Umbilicated. Cannot be found on palms and soles. Typically on trunk of child. Black guy with a cane. Molluscum contagiosum typically presents as a single umbilicated lesion in adults, but if it spreads all over this would mean that the patient is immunocompromised.

Coccidioidomycosis

Presidio (rhythm and a Spanish military settlement) San Joaquin Earthquake/San Joaquin. Earthquake as a RF (inhalation of spores now aerosolized). Also called San Joaquin Valley Fever. Tumbleweed next to the red sombrero. Coccidiomycosis does not follow the addage mold in the cold, yeast in the heat. When in the heat, it is actually a spherule full of endospores, that is much larger than an RBC (represented by the red sombrero). Man kneeling coughing. In some healthy individuals it can present as a fever with pneumonia and arthalgias. Self-limiting and lasts a couple of weeks. Man with a neck brace sitting next to immunocompromised Junipero Sera. Menigoencephalitis. Junipero Sera has a ulcer in his skin, lungs and a rod exposed on his leg (bone). Can KOH prep, or use serology for all systemic mycoses.

Name of the SketchyMicro sketch for Coccidioides immitis

Presidio San Joaquin

Coccidioides immitis

Presidio San Joaquin *Systemic Mycoses*

Symptoms of Cryptococcus neoformans infections

Primarily in immunocompromised: - Cryptococcosis - cough, fever, dyspnea, pneumonia (archeologist coughing, etc) - Cryptococcal meningitis (neck brace) - Cryptococcal encephalitis and bronchopulmonary washings (soap bubble regions)

Trypansoma brucei

Prince BRUCE to the Rescure from the Road *Protozoa/Parasite of the CNS*

Trypansoma rhodesiense

Prince Bruce to the Rescure from the ROAD *Protozoa/Parasite of the CNS*

Trypanosoma bruchei gambiense and rhodesiense

Prince bruce and sleeping beauty African Sleeping Sickness Gambia and rhodesiense (old name for zimbabwe) Coma, recurrent fevers, axillary and cervical lymphadenopathy. Goat next to a pricked, bloody finger. Trypomastigote on blood smear (goat is the symbol for anything ending in mastigote) Pink ribbon in the beauty's hair. Motile with a single flagella. Fly in the tea. Tsetse fly as a vector. Price Bruce with wine serum and a bar of soap. Suramin for peripheral blood infection (think serum for suramin) and melarsoprol for CNS infection.

Clostridium perfringens

Private Fringen's motorcycle accident. Motorcycle accidents actually a way of contracting C. perfringens (dirt and soil). Deep penetrating wounds from military combat actually a way of contracting C. perfringens (dirt and soil). Gas flowing up into the air. Gas gangrene called myonecrosis. Crash into a market where there is an alpha flag being hung up on a clothes-line with a series of clothes-pins. Alpha toxin is a lecithinase, a type of phospholipase. Crash into walnuts and tomatoes. Spores and hemolysis. Market lady with a pencil in hand. IV penicillin G as treatment. Double fine zone. Doubles the zone of hemolysis. Also knocked over a slow sign (food poisoning and the subsequent diarrhea is late onset).

Clostridium perfinges

Private Ringen's Motorcycle Accident *Gram-Positive Bacilli*

Rickettii prowazekii

Pro Boot Camp in Rickett's Tire's Arena CoA giving the NAD+ to indoor athletes. Obligate intracellular because cannot produce CoA or NAD+ on it's own. Compare Chlamydia which cannot produce ATP on it's own and is thus obligate intracellular. Rickettsia prowazekii: The outbreak play with the football players with white gloves and feet catching a louse. Epidemic typhus. Being tackled. Myalgias and arthralgias. Pneumonia. Encephalitis with dizziness and confusion. Tire Arena. Doxy.

Rickettsia prowazekii

Pro Bootcamp *Gram Indeterminate (slightly negative)-coccobacillus*

Treatment for Pneumocystis jiroveci?

Prophylaxis: Bactrim (backhand): Sulfamethoxazole + Trimethoprim Pentamidine for sulfa allergies (pentagon paddles)

Enterococcus

Protest at the California caucus. 3 signs and a lined off police scene (they ran out of normal police tape and had to use tiger striped police tape). Faecium incredibly resistant to antibiotics. "Stop the FEES" = faecium as a species name and this protester is buffer and causes more serious infection. Buff guy resisting van = VRE. Linezolid and tigecycline as treatment. "Resist the 6.5%" = this bacteria can grow in 6.5% N. CA (N. California = NaCl) "Do U HEART TREES?" = urinary tract infections, subacute endocarditis, biliary tree/tract infections (bile resistant means it can be insoluble in bile and colonize our biliary tract). Buff guy holding the "Stop the FEES" sign resisting the billy club of the police officer to show that enterococci are bile resistant. Also wearing the same boots as the viridans joker. Setting at the CA caucus = faecalis as a species name. More people underneath the CA banner to show that this bug is more common (but causes less serious infection).

Enterococcus

Protest at the Caucus *Gram-Positive Cocci*

exotoxin A

Pseudomonas aeruginosa

which is the only exception to RNA viruses that are all single stranded EXCEPT which one is DOUBLE STRANDED?

REOVIRUS

Ebola virus

RNA filovirus Natural reservoir= fruit bats Person-person transmission (direct contact with body fluids enter mucousal surface or skin breaks) Clinical: (see notes for details) Abrupt onset of fever chills malaise, myalgia Progression to multi system involvement -hemmorhagic fever, GI, respiratory, vascular, neuro, Rash= days 5-7 Death= days 6-16 (usually from hemorrhage or shock/organ failure)

(Flavi) Hepatitis C - VIRUS

RNA virus -Positive sense virus -enveloped virus -antigenic variability of envelope proteins -tranmission through blood transfusions (esp before 1990) -transmission through needle sharing or sticks -no proofreading 3->5 exonuclease activity in virion encoded RNA polymerase, leads to antigenic variation -inflammation of the liver -acute: jaundice, RUQ pain, enlarged liver, increased liver enzymes -60-80% of acute infections will go on to become chronic (think hepatitis C for "Chronic") -cirrhosis -hep C is a primary cause of hepatocellular carcinoma -leading cause of liver transplants -acute infection: ALT will rise and fall by 6 months -associated with cryoglobulins (serum proteins that contain IgM that precipitate in cooler temperatures) -no vaccine TX: Ribavirin and Interferon-alpha and protease inhibitors

Flavivirus Group - VIRUS Hepatitis C Dengue fever Yellow fever West Nile virus

RNA virus -Positive sense virus -enveloped virus -non-segmented (single segment of RNA) Hepatitis C -hepatitis or liver inflammation Dengue fever -mosquitos = Aedes Egyptei (vector) -"break bone fever" (type 2 of dengue fever) -thrombocytopenia increase risk of bleeding -hemorrhagic fever -can lead to renal failure -can lead to septic shock and death TX: mainly supportive, hydration Yellow fever -mosquitos = Aedes Egyptei (vector) -jaundice -backache -bloody stool/diarrhea -bloody vomiting -live attenuated vaccine for travelers West Nile virus -birds are the reservoir -mosquitos are vector -encephalitis- major complication -meningitis -flaccid paralysis -seizures, coma TX: mainly supportive, hydration

Rotavirus

RNA with 11 segments and triple layer structure Non-enveloped Two antigenic groups in humans (A=most disease, B=adult diarrhea) Infect enterocytes of small intestine, causes lysis when released---> sloughing of cells and diarrhea MOST IMPORTANT CAUSE OF DIARRHEA <5 in WORLD Fever, nausea, vomiting lasts 2-3 days Progresses to diarrhea for 4-8 days ◊ PROFUSE watery diarrhea ◊ Can cause chronic diarrhea in immunocompromised Symptoms associated with severe volume depletion, electrolyte imbalance, and lactic acidosis ◊ Leads to cardiac arrest and seizures Prevent with RotaTeq or Rotarix vaccine

Rhabdovirus

Rabid Wrecking Yard *(-)-sense ssRNA*

Rhabdovirus

Rabid Wrecking Yard Dog smoking a cigar. Initially infects nicotinic ACh receptors. Do not confuse as cigar shaped as like in sporothrix. Hoodie. Enveloped. Bullets on collar. Bullet shaped. Dumpster boat named integrity on a pile of cars. Cytoplasmic negri bodies as inclusion bodies. Seahorse on the boat. Hippocampal cells. Bungie cords hanging from the trees. Purkinje cells. Other animals in the sketch like foxes, bats, skunks, raccoons. Dogs not the only reservoir of rabies. If someone is known to have slept in the same room as bats and because bat bites can go unnoticed, you must administer IgG prophylaxis shot. Dog tethered to the motor of a car and her babies underneath the motor area of the car. After infecting the nAChR, the virus travels retrograde via dynein to the motor neurons. Replicates in motor neurons. Cola cans and a random power outlet. Reinforce nAChR receptors.

Reovirus

Race on the Rio *(-)-sense ssRNA*

Rotavirus

Race on the Rio -ROTOR of the Boat *(-)-sense ssRNA - Reovirus*

Colorado Tick Virus

Race on the Rio -Welcome to COLORADO (w/ tick) *(-)-sense ssRNA - Reovirus*

Clostridium tetani

Rhesus Research Revolution *Gram-Positive Bacilli*

Clostridium tetani

Rhesus research revolution (evil grin monkey with a wrench and a saw for Renshaw cells). Evil grin called Risus sardonicus. Monkey with the wrench and the saw in the left half of the sketch. See below. Monkey with scissors cleaving the SNARE trap that the G and G gasmask researcher was in sending him back to the bottom of the cage that the monkeys are in. Tetanus toxin cleaves SNARE protein that prevents the release of GABA and glycine from renshaw cells located in the spinal cord. Causes a spastic paralysis (contrast C. botulinum, which produces a flaccid paralysis). One monkey writhing with an arched back (opisthotonos) One researcher that had the SNARE cleaved from under him has a needle to represent a toxoid vaccine (orange colored like the orange colored scissors that represent the toxin because it cleaves the SNARE). Treatment (courtesy firecracker): Treatment includes anti-tetanospasmin immunoglobulin, along with adjunctive antimicrobial therapy with metronidazole. Muscle spasms can be controlled with benzodiazepines or neuromuscular blockade.

Rhinovirus

Rhino Petting Zoo *(+)-sense SS Picornavirus*

(Pico) Rhinovirus

Rhino exhibit Baby rhino. Picornavirus. *Zoo-goer feeding a lemon. Acid-labile.* Zoo-goer shielding the rhino sneeze with his hands. Fomites on hand. Inhalation. Rhino underneath a colorful tent. Antigenic variation. Photographing. Rhinovirus enters cells by attaching to ICAM-1 Rhinos sleeping in the shade. Thrives in cooler environments, such as the nose where air is constantly coming in and out. Refer to picornavirus overview video for general characteristics.

Rickettsia rickettsii

Ricket's Rock Climbing Competition

Rickettsia Sp.

Rickets Tennis *Gram Indeterminate (slightly negative)-coccobacillus*

Rickettsia prowazekii Rickettsia typhus Rickettsia rickettsii

Rickettsia prowazekii: The outbreak play with the football players with white gloves and feet catching a louse. Epidemic typhus and a description of the how the rash progresses. Rickettsia typhus: Cause of endemic typhus. Barely mentioned in the prowazekii sketch. Rickettsia rickettsii: RMSF.

Rocky Mountain spotted fever

Rickettsia rickettsii

Human Herpes Virus 8

Ring Around Kaposi *dsDNA virus - Herpes Family*

Human Herpes virus 8

Ring around a Ka-posi, Kate's Posies (posy = a small bunch of flowers) An 8 with a hermes inside of it. Kate's logo. HHV-8. Old lady kate. Kaposi sarcoma in HIV/AIDS. Rose petals on Kate's nose and arm. Kaposi sarcoma causes violacious lesions on nose, extremities and mucous membranes. Guy with a red hose. Causes proliferation of vasculature. VEG-Fertilizer. Dysregulation of VEGF and reason for the proliferation of vasculature. Roof of greenhouse that looks like palate. Many roses on the roof. Kaposi's lesions most commonly occur on the hard palate. Row of plants with a hofstra looking cover over them. GI also a location to get Kaposi sarcoma. B rating of the store and a statue of an archer. HHV-8 can infect B cells and cause a B cell lymphoma known as a primary effusion lymphoma. Russian rhododendrons and African azaleas. Higher incidence in Russian men and African populations. Russians will have lower extremity lesions, Africans will have the palatal lesions and in children, it could be fatal. Bart on the outside of Kate's posies. Confusion with Bartonella's bacillary angiomatosis. Can be differentiated based on infiltrate. Not pictured. Transmission of HHV-8 is through sexual contact.

Human Herpes virus 6

Ro-six-ola. HHV-6. Exanthem subitum. Squire boy with 4 feathers and a 4 belt buckle. Infects CD4 cells. Can cause a state of immunosuppression. Hermes on the horses flank. Member of the herpes family of viruses. 4 suns on the knights banner that is in the picture. Fever that lasts for 4 days. Squire is trembling. High fevers that can cause seizures. Nun in laces who has her face exposed. Rash that has a lacy appearance and that spares the face. Baby in her arms. Affects children 6 months to 2 years. Baby covered in laces with the face exposed. Lacy rash that spares the face. Blue fire around the nun abberation who is dressed in laces that expose her face. Rash appears as the fever subsides. Blue flames = cooling. Contrast with measles that has a rash that does not spare the face and a rash that occurs at the same time as the fever. Contrast with parvovirus where parvovirus has a fever for about a week and then they get a rash on their face.

Clostridium botulinum

Robotulism *Gram-Positive Bacilli*

Rickettsia rickettsii

Rock Climbing Competition in the Dermacenter Arena *Gram Indeterminate (slightly negative)-coccobacillus*

What is the shape/aka of a bacilli?

Rod-shape *Besides some that are rods with a CURVE to them (mustache in photos)*

Human Herpes Virus 6

Roses of Roseola *dsDNA virus - Herpes Family*

enterotoxin

S. aureus

Type III secretion system

Salmonella, Shigella, Pseudomonas, E. Coli. However, the turkey baster is not in Pseudomonas or E. coli's sketch.

Schistoma japonicum

San Franschisto Ocean Park -Fish in Front of JAPANese Flag *Trematodes (Helminth)*

Schistoma mansoni

San Franschisto Ocean Park -MerMAN and Fish in Front *Trematodes (Helminth)*

Clonorchis sinensis

San Franschisto Ocean Park -ORCA whale *Trematodes (Helminth)*

Pargonimus westermani

San Franschisto Ocean Park -PENGUINS *Trematodes (Helminth)*

Schistoma haematobium

San Franschisto Ocean Park -Swordfish *Trematodes (Helminth)*

Listeria monocytogenes

Santa's List *Gram-Positive Bacilli*

Listeria monocytonegenes

Santa's List. Pregnant women in the doorway looking at at her space cadet baby as Santa Claus is looking over his list. Early term contraction can lead to abortion. Later term contraction can lead to newborn meningitis. 3rd most common cause after GBS and E. Coli. Christmas time = cold outside. Grows well at refrigeration temperatures like 4 - 10 degrees. Meat, cheese and milk left out for Santa. Unpasteurized dairy products and cold deli meats can be a source. Christmas tree decorations that are tumbling off the tree. Said to have tumbling motility outside of the cell. Toy rocket as a present on the ground, and also a toy rocket inside of Santa's bag. Listeria rapidly polymerizes actin inside of the cell to get from place to place. Said to look like a rocket or form 'rocket-tails.' Guitar and guitar amp as a present. Ampicillin as treatment.

Trematodes (FLUKES): Schistosoma mansoni, Schistosoma japonicum, Schistosoma haematobium, Clonorchis sinensis, and Paragonimus westermani = PARASITES

Schistosoma mansoni, Schistosoma japonicum, Schistosoma haematobium -Swimmers at risk of infection -getting into the blood stream and go to the liver and mature they like to go to different parts of the body -SNAILS are intermediate host -migrate AGAINST portal blood flow to reach venous destination Schistosoma mansoni and Schistosoma japonicum - like to reside in mesetenteric veins -Schistosoma manson has "large lateral spine" seen on stool O&P -Schistosoma japonicum has a "small spine" seen on stool O&P -both these cause portal hypertension which can eventually cause cirrhosis and liver failure; jaundice - all three cause swimmers itch where the larvae penetrate the skin TX: PRAZIQUANTEL Schistosoma haematobium -likes to reside in the veins of the bladder -"large terminal spine" seen on stool O&P -migrate against portal blood flow -PRIMARILY hematuria and risk of bladder cancer TX: PRAZIQUANTEL Clonorchis sinensis -Chinese liver fluke -SNAILS are intermediate host to the fish and we can eat these uncooked in like sushi -biliary fibrosis, cholangiocarcinoma risk, pigmented gallstones -"operculated eggs" on stool O&P TX: PRAZIQUANTEL Paragonimus westermani -LUNG fluke -chronic cough with bloody sputum -SNAILS are intermediate host -transmitted through consumption of raw or undercooked crab meat with larvae -"operculated eggs" on stool O&P TX: PRAZIQUANTEL

Toxicara canis

Screamatodes 3: Return of the Flesh Eaters -CANINE (werewolf) *Tissue Nematodes (Helminth)*

Dracunculus medinesis

Screamatodes 3: Return of the Flesh Eaters -DRACULA *Tissue Nematodes (Helminth)*

Onchocerca volvulus

Screamatodes 3: Return of the Flesh Eaters -Fly *Tissue Nematodes (Helminth)*

Loa Loa

Screamatodes 3: Return of the Flesh Eaters -Swamp Man *Tissue Nematodes (Helminth)*

Wucheria bancrofti

Screamatodes 3: Return of the Flesh Eaters -WITCH *Tissue Nematodes (Helminth)*

condylomata lata

Secondary syphilis

Malassezia furfur treatment

Selenium blue/sulfate (blue stained glass window)

What is the name of the SketchyMicro sketch for Sporothrix schenckii?

Shanked by a Rose

Sporothrix Schenckii

Shanked by a Rose *Cutaneous mycoses fungi*

Shigella species

She Gorilla's Circus *Gram-Negative Bacilli - Enteric*

Shigella dysentaria

She Gorilla's Circus Emphasis on the kid whipping the balloons and plates and hourglass and turkey baster *Gram-Negative Bacilli - Enteric*

Shigella

She-Gorilla Circus All gorillas wearing green tutu's to represent the that Shigella produces green colonies on Hektoen agar (contrast Salmonella which forms BLACK colonies on Hektoen agar). 1st gorilla chained to the stool. Immotile. Contrast salmonella. 1st gorilla on a red stool surrounded by fire to represent inflammatory bloody diarrhea (leukocytes in the stool). Child circus ringleader cracking a nephron whip on the balloon of the first she gorilla. Represents HUS and schistocytes. Hemolytic uremic syndrome seen in children (typically under 10 years of age) who contract S. dysenteriae. HUS = triad of thrombocytopenia, anemia and acute renal failure. Produces schistocytes. Prodromal diarrhea and then one week later when things are just about to be looking up they develop acute renal failure? Think HUS and think Shigella or E. coli (E. coli = Shiga-like toxin). 2nd gorilla launching onto an M pad. Both invasion of M cells and use of actin filaments to propel itself into another cell. Facultative intracellular. 3rd gorilla tightwalking over a vat of acid. Acid stable. Needs far fewer organisms to cause disease. Contrast Salmonella which is acid labile. 60 second timer to the left of the 1st she gorilla to represent that the toxin acts on the 60S subunit.

S. dysenteriare, S. flexneri, S. boydii, S. sonnei

Shigella species in order of decreasing severity

Mycobacterium tuberculosis

Shoot out at the TB Corral *Mycobacteria*

Mycobacterium tuberculosis

Shootout at the TB Corral Lowenstein general store Acid fast cowboy Man coughing inside of an old buggy Yellow lasso on the cowboy with the mycolic acid garb. Serpentine cord factor (virulence factor). Cord factor activates TNF alpha, activates macrophages (firecracker says inhibits maturation of macrophages) and creates granulomas. TNF alpha prevents the bacteria from going anywhere, but now the bacteria can hide. However, TNF alpha still important for the immune system. If starting a patient on a TNF alpha inhibitor you first want to do a PPD screen to make sure you aren't putting them at risk for reactivation of TB. Clouds puffing up, but not coalescing next to yellow spurs on the cowboy with the mycolic acid garb. Sulfatide virulence factor that prevent phagosome formation and phagocytosis. After primary infection there are 3 outcomes 1. Healed latent infection 2. Systemic Infection (miliary TB) 3. Reactivation TB Gun complex and the TB lung cacti in front with gunshots in the middle lobe BCG needle in the pile of dirt. BCG vaccine can give a positive PPD test even if the patient has not been exposed to TB. TB usually heals, but when it doesn't it can seed almost any organ. Right side of the sketch shows the TB lung cacti and bullet holes in the upper lobe. Reactivated TB usually affects the upper lobes. Man coughing in the old buggy and the scene taking place at night. Reactivated TB usually has these characteristic features: cough, night sweats, hemoptysis. Stack of pots and man who is getting his cowboy hat shot at. Two common areas of reactivation. Potts disease in the vertebral column. CNS involvement (10-15% of the time). Recall that the same cowboy hat being shot at is also in the Nocardia sketch.

Parvovirus B19

Small non-enveloped DNA virus Can only infect human RBC progenitor cells --> causes acute stop of RBC production Normal person=nbd Patient with high RBC turnover= aplastic crisis Immunocompromised = pure red cell Aplasia---> unremitting and devastating anemia Brief clinical: -erythema infectiosum "fifths disease" (slap cheek rash) -arthropathy Symmetrical in small joints , women -transient aplastic crisis (need underlying hemolytic disorder) Dyspepsia due to severe anemia PRCA---> immunocompromised patients Diagnosis: IgM and IgG *need PCR if immunocompromised patient*

Filovirus

Soccer Field'O virus (Ebola = E-GOAL-a) Marburg as a last name on the jersey. Marberg hemorrhagic fever. Defender lying on the ground in a pool of blood. Hemorrhagic fever. Spirals around the goal post. Helical. Monkey medics. Can be a source of transmission. Both ebola and Marburg fever are hemorhaggic fevers. Takes place at night. Negative sense RNA. FA: Ebola: endothelial cells, hepatocytes, phagocytes, 21 day incubation period, flu, diarrhea, vomitting, high fever, myalgia, DIC, hemorrhage, shock, RT-PCR, high mortality, bodily fluids, dead bodies, bats, primates, noscomial.

Filovirus & 2 Types

Soccer Field'o -Marburg Virus -Ebola Virus *(-)-sense ssRNA*

Marburg Virus

Soccer Field'o -Marburg announcing GOAL *(-)-sense ssRNA - Filovirus*

Ebola Virus

Soccer Field'o -eBOOOOOOOALa *(-)-sense ssRNA - Filovirus*

Blastomyces dermatidis endemic location and transmission

Southern/Eastern US or Great Lakes + Ohio River Valley (map+ valley and river) Transmission: Spores via inhalation (cannon)

Staph epidermidis and Staph saprophyticus - BACTERIA

Staph epidermidis and Staph saprophyticus -gram positive take up crystal violet stain -staph grows in clusters -CATALSE positive -UREASE positive (urea ->ammonia conversion) - coagulase negative Staph epidermidis -part of normal skin flora -contamination of blood cultures -effects artificial joints and prosthetic joints -indwelling catheters is a common source of infection -MCC of endocarditis in artificial heart valves -produces biofilms coating valves etc. -Novobiocin sensitive -treat with VANCOMYCIN Staph saprophyticus -Novobiocin resistant -common cause of UTI in sexually active females

Necator americanus

Super Worms! -AMERICAN Dude *Intestinal Nematodes (Helminth)*

Ancyclostoma duodenale

Super Worms! -American DUDE *Intestinal Nematodes (Helminth)*

Ascaris lumbricoides

Super Worms! -Lumberin Tree Man *Intestinal Nematodes (Helminth)*

Trichinella spiralis

Super Worms! -SPIRAL Pig *Intestinal Nematodes (Helminth)*

Strongyloides stercoralis

Super Worms! -STRONG Dude *Intestinal Nematodes (Helminth)*

Enterobius vermicularis

Super Worms! -VERMINE Lady *Intestinal Nematodes (Helminth)*

CD4 less than 100

T gondii

superantigen that stimulates T cells leading to widespread cytokine release and shock

TSS toxin (S aureus)

Cestodes (TAPE WORM) - PARASITE Taenia genus (Taenia solium,Taenia saginata) diphyllobothrium latum (fish tapeworm) echinococcus granulosus

Taenia solium -intermediate host for t. solium is pigs -hooks on proglottid heads of T.solium seen on O&P TX: Praziquantel Taenia saginata -intermediate host for T. saginata is cattle TX: Praziquantel neurocysticercosis - taenia EGGS transmitted by water contaminated with animal feces; lesions in the brain; looks like cheese cysts on head CT; seizures; immigrant or farmer and symptoms of hydrocephalus; TX: Albendazole diphyllobothrium latum (fish tapeworm) -resides in the small intestine and causes diarrhea -B12 DEFICIENCY (cobalamine deficiency) LEADING TO MEGALOBLASTIC ANEMIA -longest tapeworm -proglottid segments seen on stool O&P TX: Praziquantel or Niclosamide echinococcus granulosus -dogs are definitive host, sheep are intermediate host -humans are incidental host transmitted by dog feces -"egg shell calcifications" (buzz word) in cysts on liver CT -hydatid cysts in liver -cysts rupture causes an anaphylactic reaction and acute abdomen -eosinophilia

Cryptosporidium

Tales from the Crypt *Protozoa of the Intestinal Tract* NOT Crypt for Cryptococcus

Cestodes aka?

Tapeworms (Helminth)

Leptospirosis interrogans

The (Fresh?water) Surfer's Oasis Hawaiian surfer rubbing his eyes with red sunglasses on. Conjunctival suffusion (redness without exudate). Surfing stance. Myalgias that are classically of the calves. Riding a yellow wave. Animal urine. Whale in the background. The severe form of leptospirosis also known as icterohemorrhagic leptospirosis. Red inner tubes that are being thrown about. Spread hematogenously and seeds many organs. Two most imporant talked about in sketchy are the kidneys are the liver. Kidney shaped inner tube being launched into the air by the whale. Kidney dysfunction. Yellow suit of the surfer that was previously yellow in the sketch. Jaundice.

Pseudomonas aeruginosa

The 3 maids, 3 suitors and 1 dalmation of Pseudo Mona Blue ring. Oxidase positive. Cat. Catalase positive. Dead-giveaways: 1. blue-green around the red hot tub. pyocyanin/pyoverdin production and gram negative rod. 2. grapes. grape like odor Nurse maid pouring more chlorine into the hot tub. Nosocomial pneumonia and respiratory failure in CF patients (recall mutation in chloride channel). Urine pot next to the nurse maid. Nosocomial UTI. Maid caught on fire with an air bellow. Aerobic. Pseudomonas infection a feared complication of burn patients. Fish skeleton next to the encapsulated jar of candy and mortar and pestle. Cause of osteomyelitis in diabetics and IVDU. Pseudomonas is encapsulated. Maid listening to the suitors with an ear trumpet through the door. Otitis *externa* (swimmer's ear). Suitor in green with a bowtie playing an accordian = ADP-ribosylation (recall diphtheriae toxin works in a similar mechanism). Suitor with a psi kneeling holding out a flower = aminglycoside and fluoroquinole as tx. Fluoroquinolones are especially useful in pseudomonas UTIs. Suitor playing a PIPE (do not confuse with a flute. Flucytosine would also not make sense as pseudomonas is a bacteria). Piperacillin or Ticar. as a treatment because these are the antipseudomonal penicillins. Dalmation. Ecthyma gangrenosum.

Streptococcus viridans

The Alpha Knight Tournament *Jester on Right* Also: -Strep sangineous -Strep mutans *Gram-Positive Cocci*

Streptococcus pneumonia

The Alpha Knight Tournament *Knight on Left* *Gram-Positive Cocci*

Blastomycoses dermatidis

The Blast of the Cannon *Systemic Mycoses*

Borellia burgdorferi

The Bow and Arrows of Borrelia *Spirochete*

Borrelia

The Bows and the Arrows Bows and arrows competition in the NE US. Robin of Ixodes shooting an arrow riding on a unicycle in lyme colored garb. Ixodes tick found on deer. Causes lyme disease. FYI rodent is the host of the larvae and deer the host of the adult tick. Doxy as tx. Going left to right are the stages of the disease. All have targets for arrows. Arrow hitting a bull's-eye target on the left. Erythema migrans. A heart and two bells on either side for the middle target. Heart block and bilateral bell's palsy. Straw 'burning man' guy who is supposed to be a moving target (most difficult) with an arrow in the knee and an arrow in the head on the right. Migratory polyarthritis and encephalopathy. Other two contestants in the competition are Sir Wright and Sir Giemsa. Giemsa and Wright stain for this spirochete. Recall Giemsa stain is used for Chlamydia and is represented by the treasure chest full of gems with buzzing knats around. Knats to represent that nucleic acid amplication a.k.a. PCR is now used more frequently.

Candida albicans

The Canadian playground with the 100lb. slide and the "play nyce" sign for nystatin 5 things it causes. Oral, vaginal, esophageal candidiasis, diaper rash, and candida infective endocarditis. 37 flavors snow cone stand. Candida forms germ tubes/true hyphae (mold) at 37 degrees celcius. Canadian shrubbery that is segmented and looks like pseudohyphae. Thermometer next to it. Stash of snowballs that look like yeast cells. Yeast form at 20 degrees celcius. Cat. Catalase positive. Baby in red swing. Causes diaper rash in characteristic distribution due to the heat and humidity within a baby's diaper. Old man with a cane and kid throwing a snowball. Oral candidiasis seen in immunocompromised patients or those using oral steroids. Oral steroid use must be followed by oral rinsing to avoid development of oral candidiasis. Adult scraping snow off the drive way. Oral candidiasis can be scraped off the oral mucosa. Leukoplakia cannot be scraped off. KOH right next to the woman scraping snow. KOH is used to prep oral scrapings when attempting to diagnose oral candidiasis. Max 100 lbs. CD4 <100 makes the patient susceptible to candida esophagitis. AIDS defining illness. Woman dropping her jar of candy, prescription pills (represent antibiotics) and birth control as she is pelted in the crotch with a snowball. Vaginal candidiasis and the things that predispose a woman to getting yeast infections. Playground open until 4pH. Candida infections do not change the pH. Three heart shaped pyramids. Candida often found in certain types of heroin. IVDU. Seeds the tricuspid valves. Pinecones. Minor candida infections. Diaper rash baby holding a pinecone. Azole for diaper rash. Frog ride next to the immunocompromised man. Amphotericin B for immunocompromised, disseminated infections. Cap on the old man. Capsofungin may be used for disseminated candidal infections resistant to amphotericin. "Play NYCE" sign next to the face and esophagus slide for candidal esophagitis.

Gardnerella vaginalis

The Fish Garden *Gram Indeterminate (both red and purple staining)*

Poliovirus

The Flamingo Breeding Pool *(+)-sense SS Picornavirus*

Proteus mirabilis

The God of the Public Restroom *Gram-Negative Bacilli - Enteric*

Staphylococcus aureus

The Golden Staff of Moses *Gram-Positive Cocci*

Mycobacterium leprae - Tuberculoid form

The Good, The Bad, and the Lion Faced #1 jail cell side *Mycobacteria*

Mycobacterium leprae - Lepromatous form

The Good, The Bad, and the Lion Faced #2 jail cell side *Mycobacteria*

Helicobacter pylori

The Helicopter Pilot *Gram-Negative Bacilli - Enteric*

Histoplasma capsulatum

The Historians Cave *Systemic Mycoses*

Treponema pallidum

The Pallidum Observatory Spiral shaped galaxy off in the distance and spiral shaped staircase. Spiral shaped. Spirochete. Attic represents diagnosis and primary syphilis. Secondary syphilis takes place underneath the dome. Tertiary and congenital syphilis takes place outside. Congenital syphilis represented by the constellation of orion and his horse and the children down below. Monitor reading Darkfield Galaxy with a list underneath it and "*V*ideo *D*isplay *R*esearch *L*aboratory" underneath the monitor. VDRL stands for venereal disease research lab and is a non-treponemal screen. Has many false positives. Mono, RF, SLE, Leprosy, IVDU. Because of so many false positives, it is necessary to have a confirmatory test. Gigantic telescope reading *F*ield *T*elescope *A-Ab*. Confirmatory test FTA-ABS. Astronomer being poked from behind by the sundial and not noticing. Sundial supposed to be phallic and the astronomer not noticing is supposed to represent the painless chancre found on the penis in primary syphilis. Astronaut with red gloves and boots pointing to a planet with a lot of bumps. Rash on the palms and soles of the feet (only characteristic of secondary syphilis, RMSF a.k.a. Ricketsii ricketsii, and Coxsackie. RMSF's rash starts on the palms and soles and moves towards the trunk. Ricketsii prowazekii has a rash that spares the hands and feet). Lot of bumps = condyloma LATA. Note that this is note the same as gummas. Gummas are a characteristic of tertiary syphilis and are represented by the crater of the moon. Moon with craters. Gummas. Tree in the shape of an aorta. Aortitis and thoracic aneursym/vaso vasorum destruction. Columns in the back of the picture that are cracking. Destruction of the posterior columns of the spinal cord known as tabes dorsalis. Greeter in an argyle sweater that is accommodating, but not reacting to the kid shining the light in his eye. Arygll-robertson pupil. Orion in the constellation has a saber on his hip that goes down to his shin. Horse in the constellation has a saddle on his back for saddle nose deformity. Kids outside the observatory are cold. They have earmuffs on and they are chattering their teeth. Deafness, Hutchinson teeth (notched incisors) and mulberry molars. Jarisch Herxheimer comet viewing. Jarisch Herxheimer reaction (~1 hr.) when treating someone with penicillin. Antibiotic induced spirochete death and release of toxins. *This indicates that the treatment is working.*

Picornavirus Family

The Peak-orna Animal Nursery *(+)-sense SS Picornavirus*

Strep pyogenes (Group A strep)

The Pie Genie's Bakery *Question you've gotten wrong a bunch: Acute RF is a type II HSR. PSGN is a type III HSR. Recall that nephritic syndromes are characterized by immune complex deposition.* The *H*ot *A*pple pie underneath the pie display and the red beta hemolytic light bulb = hyaluronic acid, encapsulated, and beta hemolytic The pyogenic infections: Honey crusted pie holding chef to represent impetigo (careful though as Staph aureus can also cause impetigo). Red necktie = strep pharyngitis. Big red hulk hand gloves = erythema of the skin as cellulitis and erysipela (erysipela is cellulitis with well-defined borders). The toxigenic infections: The chef putting a strawberry to his tongue, wearing a red necktie and red frosting a gingerbread man while being cognizant to skip the face. He represents Scarlet Fever (1. strawberry red tongue, 2. pharyngitis, 3. rash that spares the face). He is also wearing a red cape to represent toxic shock *like* syndrome, do no confuse with toxic shock syndrome of staph aureus. Lastly, he burnt one gingerbread cookie to represent necrotizing fascitis. The burnt gingerbread man has one leg off because it is sometimes necessary to amputate the affected leg. The gingerbread man has a B on it to represent that that toxin causes NF while the other toxins cause the other toxigenic infections of Strep pyogenes. Master chef wearing a miter hat and swatting away another chef who is trying to eat his Jones criteria cupcakes. The M also stands for M protein which is part of Strep and also found in our heart, which sometimes creates the molecular mimicry that is responsible for Rheumatic Fever. The J in joints is why it was called Rheumatic fever in the first place. The J cupcake is seen spilling frosting onto another chef's elbow for joints. N cupcake has gumdrop decorations on it for (cutaneous nodules). E cupcake has red squiggly lines on it for erythema marginatum. S cupcake is seen falling off for Sydenham's Chorea. Master chef (RF) and PSGN chef (post strep glomerular nephritis) both be precipitated by pharyngitis. However, PSGN chef has a honey crust crumbs on his face and a pencil. So, impetigo usually precedes PSGN and even though the PSGN chef has a pencil for penicillin, he still has PSGN. Another way of saying that is, penicillin can prevent RF during the pharyngitis stage, but cannot prevent PSGN. Chef handling the O-shaped jelly filled doughnuts with antibody tongs. Woman customer across from him counting the O-shaped jelly filled doughnuts with tongs = Anti-Streptolysin O (ASO) titer as a way to diagnose someone who just had a recent S. pyogenes infection. Basset hound seen munching on a pastry = Bacitracin sensitive. This is how you wound differentiate Group A strep from Group B strep. Recall in Group B strep, the galactic baby, that the basset hound is unable to lick the baby and thus, Group B strep is bacitracin resistant.

Streptococcus pyogenes

The Pie Gienes' Bakery *Gram-Positive Cocci*

Chalmydia pneumoniae

The Pirates of Chlam Island -Clam shell bra on mermaid *Gram-Indeterminate*

Chalmydia psittaci

The Pirates of Chlam Island -Parrot pooping *Gram-Indeterminate*

Chalmydia trachomatis

The Pirates of Chlam Island -Trachomatous (pirate), STI (mermaid w/ baby), LGV (mermaid inguinal region) *Gram-Indeterminate*

Plasmodium malariae

The Queens and Warlords of Plasmodia -MAL-AIR Smelling Warlord *Protozoa/Parasite of the Blood*

Plasmodium vivax

The Queens and Warlords of Plasmodia -Warlord with AXE *Protozoa/Parasite of the Blood*

Plasmodium falciparum

The Queens and Warlords of Plasmodia -Warlord with FALSE mask *Protozoa/Parasite of the Blood*

Plasmodium ovale

The Queens and Warlords of Plasmodia -Warlord with SHIELD *Protozoa/Parasite of the Blood*

Plasmodium

The Queens and Warlords of Plasmodium. Explanation of what is meant by 48 and 72 hour fever cycles. These fevers are 48 or 72 hours apart. For example, 72 hour fever would be fevers on the 1st and 4th day. 48 hour fevers would be fevers on the 1st and 3rd day. Not well-represented in the sketch. For drug sensitive malaria, give chloroquine. For drug resistant malaria, give mefloquinine or atovaqoine/proguanil. For life-threatening malaria, give artesunate and IV quinidine. For the hypnozoites (dormant form in liver of vivax/ovale), add primaquine. Malariae warlord has 4 buttons and the 1st and 4th are lit up. 72 hour fever cycle for P. malariae. Ax and oval cow-skin liver spot shield who is hypnotizing the color queen with a metronome that has 1st and 3rd and 5th dots lit up. 48 hour fever cycle of vivax and ovale. Primal queen coming to the rescue of color queen who is being hypnotized by vivax/ovale. Give primaquine to vivax/ovale. Vivax/ovale might be resistant to chloroquine? Falciparum warlord has a tattered skirt. Irregular fevers of falciparum.

Legionella

The SS Cysteine Joins the Legion *Gram-Negative Rod - Respiratory*

Salmonella enteritidis

The Salmon Dinner *Chicken* *Gram-Negative Bacilli - Enteric*

Salmonella typhi

The Salmon Dinner *Seagull* *Gram-Negative Bacilli - Enteric*

Salmonella

The Salmon dinner for the chicken and the seagull. Flopping salmon tail (despite it being dead?) to represent that it is motile. Contrast with Shigella, which is not motile. Lemon next to the salmon to represent that these organisms are acid labile and thus, you only need a large amount of organisms to cause infection (because acid is degrading the majority of them, contrast with shigella, which has one of the She-gorillas in the She-gorilla circus balancing on a tight rope over a pool of acid. Thus, shigella only needs a few organisms to cause disease). Acid labile also means that you are more susceptible to acid labile organisms whenever you are producing less stomach acid (taking omeprazole, had pernicious anemia, etc.) Salmon on a black plate (Hektoen Enteric Agar a.k.a. HEK, HE, or HA) to show that it produces H2S and forms black colonies on plates. Contrast Shigella which does not. Wikipedia says the HEK agar is specifically used to discriminate between salmonella and shigella. All enteric bacteria that are H2S positive are also motile. Left represents salmonella species. Chicken Right represents S. typhi. The seagull with the typhoid Mary apron on (characteristic rose spots on the abdomen) and that chronic carriers of salmonella typhi harbor it in their gallbladder. "Pea soup" looking bird droppings underneath the seagull to represent "Pea soup" diarrhea in S. typhi. Flower on the seagull side to represent fluorquinolones as the treatment for S. typhi. Sickle and capsule to represent encapsulated organism and sickle cell patients. #1 cause of osteomyelitis in sickle cell patients. Vaccine poking the leg of the seagull to represent that a vaccine is available for S. typhi. Contrast S. enteriditis and shigella which do not have vaccines.

Pseudomonas

The Suiters of pseudo Mona *Gram-Negative Bacilli - Enteric*

Leptospirosis

The Surfers of Oasis *Spirochete*

Babesia species

The Vampire BABES *Protozoa/Parasite of the Blood*

Babesia

The Vampire Babes. Protozoa of the blood. Robin of ixodes about to be fed on while his is tied up and sitting over a maltese cross. Ixodes tick is the vector. Maltese cross is formed by a tetrad of trophozoites. Don't forget about ring form. Also, due to ixodes tick, consider co-infection with lyme disease from borrelia. Stained windows are cracked. Hemolytic anemia. Atova, the vampire queen with a sickle and crows on her shoulders. Atovaqoine and azithromycin as treatment. Higher risk of severe disease in sickle cell patients or those with asplenia. Robin's clothes are tattered. Irregularly cycling fevers. Robin's clothes have a spleen shaped hole. Higher risk of severe disease in asplenia. Red carpet. Thick blood smear as diagnosis. Maltese cross a little off center and pointing to the northeast. NE geographic distribution.

Neisseria gonorrhoeae

The Violinists Last Clap *Gram-Negative Cocci*

Legionella

The WWI iron-made, charcoal powered S.S. Cysteine joins the legion. ^ to represent growth on charcoal medium with iron and cysteine. Silver being painted on the red iron. Gram negative but stains poorly so use of a silver stain is necessary. Red iron still yet to be painted is to remind of gram negative origin. The paint looks white, but should be silver and the red iron looks brown, but should thought of as red. Sailor with the salt wheelbarrow spilling into the ocean. Hyponatremia sometimes present. Sailor peeing. Urine antigen test. Legionella causes two diseases: pneumonia and pontiac fever. Old guy next to pontiac car smoking looking at blueprints of the ship's hull. Pontiac fever (mild flu like syndrome that is self limiting). Blueprints of the ships hull has a white unilateral opacity. Legionella pneumonia often has a unilateral lobar pneumonia. Common in smokers. Pneumonia with diarrhea and hyponatremia? Legionella Pneumonia with neurologic symptoms such as headache and confusion? Legionella.

Staph saprophyticus

The beauty in beauty and the plumber (she's not navel sensitive because she is in shape and thus novobiocin resistant). The beauty is seen drinking out of a martini glass with two straws facing outwards (ureters leading to a bladder). Staph sapro is the 2nd leading cause of a UTI after E. Coli. Both are coagulase negative and this is signified by the plumber and the beauty who have just put the gell *HYPHEN* o into the bowl. The hyphen in the gell-o is to represent coagulase negative (contrast staph aureus where Moses has parted the red sea and the red sea looks more solid and coagulated. This gell-o looks more liquid and thus, non-coagulated). Urease positive with the spray bottle and catalase positive with the cat. Van in the background = vancomycin as a treatment.

Blastomycosis

The blast of the cannons (Civil War geographic location, Blasto is present around great lakes as well) Geographic difference from Histo. Blasto is around the lakes and the east coast. Cannonballs in the soldiers hands. Single, broad based budding as the method of replication. Cannonballs creating a lung pattern and smoking. CXR has a patchy alveolar infiltrate. Lesions or cavities may also be present on imaging. Statue of Robert E. Lee with ulcers and an exposed leg rod. Systemic disease affects the skin and bones. Yellow river. Rapid urine antigen testing. Itraconazole.

Strep pneumoniae

The encapsulated knight in the alpha knight tournament (alpha hemolytic, alpha means partial hemolysis and green). Heavily armored with a little bit of rust to represent encapsulated and the "rust-colored sputum" Carrying with him two lances, a flag with three axes on them, AND A SICKLE. Lancet shaped diplococci, ceftriaxone, and a cause of sepsis in patients with sickle cell disease and asplenic patients. Armor lacking chin protection = optochin sensitive (contrast strep viridans which has the large jester face jaw armor mask) The common *MOP*per next to the knight. MOPS mnemonic. Strep pneumoniae is the most common cause of meningitis, otitis *media* (in children), bacterial pneumonia, sinusitis. Knight's horse has mud on it's feet to represent bile soluble (contrast strep viridans which is bile insoluble) Marcolide crow *From Kaplan Q bank: IgA protease as virulence factor. Strep pneumo and Neiserria.*

Bacillus cereus

The guy reheating rice in King Anthra's (the Viking) Axe sketch. Causes reheated rice syndrome. No play-on words for B. cereus and rice.

Histoplasma capsulatum

The historian's cave. Ohio and MI river valley on the historian's map. Bird, bat, cave. Bird, bat droppings, and cave as method of transmission. Cave stalagmite legs that look like someone is peeing. Red bumps are also on these legs. Rapid urine antigen test. Erythema nodosum. Erythema nodosum also seen in cocci, and more associated with cocci. You will use geography to differentiate. Smaller red stalagmite. Rapid serum antigen test. Canary brought down in the cage. Small intracellular oval bodies within macrophages. Also means that they are much smaller than RBCs (size in relation to RBCs is important to know for systemic fungi). Open book with TB. Histoplasma may mimic TB in presentation. Cane in front of the cow. Dissemination in the immunocompromised can cause HSM.

Cytomegalovirus

The mega low prices you'd find at a supermarket. Woman proding the sleeping employee next to the toy shelf. Latent in mononuclear cells. The toys represent the different kinds of cells that mononuclear cells are. They are B and T cells and macrophages. Hermes messenger also on the toy shelf. Part of the the herpes family of viruses. CMV is HHV-5. Boy who drove his car into the the blueberry muffin stand. Congenital CMV. The most common fetal viral infection. #1 on the boys shirt. #1 cause of sensorineural hearing loss in children. #1 cause of mental retardation from a congential viral infection. Blueberry muffins. Petechial rash. Recall congenital rubella. Covering his ears and has a ventricle helmet. Sensorineural deafness and ventriculomegaly. Milk splashes that landed right around the ventricles. Periventricular calcifications. Intracranial calcifications. Recall toxoplasma also has intracranial calcifications. Man slipping on the spilled milk and in motion. Periventricular calcifications cause of the seizures in congenital CMV infections. Yellow cow with a liver and spleen spot. HSM and jaundice in congenital CMV. Congenital CMV all together: blueberry muffin petechial rash, sensorineural deafness, ventriculomegaly with periventricular calcifications, seizures, HSM and jaundice. 80-90% off sign. 80-90% of congenital CMV infections are asymptomatic and thus they are off the hook from all of those nasty symptoms. Red balloon baby. Hydrops fetalis. CMV infections in a pregnant mother can also be transmitted in utero and cause hydrops fetalis, leading to spontaneous abortion. Most common if mother is infected with CMV in the 2nd trimester. Butcher coughing. Pneumonia in organ transplant patients. Old man with cane checking out a frozen pizza that looks like a retina. CMV retinitis in AIDs patients. Described as a pizza pie retinopathy. Register check out reading 'Charity Drive 50 cents." CMV retinitis when CD <50. Conveyor belt that looks like an esophagus with linear marks on it. CMV esophagitis. Need to be able to differentiate from Herpes esophagitis. Singlular, deep, linear. Herpes is multiple and shallow. Pink groceries bags clumped together that are supposed to look like colonic hofstra. CMV colonitis. Red ulcers. Owl eye cereal. Owl eye inclusions in cells. Compare EBV. Green 'cans only' recycling bin. Specifically gancyclovir as treatment. Car with a net that the little boy is driving. 2nd line treatment is foscarnet UL97 on the car. Foscarnet is used when the virus has a mutation in the UL97 gene that makes it resistant to gancyclovir. The mom with the very red throat holding box that says 'no mo spots.' CMV infections in healthy individuals. CMV mononucleosis. Sore throat, lymphadenopathy and fatigue. Differentiate from EBV mononucleosis with the monospot test. CMV mononucleosis will have a negative monospot test. Sore throat differential: strep pharyngitis, EBV mononucleosis, CMV mononucleosis. Can differentiate with amoxicillin, ampicillin and the monospot test.

Helicobacter pylori

The mustache helicopter pilot cleaning his helicopter windshield with a spray bottle. Spray bottle. Urease positive and the urease breath test (called UBT) Blue ring on the pilot. Oxidase positive. All of the curved rods are oxidase positive (Helicobacter, Campylobacter, Cholera). Mustache. Comma shaped. Comma shaped (Helicobacter, Campylobacter and Vibrio are all comma shaped, but Helicobacter and campylobacter and more helical/spiral shaped). Proton bomb clogging the duodenum gas line for the helicopter. PPI as tx and H. pylori causing duodenal ulcers. An ammo box. Amoxicillin as treatment. Do no confuse amoxicillin ammo symbol with ampicillin (an amp, recall Listeria). Crows everywhere including a crow on the keep clear sign. Marcolides as treatment, specifically clarithromycin. Do not confuse 'keep clear' sign in this sketch with the 'keep clean' sign in the C. diff chocolate factory sketch. 'Keep clear' is to represent clarithromycin as a tx in H. pylori and the 'keep clean' sign in C. diff is supposed to represent clindamycin as a cause of C. difficile (recall that metronidazole and oral vancomycin are treatments for C. difficile). Dumpster with lots of tissues in it (tissues that he is using to clean the helicopter with) and cancer on the side of the helicopter. Two cancers that H.pylori can cause. lymphoma of the MALT (mucous associated lymphoid tissues) and gastric adenocarcinoma.

Staph epidermidis

The plumber in beauty and the plumber (he's navel sensitive and novobiocin sensitive). The beauty is staph sapro and she is not navel sensitive and thus novobiocin resistant. Think of the plumber as putting in prosthetic devices. Staph epidermidis is known as the bane of the orthopedist's existence. But also heart valves as represented by the rusted over heart under one sink!!! Both are coagulase negative and this is signified by the plumber and the beauty who have just put the gell *HYPHEN* o into the bowl. The hyphen in the gell-o is to represent coagulase negative (contrast staph aureus where Moses has parted the red sea and the red sea looks more solid and coagulated. This gell-o looks more liquid and thus, non-coagulated). Urease positive with the spray bottle and catalase positive with the cat. Van in the background = vancomycin as a treatment.

(Pico) Coxsackievirus

The two birds in two cages Left side is A, right side is B. Baby cockatoo in the sketch (on the right side) represents that Coxsackie A and B are picornaviruses (enteroviruses, recall ENTER aviary). Statue of David on the left having his hand, foot and mouth poked out by the cockatoos. Naked. Hand foot and mouth disease that causes rashes on the palms and soles. Compare and contrast the other diseases that cause rashes on the hands and foot. Secondary syphilis and RMSF cause a rash on the hands and feet. RMSF's rash moves inward. Ricketsii prowaseki's rash starts centrally and moves outward (outbreak) and then spares the hands and feet. On the right is a cockatoo with two red bird feed bags that look like hearts. Dilated cardiomyopathy. One of the cockatoos is being squeezed to represent devil's grip a.k.a. pleurodynia a.k.a. Bornholm disease. Little boy in a space cadet helmet to represent viral meningitis. Refer back to the picornavirus overview sketch for the CSF findings of viral meningitis. Little girl in a bathing suit. Coxsackie more common in summer months. Refer back to picornavirus overview.

Chlamydia trachomatis (disease)

There are several different types... *A-C* = blindness associated with trachoma disease -Leading cause of blindness worldwide -Transmitted by hand to eye contact or fomites *D-K* = STI: watery discharge, often asymptomatic, risk for progression to PID if not recognized and treated -Women with active infection + vaginal delivery --> neonatal conjunctivitis and/or pneumonia (staccato cough) that presents 1-2 weeks after birth (later onset than gonorrhea) *L1-L3* = LGV (lymphogranuloma vereneum): infection of lymphatics, especially inguinal nodes, that starts out with painless lesion *Sequel* -Reactive arthritis/Reiter's syndrome = cross-reactive immune response, most often in sacroiliac joint and knee (uveitis + urethritis + arthritis)

What is the name of the SketchyMicro sketch for Dermatophytes?

Tinea Tin Man

Dermatophytes

Tinea the Tin Man *Cutaneous mycoses fungi* -4 types = *T*richophyton, *E*pidermophyton, *M*icrosporum, Onchomycosis (*Oz*

Dracunculus medinensis, Onchocerca volvulus, Wuchereria bancrofti, Toxocara canis, Loa loa

Tissue Nematodes Screamatodes III: Return of the Flesh Eater *The horror movie set* Dracula actor. Dracunculus medinensis. Dracula actor drinking water. Transmission by water contaminated with copepods containing larvae. Untied shoes. Dracula worms, adult females, emerge from painful ulcer in skin (typically on lower extremities). Treatment is taking a match stick and slowly unraveling the worm out of the ulcer. Thought to be basis of the snake intertwined for the symbol for medicine. Fly man clutching his eye wearing a lab coat that has spots on it. Oncho. Hyper and hypo-pigmented spots that occur with onchodermatitis. Cause of river blindness. Transmission by the black fly. 2nd most common cause of infectious blindness after trachoma. Microfilariae in eye causes blindness. Microscope behind fly man. Microfilariae seen in skin biopsy under microscope. No dumping, drains to river sign behind fly man. Rivermectin as treatment. Witch that has ruffles and MC hammer pants and is coughing. Wuchereria that causes elephantiasis, a long-standing complication of lower extremity lympadenopathy. Coughing because microfilariae in lungs causing a hypersensitivity reaction. Witch reading diet and carb magazine. Diethylcarbamazine as treatment. Mosquitoes hovering around the witch. Blood smear on her hat. Mosquitoes are vector and blood smear for diagnosis. Wolfman with a poopbag and nightshades on sitting in a bended metal bar chair. Toxocara canis. Transmission by ingesting food contaminated with dog or cat feces. Larvae apparently never mature when they are inside of us and circulate on for year. Visceral larvae migrans. If the larvae gets to the eye, it is called ocular larvae migrans and can cause blindness. Treatment is albendazole. Creature from the black lagoon. Fish man who has conjunctivitis and local subcutaneous swellings all over his body. Loa loa, african eye worm. Local subQ swellings are known as calabar swellings. Blood smear across loa loa's face. Microfilariae seen on blood smear. Deer flies buzzing around the swamp man. Transmission by deer flies. Swamp man is reading diet and carb magazine. Diethylcarbamazine. Swamp man also sitting on a bent metal chair. Albendazole as another treatment to diethylcarbamazine.

Togavirus

Toga, toga, toga (arbovirus and rubella, NOT rubeola, rubeola is measles). Wearing togas. Enveloped. The turban wearing horse messenger knocking his head on the arbor. Arbovirus (short for arthropod virus, vector mosquito or ticks) as a cause of Western/Eastern/Venezuelan Equine encephalitis. Takes place in Rome to help remember roman aqueduct to help remember PDA in rubella. Child on throne represents childhood rubella. Aqueduct baby represents congenital rubella. Fanning adults represents rubella in adulthood. Toga child on the throne with rubies falling off and dangly neck pieces. Rash starts on the head and face and moves downward. Dangly neck pieces to represent postauricular/occipital lymphadenopathy. Congenital rubella represented by the yellow buddha baby on the *OPEN* aqueduct next to the torches. Holding hands over ears. Deafness. Blank eyes. Cataracts/blindness. Blue jewels. Blueberry petechial rash. Yellow. Jaundice. Open aqueduct sign. PDA. Adults. Lymphadenopathy and arthritis. Live puppet show to represent the MMR vaccination. One puppet is shown defending a pregnant lady. Do not give MMR vaccine, which is live, to a pregnant women. 200 tickets next to the puppet show. Should only be given to HIV positive patients when CD count is above 200. Same goes for the shingles vaccine (Max occupancy 200 for the senior seating). Tickets are also being ripped off into smaller pieces. Long polypeptide being cleaved. Also used in picornavirus and calicivirus sketches.

Togavirus & 2 Types

Toga-Toga-Togavirus -Arbovirus (Guy Hitting Head on ARBOR) -Rubella (Rest of Photo) *(+)-sense ssRNA*

Arbovirus

Toga-Toga-Togavirus -Guy Hitting Head on ARBOR *(+)-sense ssRNA togavirus & bunyavirus (arbor in back)*

Rubella

Toga-Toga-Togavirus -Rest of photo besides guy hitting head --Congenital, Childhood, and Adult type *(+)-sense ssRNA togavirus*

Toxoplasma gondii - PARASITE

Toxoplasmosis -intracellular parasitic protozoan -pregnant women and immunocompromised at risk -(1)pregnant women at risk of transplacental transfer ToRCHeS -(2)water or vegetables containing oocytes shed in animal feces -(3) raw or undercooked meat can transfer the cysts -can be transmitted by CAT FECES -OOCYTES in the feces ("toxo eggs") -causes MULTIPLE RING ENHANCING lesions on CT or MRI particularly in immunocompromised -encephalitis -brain biopsy to differentiate from CNS lymphoma -asymptompatic in immunocompetent people -congenital toxoplasmosis triad (1) intracranial calcifications (2) hydrocephalus (3) chorioretinitis -seizures and deafness also associated with congenital toxo -diagnosed made by serology or biopsy looking for intramuscular cysts TX: sulfadiazine and pyrimethamine prophylaxis when seropositive for IgG+ for toxo AND CD4 count <100 = TMP-SMX

Schistosoma mansoni, S. japonicum, S. haematobium, Clonorchis sinensis, Paragonimus westermani

Trematodes a.k.a. flukes San Franschisto Ocean Park Portal into the fish. Portal system. Maturation occurs in the liver. School of blue fish going one way. Schistocytes going another way. All do it the hard way and migrate against portal blood flow. Merman in the portal with a fin on his back/side. S. mansoni with a large lateral spine. Japanese tourists and the circular fish. S. japonicum. Portal about to burst. All schistocytes acutely cause a swimmer's itch. Chronically, mansoni and japonicum cause portal hypertension and potential GI hemorrhage, cirrhosis and liver failure. Asian dad wearing a yellow coat. Jaundice. Swordfish piercing a bladder-shaped jellyfish and a crab. S. haematobium (no name hook) causes hematuria and bladder cancer. Pretzel in the tank. Praziquantel as treatment. Orca. Clonorchis sinensis. Seagull on pigmented stones. Pigmented gallstones. Seagull with the robe and the crab. Biliary fibrosis and potential for cholangiocarcinoma. Eggs with yamikas on them. Operculated eggs on O and P. Penguins with lung spots feasting on crab legs. Paragonimus westermani Lung fluke transmitted through consumption of raw or undercooked crab meat with larvae. Penguin eggs with yamika. Operculated eggs on O and P.

Trichomonas vaginalis

Tricks for Money *Protozoa/Parasite of the Tissue*

Trichomonas vaginalis

Tricks for money, the Seattle magician on the street corner Seattle to help remind of the wet mount necessary to visualize the distinct looking, motile trophozoite. Magician pulling a strawberry out of his cervix looking hat. Strawberry cervix as a buzzword and cervicitis. Green-yellow hues. Malodorous green-yellow discharge. Car splashing/Seattle. Diagnosis and visualization of the distinct looking, motile trophozoite on wet mount. Street corner artist selling inflamed vagina looking paintings for 4.5 and up. Grows in pH 4.5 and up (normal vaginal pH is 4). Vaginitis. *pH, microscope, D/C comparison of vaginal infections.* Gardnerella vaginalis. Grows at pH 4.5 and up. Plants at price 4.5 and up. Candida albicans. Grows at pH 4 (does NOT change pH. Canadian playground open until 4pm (does not go higher/past 4). Trichomonas vaginalis. Grows at pH 4.5 and up. Street art next to the magician on the green street corner sold at price 4.5 and up. Thus, pH of 4.5 can narrow it down to Trichomonas and Gardnerella. Under the microscope this is what each would show... Gardnerella vaginalis. Clue cells. Candida albicans. Pseudohyphae. Trichomonas vaginalis. The distinct looking trophozoite (but they may not be that obvious and in that case *motile* is the buzzword). Discharge of each... Chlamydia. Watery. Gonnorhea. Thicker than Chlamydia. Gardnerella vaginalis. Gray-White. Candida albicans. Vaginal thrush. Trichomonas vaginalis. Malodorous yellow green.

-Splits urea into ammonia and CO2 which helps reduce acidity

Urease

Varicella zoster virus

Varicella "Zeus"-ter virus, a greek tragedy about Zeus. Hermes toy above the stage. Part of the herpes family. VZV is HHV-3. Kids with squirt guns. Respiratory droplet transmission. All ages welcome. Blisters will be in all stages of development. This is in contrast to smallpox where the blisters will all be in the same stage of development. Live show sign in the shape of syringe above the 'all ages welcome' sign. Live attenuated vaccine for varicella. Kid playing with the tank that has multinucleated giant cell camo. Tzanck smear for diagnosis. Recall HSV-1 + 2 sketch. Adult on stage represents the infection in adults. Coughing with a cane and a turban. Pneumonia in adults and encephalitis in the immunosuppressed. Blue recycling bin. Acyclovir for treatment in children 12+, adults and immunosuppressed. Woman sleeping on the roots of the trees extending outwards. Latent in the dorsal root ganglia. Rose petals in a dermatomal distribution. Zoster/shingles. Rarely crosses the midline and when it does, it is a red flag that someone is immunocompromised. Zeus striking him with a lightning bolt. Extremely painful rash of shingles. Shirtless guy without a rash, but still a lightning bolt. Postherpetic neuralgia. Pain after rash subsides. Eye patch being worn by the man on stage. Herpes Zoster Opthalmicus. Live show sign in the shape of a syringe above the 'seniors only' sign. Live attenuated vaccine for shingles. Because it is live, do not give to patients who are pregnant or immunocompromised. Max occupancy 200. Can give the vaccine to HIV patients if their CD count is above 200. Same goes for the MMR vaccine (200 tickets for next to the puppet show in the Togavirus rubella sketch). Question stem: immunocompromised, vesicles on their forehead and blindness? Herpes Zoster Opthalmicus. Family wearing recycling shirts next to the roof top with roof shingles. Famcyclovir for shingles. Violet recycling bin next to the blue recycling bin. Valcyclovir for shingles. Keep straight the treatments for each: Acyclovir for varicella in childrens 12+, adults and immunocompromised. Famcyclovir and Valcyclovir in those who get shingles. Torches around the stage. Torch infection. Doll being victimized by chicken. Stubby arms and legs, stuffing ripped out in a dermatomal distribution and a missing eye. Congenital varicella syndrome. Limb hypoplasia, cutaneous dermatomal scarring, and blindness.

Varicella Zoster Virus

Varicella Zeuster *dsDNA virus - Herpes Family*

Herpes Zoster Virus

Varicella Zeuster Shingles (recurrent VZV) *dsDNA virus - Herpes Family*

Arboviruses

Viruses that require a biting arthropod to complete the cycle Need two hosts: - vertebrate - arthropod Mostly zoonosis Small spherical RNA viruses

Mycoplasma pneumoniae

Walking on Thin Ice *Gram Indeterminate*

Mycoplasma pneumoniae

Walking on thin ice Don't eat on the ice. Eaton agar. IgG snowflakes that are clumping the RBC pucks. Cold agglutination test. Stormy weather but actually a good hockey game. Looks worse than the patient is on CXR. Hence, cause of a walking (pt. walking about) pneumonia (would typically keep a patient bedridden). Classical cause of a walking pneumonia, however, there are others. Recall non-trachomatis species of Chlamydia that produce atypical pneumonias. Hockey net has a cholesterol design in it. Only bacteria with cholesterol in it's membrane. Crow hanging on the hockey goal. Macrolides as tx. Hockey goalie wearing a military jersey with the number "<30" for high risk populations.

Epstein-Barr virus

Ye Olde Epstein Bar. Woman leaning in for a kiss. Kissing disease transmitted primarily through saliva. Knight tugging on the back of the guy's shirt. Tender lymphadenopathy. Knight reacting to having a drink spilled on him. Reactive CD8+ cells seen on blood smear. Also go by the name of Downey or atypical cells. Can also be natural killer cells. In response to the infection the T-cells proliferate which is why your lymph nodes and spleen become enlarged. Cow behind the bar with a spleen spot. Splenomegaly. Sleeping archer. When the virus encounters a new host, it targets the B lymphocytes. There it remains latent. Must B 21 to enter sign. EBV envelope glycoprotein binds CD21 to infect B cells. Guy being kissed drooling and with exudates coming out of mouth. Pharyngitis. Mono causes pharyngitis and this is often confused with strep pharyngitis. Strep pharyngitis more often seen in children and adolescents. Pharyngitis caused by mono is more likely to be asymptomatic at a young age. At older ages, mono more likely to be symptomatic. Person drawing a maculopapular rash on the sleeping archer. If mistakenly given ampicillin or amoxicillin, those infected with mono will break out into a rash. The picture of the stern owl amongst some reeds. Association with B cell lymphoma. B cell lymphomas can be divided into two main groups. Hodgkin's lymphoma and non-Hodgkin's lymphoma. Hodgkin's lymphomas are characterized by Reed-Sternberg cells that look like "owl's eyes." Associated with the mixed cellularity subtype. Bar kid dressed in African clothing eating crab puffing out his cheeks. African Burkitt lymphoma. A non-hodgkin lymphoma. Characterized by large jaw lesion and swelling. This is the endemic kind. In the non-endemic kind (less of an association with EBV), the lesion develops in the ileocecum and peritoneum. Crab pinching the Asian man's nose. Nasopharyngeal carcinoma associated with Asian EBV patients. Old hairy man sitting in the corner of the bar with a cane. Oral hairy leukoplakia in HIV patients. Characterized by white patches on the lateral aspects of the tongue. Can be confused with oral thrush of candida. Difference is that you can scrape off candida, but you cannot scrape off leukoplakia. Dart board with star shaped darts clumped on a red central target. Diagnosis of EBV through the monospot test. In the acute phase, EBV activates B cells to secrete heterophile anti-sheep red blood cell antibodies. These antibodies will clump or agglutinate sheep or horse red blood cells. IgM molecules that clump RBCs. No contact jousting in the bar. Treatment is supportive, but you must tell your patients no contact sports for risk of splenic rupture. Also known as HHV-4. Sore throat differential: strep pharyngitis, EBV mononucleosis, CMV mononucleosis. Can differentiate with amoxicillin, ampicillin and the monospot test.

Epstein-Barr Virus

Ye Olde Epstein Barr *dsDNA virus - Herpes Family*

Yersinia enterocolitica

Yersin's Pets - Yersinia Enterocolitica represented by the English Terrier (meant to sound like Entercocolitica) licking the toddlers RLQ. Petis is the cause of the bubonic plaque and has 3 adult characters in the sketch. *Yersinia Enterocolitica* Toddler on a red stool, with milk in his hands, a safety pin and being licked by an English Terrier puppy. Toddlers who play with puppies are affected (transmission through puppy feces). Contaminated milk also a source (recall Listeria). Red stool for bloody diarrhea and the safety pin is meant to represent the bipolar colony growth on plates. Cold frost on the window of the store to represent cold resistance (recall Listeria was the same). Toddler with RLQ pain, fever, elevated white count and the stem mentions puppies, think Yersinia because of it's ability to cause pseudoappenditicis. Encapsulated rodent to represent that Yersinia species are encapsulated and that fleas on rodents were how Yersinia pestis was spread. Guy with a psi picking up puppy poop = aminoglycosides as treatment. *Under zoonotics in FA is Yersinia Pestis* Prarie dog/rodent underneath the capsule. Prarie dogs and rodents as the reservoir for fleas, which carry the disease. Flea sign on the door. Fleas Fleas, causes plague. Two most common post-infectious sequelae of yersiniosis: Reactive arthritis associated withe HLA-B27 expression and erythema nodosum

Yersinia enterocolitica

Yersins Pets English Terrier *Gram-Negative Bacilli - Enteric*

Yersinia pestis

Yersins Pets Rodents *Gram-Negative Bacilli - Enteric*

Leishmania donovani + baziliensis

Zombie in the desert Zombie in brazil robe with flies buzzing around him. Cutaneous form caused by the braziliensis strain. Vertebrates are host (humans), sandflies are the vector (think desert scene). Goats in cages. Amastigotes are the intracellular form, seen within macrophages. Promastigotes are what is seen in the vector. Amastigotes are what would be seen in hosts. Hyperpigmented spots on Donovan. Visceral leishmaniasis caused by the donovani strain. Black fever, or kala-azar caused by visceral leishmaniasis. Fever of donovan. Fever caused by visceral. Pan of meats. Pancytopenia in visceral. Cow with liver and spleen shaped spots. HSM in visceral. T-bone steak offering *for the zombie.* Stibogluconate for cutaneous leishmaniasis. Frogs. Amphotericin B for visceral leishmaniasis.

spillng of hydatid cyst causes

anaphylaxis

mechanism of aminoglycoside resistance

antibiotic modifying enzymes

intraerythrocytic ring forms

babesiosis

inc procalctonin indicates

bacterial infection

resp epi with cuboidal

bronchioles

psuedohyphae

candida

Coxiella burnetii - BACTERIA

cause of Q fever -pneumonia, headache, cough and fever -MAY CAUSES HEPATITIS -gram negative -no rash -once classified as rickettsia species -obligated intracellular organism -forms a spore structure that can survive in the GI of animals -contained in spore like structure in animal poop -transmitted to humans in aerosol transmission -immunocompromised can cause endocarditis -vets can receive an acellular vaccine- may transmit by birthing a baby animal -pasteurized milk can kill most organisms treatment - self limiting and goes away in 2 weeks

Trichomoniasis vaginalis - PARASITE

causes vaginitis and cervicitis -cervicitis described as "strawberry cervix" -vaginitis cause symptoms of burning and itching and malodorous discharge -symptoms include yellow green discharge -wet mount KOH prep -distinct MOTILE TROPHOZOITES seen on wet mount -pH of vaginal fluid 4.5 and up with infection -sexually transmitted infection, STD treat both partners -Treatment: METRONIDAZOLE

elimination of intracellular pathogens reliant on

cell mediated immune reposnse

eradicates active malarial infection

chloroquine

activates adenylate cyclase via Gs ADP ribosylation, inc cAMP production in the host cell, causes secretory diarrhea, dehydration and electrolyte imbalances

cholera toxin

Ganciclovir MOA

comp inh incorporation of GTP into CMV DNA strands by DNApoly

Difficult vocabulary words condyloma acuminatum condyloma lata opisthotonos risus sardonicus trismus coryza erythema marginatum erythema migrans erythema multiforme erythema nodosum erysipelas

condyloma acuminatum = genital warts caused by HPV (HPV pill bug sketch, interferon arcade - Pacht-derm man game) condyloma lata = genital warts caused by syphillis (the wart like planet being pointed at by the character representing secondary syphillis in the treponema pallidum space observatory sketch). opisthotonos = arched back spastic paralysis (C. tetani rhesus monkey research sketch) risus sardonicus = raised eyebrows and open grin (C. tetani rhesus monkey research sketch) trimus = lockjaw (C. tetani) coryza = rhinitis (not all-inclusive, measles weasles and board and care of the disabled Gi, the catarrhal phase) erythema marginatum erythema migrans erythema multiform. Many causes, but typically HSV-1. erythema nodosum. Histo or cocci. More associated with cocci. Indicates a robust immune response and generally only seen in healthy people. erysipelas

campylobacter jejuni - BACTERIA

curved gram neg rod of the digestive tract (this is one of three curved) -oxidase positive (as are all the other two curved) -thermophilic - grows at 42 degrees celsius (intrinsically linked to heat) -poultry reservoir -bloody stool -invasive -reactive arthritis (Reiters syndrome) -Guillain-Barree syndrome- ascending paralysis (remember botulism is descending paralysis)

induces actin depolymerization

cytotoxin B (C diff)

pharyngitis with exudates cervical lymphadenopathy unvaccinated

diptheria

HPV

dsDNA

harbored by white tailed deer

ehrlichia chaffeensis

binds HIV gp41, inhibits viral entry

enfuviratide

Intestinal nematodes - PARASITES enterobius vermicularis - pinworm Ancylostoma duodenale hookworm Necatar Americanus hookworm Ascaris lumbricoides Strongyloides stercoralis Trichinella spiralis

enterobius vermicularis PINWORM -female pin worms lay eggs at the anus -fecal oral route -scotch tape test shows eggs under the microscope TX: Pyrantel pamoate and ALBENDAZOLE Ancylostoma duodenale and Necatar Americanus hookworms -hookworm larvae penetrate skin of soles of feet -bloods stream -> lungs -> GI tract (matures in GI tract) -severe iron deficiency anemia because they suck on blood -eggs in stool -high eosinophil count (esophinophilia) TX: Pyrantel pamoate and ALBENDAZOLE Ascaris lumbricoides - giant roundworm -bloods stream -> lungs -> GI tract (matures in GI tract) -respiratory symptoms -intestinal obstruction occurring and ileo-cecal valve -eggs in stool -high eosinophil count (esophinophilia) TX: ALBENDAZOLE Strongyloides stercoralis -larvae penetrate skin of soles of feet -bloods stream -> lungs -> GI tract (matures in GI tract) -larvae hatch from eggs laid in intestinal wall, penetrate wall, enter blood stream -LARVAE in stool -high eosinophil count (esophinophilia) TX: ALBENDAZOLE and ivermectin Trichinella spiralis -undercooked meat like pork or bear -periorbital edema -vomiting and fever -larvae enter blood stream and travel to striated muscle where the larvae forms cysts within the striated muscle -severe myalgia and muscle inflammation -high eosinophil count (esophinophilia) TX: ALBENDAZOLE

superantigens that acts at GI tract causing vomiting

enterotoxin (S aureus)

inhibits HIV and target cell coming together

fusion inh

Enfuvirtide

fusion inhibitor

Actinomyces israelii- BACTERIA

gram POSITIVE branching (filamentous) rod -obligate anaerobe -normal flora of the oral cavity -infection happens with jaw trauma (like dental procedure) -cervical facial actinomyces -formation of sinus tracts that drain pus of yellow sulfur granules TX: penicillin G and surgical drainage (for more complicated infections)

amphotericin B AE

hypokalemia, hypomagnesemia (renal tox)

acyclovir MOA

inh viral DNA polymerase

inh HIV DNA integration into host genome

integrase inh

Raltegravir

integrase inhibitor

dolutegravir

integrase inhibitor

Listeria monocytonegenes - BACTERIA

is gram positive bacillis -infections in pregnant women (20x more likely) -pregnant women are discouraged from eating soft cheese may lead to early termination or disease in newborn -3rd MCC of meningitis in the newborns -in adults over 60 can cause meningitis -narrow zone of hemolysis when plated -beta hemolytic -facultative intracellular -TUMBLING motile extracellularly on LM -ACTIN ROCKETS intracellular and can jump from cell to cell -catalase positive -survives and multiplies in near freezing temperatures (can contaminate things even in the refrigerator) -contaminates UNPASTEURIZED milk and soft cheeses TREATMENT AMPICILLIN esp to cover elderly getting meningitis

MacConkey agar

lactose fermenting enterics. Form pink colonies. Represented in sketches by the pink milk carton. Narrows it down to a few. E. coli The dinosaurs. Enterobacter (pterodactyl), Serratia (triceratops), and Klebsiella (club tail) Caveat: Serratia grows slowly on the culture. However, other ways to culture Serratia.

3 parts of LPS (gm -)

lipid A, core polysaccharide, O side chain

where does malaria remain dormant

liver

AE of ganciclovir

low blood counts

Plasmodium (4) species - PARASITE Plasmodium malariae Plasmodium vivax, Plasmodium ovale, Plasmodium falciparum

malaria -fever, HA, pts often have splenomegaly and anemia -diagnosis by blood stain and Giemsa stain to see parasites in RBCs -anopheles mosquitos carry sporozoites in saliva -sporozoites mature to trophozoites in liver -schizont divides into merozoites which burst from hepatocytes and infects RBCs -lifecycle continues to RBC: trophozoite -> schizont -> merozoites ->infect RBC -ring form of immature schizont shape in it -merozoite can also form gametocyte (sexual form of plasmodium) Plasmodium malariae -Quartan fever cycle - occurs on day 1 and on 72 hours later occurs again (day 4) Plasmodium vivax and Plasmodium ovale -treat them the same -produce dormant formed in the liver called hynozoites -hypnozoites in hepatocytes -Tertian fever cycle - fever on day 1 and 48 hours later occurs again on day 3 Plasmodium falciparum -most severe illness -fever patterns are irregular -pts may present with neurological symptoms as cerebral malaria (occluding vessels to the brain) -parasitized RBCs occlude vessels to kidneys and lungs -banana shaped in the peripheral blood smear -sickle cell disease is protective against P. falciparum TX: -chloroquine- works by blocking plasmodium heme polymerase -primaquine- destroys hypnozoites in hepatocytes (check for G6PD deficiency before taking this can cause severe anemia) -mefloquine- good against resistance species; prophylaxis medication for travelers in chloroquine resistant areas -atovaquone/proguanil- prophylaxis or treatment drug better for resistant species; prophylaxis medication for travelers in chloroquine resistant areas -artemisins for severe Plasmodium falciparum infections (atovaquone/proguanil can also be used here) -IV artesunate for severe malaria infections -IV quinidine for severe malaria infections; side effects is cinchonism, including tinnitus and HA

inh HIV entry by blocking the HIV gp120 allosteric interaction with CCR5

maraviroc

prevent hematogenous spread of candida

neutrophils

Disinhibits adenylate cyclase via Gi ADP ribosylation, increasing cAMP production in the host cell, causes increased histamine sensitivity and phagocyte dysfunction

pertussis toxin

CD4 less than 200

pneumocystis jirovecii

eradicates hypnozoites of malaria

primaquine

chancre

primary syphilis

inh HIV polyprotein cleavage

protease inh

Atazanavir

protease inhibitor

Indinavir

protease inhibitor

Ritonavir

protease inhibitor

darunavir

protease inhibitor

lopinavir

protease inhibitor

Clostridium botulinum

robotulism (children eating spores in the honey vs. eating preformed toxins, canned food and adults). A gas mask researcher (does not have G and G on his suit) uses orange scissors to cut the powerline from the ACh battery to the robots. One robot is seen trying to revive the floppy robot baby with honey. Also on the table and covered in honey are metal 'nuts.' Tetani and botulinum both cleave SNARE but in different places. Botulinum cleaves SNARE at the NMJ, while tetani cleaves SNARE in the renshaw cells of the spinal cord. Ingestion of spores (metal nuts = walnuts) in honey leads to floppy baby syndrome. Causes flaccid paralysis (contrast tetani, which causes spastic paralysis). Adults can handle the spores, but they can't handle the preformed toxins, which exist in canned food (why we are always told to heat canned food thoroughly and the oxygen-less atmosphere of the canned food is perfect for the survival of the obligate anaerobic clostridium species). Adult disease = ingestion of preformed toxins. Infant disease = ingestion of spores. Likely won't give canned food in the question stem, but will mention someone about a whole family experiencing neuro symptoms after eating dinner.

fever FOLLOWED by rash

roseola (HHV-6)

villous blunting of the duodenum and jejunum rna virus

rotovirus

sterilizing equipment fail

spore forming bacteria- bacillus species and clostridium species

Coronavirus- VIRUS

ss RNA virus -Positive sense virus -encapsulated virus -HELICAL SHAPED virus - unique to coronavirus -can cause common cold -acute bronchilits, can lead to acute respiratory distress syndome -SARS -replicates in the cytoplasm (like all POSITIVE sense RNA virus)

proliferative endarteritis of small vessels with surrounding plasma cell rich infilrate

syphillis

gummas

tertiary syphilis

HPV affects what cords

true vocal cords

resp epi with squamous stratified

true vocal cords

Trypanosoma brucei - PARASITE trypanosoma brucei gambiense trypanosoma brucei rhodesiense

trypanosoma brucei gambiense trypanosoma brucei rhodesiense -tsetse fly vector for these parasites - PAINFUL bite -sleeping sickness -endemic to western and southeastern Africa -AFTER biding the parasites move from the blood to the lymph nodes -cervical and axillary lymphadenopathy -recurrent or undulating fevers -coma - one of the only parasites to penetrate the CNS -trypomastigotes seen on blood smear -variable surface glycoproteins coats, undergoing constant antigenic variation (enabling chronic infection - hence the recurring fevers) -motile with a single flagella -TX melarsoprol treatment - CNS infection -TX suramin treatment - peripheral blood infection (think suramin for the serum)

flu vaccine inhibits

viral entry