Sketchy Micro

Clostridium perfringens

Private Ringen's motorcyle class Gram positive Soldier fallen off motorcycle: motorcycle accidents and deep wounds from military combat exposed to dirt and dust walnuts: spore forming pots of soil: in soil gas mask: obligate anaerobe gas rising: gas gangrene(clostridial myonecrosis) crackling sound on palpation gas formed under tissue as organism consumes carbohydrates alpha flag: necrosis due to alpha toxin clothes pins: lecithinase: cleaves lecithin, a phospholipase, causing damage to membranes smashed tomatoes: hemolysis double fine zone: double zone of hemolysis on agar Pencil: IV Penicillin G Food poisoning ingest large amount of spores which germinate and then produce toxin knocked over slow sign: late onset transient diarrhea

rickettsia prowazekii

Pro Boot Camp inside: obligate intracellular white crowd: poor staining Rickett's tires, COAch, NAD+ play starts in middle and moves out: rash starts on trunk, moves out red except helmets glove and shoes: rash general coach: military and prisoner of war camps are at risk football: louse poop into blood The Outbreak: epidemic typhus myalgia, pneumonia, encephalitis, dizziness and confusion

Enterococcus faecium and faecalis

Protest the caucus purple court house: gram positive entero: intestinal California people: faecalis, more common Stop the Fees sign: faecium, less common Buff protester: faecium is more dangerous Resist the 6.5% N. Ca: can grow mediums in 6.5% NaCl Boots: bile resistant 3 main infections: Do U Heart Trees sign: U: UTI Heart: endocarditis Tree: biliary tree infections Can't get protesters in van: VRE: vancomycin resistant enterococcus Tiger striped police Line: use linezolid or tigecycline

Clostridium difficile

Field Trip to the Chocolate Factory Gram positive rod walnuts: spore forming nosocomial diarrhea clean sign: clindamycin causes c. diff chocolate: diarrhea exotoxins: work station A: exotoxin A binds to brush border of intestines and causes inflammation and cell death and watery diarrhea A for apple Brushing apples: brush border Work station B: exotoxin B B is for Black licorice: actin filaments Kid eating licorice: depolymerizes actin, enterocyte death and necrosis Worker packaging candy: yellow gray exudate that forms pseudomembrane over mucosa contaminated shoe: PCR assay to look at toxin gas mask: obligate anaerobe van with tongue: oral vancomycin metro: metronidazole

Francisella tularensis

Francis the Rabbit Rabbit: main reservoir dermacentor ticks: vector raddish: gram negative, coccobacilli open cage: facultative intracellular rabbit hole: ulcer at site of tick bite tunnel: lymph system collection of radishes: granulomas with caseating necrosis dirt mounds: regional lymphadenopathy sigh, rake: streptomycine, aminoglycoside tularemia

Strep agalactiae (Group B strep)

Galactic Baby Purple planet: gram positive Galactic baby: agalactiae baby: serious infections in newborns stuffed hippo: hippurate positive test, hydrolyzes sodium hippurate clear capsule helmet: polysaccharide capsule tent: CAMP test positive red B lightbulb: beta hemolytic Basset hound can't lick baby: bacitracin resistant space helmet: #1 cause of meningitis in neonates red baby clothes: neonatal sepsis baby coughing: pneumonia arrow: group b strep and staph aureus synergistic hemolytic mother ship: baby gets infection from passing through vaginal canal 35wk: at 35 weeks all pregnant women are swabbed in vagina and rectum to see if they are colonized for strep agalactiae pencil: if mom has colony, treat with intrapartum (during birth) penicillin

Campylobacter jejuni

Gram negative Rod Camping Guy and the Bears: Guillain Barre syndrome, immune system attacks nerves sausage links tied around bear cub: demylenation of peripheral nerves starting with lower extremities, paralysis fire: thermophilic, prefers to grow in heat roasting chicken: main reservoir is intestinal tract of poultry fecal oral transmission red stool: bloody diarrhea curved mustache: curved gram negative blue ring: oxidase positive bear cub invading cooler: invasive, bacteremia knee slap: reactive arthritis, reiter syndrome

Klebsiella pnemonia

Gram negative Rod Enterodactyl, Triserratiatops and Kleb-Tailed Dinosaur Oxygen mask: pneumonia urine: UTI hospital: nosocomial infections, hospital acquired pills on ground: multi-drug resistant carbopenim: resistance usually not seen pink milk carton: ferment lactose, MacConkey agar shows up pink stuck to table: immotile 3 spikes with A's: alcoholics, abscesses, and aspiration scales: capsule Jelly spilling: currant jelly sputum Chest X-ray lesion: might at first think it is TB ammonia bottle sprayed at klebsiella: urease positive

Serratia marcescens

Gram negative Rod Enterodactyl, Triserratiatops, and Kleb-Tailed Dinosaur Oxygen mask: pneumonia urine: UTI hospital: nosocomial infections, hospital acquired pills on ground: multi-drug resistant carbopenim: resistance usually not seen pink milk carton: ferment lactose, does so slowly so sometimes can get a negative test result charging: arm up red dinosaur: red pigment when cultured, ring around shower

Proteus mirabilis

Gram negative Rod The God of the Public Restroom Proteus: god of the sea octupus: demonstrates swarming motility when plated helmet with stag horns: staghorn calculi ammonia spray: urease positive, creates alkaline environment stone: struvite kidney stone formation Bathroom: UTI fish in bathroom: fishy odor smelly rotten eggs: sulfonamides

Yersinia enterocolitica

Gram negative Rod Yersin's Pets English terrier: enterocolitica puppy poop: transmitted through puppy feces toddler: toddler's affected baby bottle milk: can be transmitted through milk products icycles: resistant to cold temperatures safety pin: bipolar staining capsule: capsule red stool: bloody diarrhea systemic fever, leukocytosis, abscesses, intestinal perforation, necrotic small bowel, etc. dog licking right lower quadrant: mimic appendicitis

Yersinia pestis

Gram negative Rod Yersin's Pets cause of the black plague rodents: prairie dog and rats are main reservoirs flea spray: transmitted by fleas guy with swollen armpits: bubous, swollen tender lymph nodes turkey baster: type 3 Yops secretion sigh: streptomycin bicycle wheel: with tetracycline for treatment vaccine

Enterobacter

Gram negative rod Enterodactyl Oxygen mask: pneumonia urine: UTI hospital: nosocomial infections, hospital acquired pills on ground: multi-drug resistant carbopenim: resistance usually not seen pink milk carton: ferment lactose, does so slowly so sometimes can get a negative test result flying: motile

Strep pyogenes (Group A Strep)

Pie Bakery Purple coat: Gram positive Pie baker: strep pyogenes Glass capsule: Group A strep is encapsulated hot apple pie: hyaluronic acid makes up capsule red B lightbulb: beta hemolytic Pie baker genie: Pyrogenic infections: honey crispy pie: impetigo Basset Hound eating sweets: bacitracin sensitive red handkerchief: strep throat, pharyngitis big red mittens: cellulitis, most common cause erysipela( well demarcated borders, very superficial) Mast chef: Rheumatic Fever red handkerchief: starts after strep pharyngitis infections M on hat: M protein, main virulence factor Chef can't grab cupcake: interferes with opsonization Pope hat: Molecular mimicry, M protein mimics myosin in heart and causes body to attack own heart, affects mitral valve causing mitral stenosis JONES cupcakes: joints (polyarthritis), heart problems (myocarditis, pericarditis, valvular damage leading to murmurs), nodules (subcutaneous on arms and knees), erythema marginatum (rash with thick red borders), sydenham's chorea (rapid involuntary movement, especially of hands and face) Twisted cord: Post strep glomerulonephritis Damage due to circling antibody/antigen immune complexes that deposit into glomeruls symptoms: brown cord: dark brown cola colored urine, swollen face: facial edema calendar: 2 weeks after strep infection Red handkerchief and honey crusted crumbs: can happen after pharyngitis or impetigo ( superficial infections) Pencil: treat with penicillin Even though the chef has pencil, he can STILL get glomerulonephritis Virulence: Leaking jelly filled donuts: streptolysin O/ makes s. pyrogenes beta hemolytic muffins with phosphates on them: Streptokinase, converts plasminogen to plasmin (fibrinolytic) -given as medication to prevent clots during MI's or strokes twists: DNase, depolymerize DNA Toxin infections: SPE: streptococcal pyrogenic exotoxin Scarlet fever, speA and C : reddening and swelling of tongue (strawberry tongue), red handkerchief-pharyngitis, widespread rash that spares face-red icing on gingerbread Toxic shock like syndrome: SpeA and C lightning bolt cape: superantigen, shock Flesh eating bacteria: necrotizing fascitis burnt gingerbread man with no leg: invades fascia and spreads rapidly Burnt: speB Tongs: antibodies Lady buying donuts: Antistreptolysin O titer: tell us whether or not we previously had a group A strep infection

Clostridium tetani

Rhesus Research Revolution tetanus Gram positive rod gas mask: obligate anaerobes walnuts: spore forming barbed wire: inside puncture wound closed off to air, rusty nails or barbed wire spastic paralysis, relentless muscle contractions and rigidity Rhesus monkeys grinning: risus sardonicus, lock jaw monkey arching back: opisthotonos= arching of back tetanus toxin/tetanospasmin: scissors: protease Snare trap: cleaves SNARE guy trapped in net: inhibits exocytosis of neurotransmitter into synapse G and G labs: inhibits release of inhibitors GABA and glycine monkey with wrench and saw: GABA and glycine release from Renshaw cells sense overactivity of motor neurons orange syringe: toxoid vaccine pots of soil: soil

Rickettsia rickettsii

Rickett's rock climbing competition inside poor gram staining rocky mountain spotted fever rock climbing holds: ticks, dermacentor tick, direct biting 2-14 days before rash rash on ankles and wrists then moves centrally headache, sweating, fever, sever muscle pain

Clostridium botulinum

Robotulism gram positive rod canned robots: improper canning of food allows spores to survive, ingestion of preformed toxin walnuts/ mechanical nuts: spore former gas mask: obligate anaerobe droopy eyes: flaccid paralysis, starts superior and moves down, ptosis only affects peripheral nerve system, can't cross BBB Ach current: almost same toxin, cleaves SNARE protein, attacks motor neurons that release acetylcholine robot baby: flaccid paralysis, "floppy baby syndrome" honey: baby ingests toxin spore and get sick because no competition of microbiome yet

Legionella pneumophila

S.S. Cysteine Joins the Legion Gram negative rod silver ship: silver stain coal: charcoal yeast extract anchor and SS Cysteine: cysteine and iron Legionaire's disease: sailor smoking: smokers cargo storage in map: unilobar infiltrate salt falling into water: hyponatremia paint can hitting sailor: neurologic symptoms, headache and confusion paint on pants: diarrhea fire: high fever Old pontiac: pontiac fever, fever and malaise culture respiratory sputum: 3 to 5 days sailor peeing into water: rapid urine antigen test crows: macrolides flowers: flouroquinolones blue ring: oxidase positive

mycoplasa pneumoniae

Walking on Thin Ice walking pneumonia outside: no cell wall ringed net: cholesterol in cell membrane, sterols patchy clouds: X-ray appears much worse than the patient feels, patchy infiltrate camo jersey: young adults in areas of close contact, military recruits snowflakes: cold agglutinins, clumping of RBC's in cold temps due to igM don't eat on ice: eaton's agar crows: macrolides

rickettsia

rickettsia tennis inside: obligate intracellular crowd is white: doesn't gram stain well COAch: CoA needed NAD+ energy drink: bacteria need NAD+ pink tennis balls: coccobacilliary shape, weakly gram negative Will and Felix: Weill-Felix Test, agglutination test headache and fever bright red tennis net strings: vasculitis red bumps on court: rash Rickett's tires: doxycycline giemsa

Neisseria meningitidis

A Shocking Death on Campus College dorm: spread through respiratory droplets (sneezing, kissing, coughing, etc.) in closed dorms malt liquor: only meningitidis ferments maltose, both ferment glucose swab at top of bottle: first colonizes nasopharynx syringe capsule: polysaccharide capsule that inhibits phagocytosis Syringes under A, C, and D but not B: Type B capsule not included in vaccine, causes most infections sickle and hammer flag: sickle cell and asplenic patients more at risk envelopes on fire: LOS proteins cause inflammatory response, LOS blebs sprinklers: inflammation leads to leaky capillaries wet spots on carpet: petecchiae rash Spotted boxers: petechial rash indicates thrombocytopenia shocked outlet: capillary leakage leads to hypovalemia and shock water tower: adrenal insufficiency is fatal, water house-friderichsen syndrome overall mortality rate with antiobiotic treatment: 15% firefighter with three axes "TRI AXES": third generation drug, ceftriaxone Friends looking over, rifle on police man: close contacts get rifampin prophylaxis

strep pneumoniae and viridans

Alpha Knight Tournament purple flags: gram positive alpha knight tournament: alpha hemolytic green a: green hue with alpha hemolytic numero uno: pneumoniea armor: polysaccharide capsule exposed chin: optochin sensitive lancet: lancet shaped diplococci mud: bile soluble rust chest: rust colored sputum, lobar pneumonia MOPS: meningitis, otitis media, pneumonia, sinusitis/ most common bacterial cause for all of these cracked IgA dimer shield: protease that cleaves IgA sickle: patients with sickle cell at high risk for strep pneumoniae crows: MACROLIDE, susceptible to erythromycin Three axes flag: third generation, ceftriaxone Sign of where to sit: -Adult vaccine: 23, IgM response -Children vaccine: 7, IgG response Strep veridans: no armor: no capsule chin covered: optochin resistant donkey boots: bile insoluble nasty donkey teeth: dental caries Pope hat: subacute endocarditis, effects previously damaged mitral valve plate on jester: veridans adheres to platelets deck of cards: makes dextrans from glucose to stick to plate

Bartonella henselae

Bart the Leopard Gram negative Rod cat scratch fever Van Gogh's starry night: special stain, warthin-starry stain, silver stain scratched princess shoulder pads: enlarged lymph nodes man: bacillary angiomatosis in immunocompromised people, get raised red vascular lesions all over skin (HIV) bicycle wheel: doxycycline for angiomatosis crows: amacrolide azithromycin for cat scratch

Staph epidermidis

Beauty and the Plumber COVERS ALL OF SKIN, GOOD AT MAKING BIOFILMS purple curtains: gram positive plumber: staph epidermidis hardware plumbing: infects artificial joints tubing under sink: infects catheders heart shaped knob: most common cause of endocarditis affecting artificial heart valves gunk: biofilm van: vancomycin dirt on plumber's hands: part of normal flora drip pan with dirty liquid dripping into culture: contaminates blood cultures exposed belly button: novobiocin sensitive cat: catalase positive ammonia spray bottle: urease positive CONS: bowl of jello untouched: coagulase negative

Staph saprophyticus

Beauty and the Plumber purple curtains: gram positive belly button not exposed: novobiocin resistant flirty female: common cause of UTI in sexually active females yellow drink: UTI cat: catalase positive ammonia spray bottle: urease positive CONS: bowl of jello untouched: coagulase negative

Bordetella pertussis

Board and Care gram negative rod whooping cough highly contagious, respiratory, attaches to respiratory epithelium using pilli and releases toxin streamers: filamentus hemagglutinin pertussis toxin: bowtie: ribosylates Gi GI uniform: Gi wheelchair: disable Gi protein military camp: rise in cAMP when Gi is inhibited popcorn: disables chemokine receptors for lymphocytes, cannot enter lymphoid tissue, lymphocytosis adenylate cyclase toxin EF shield: increases cAMP by acting like adenylate cyclase, acts like anthracis EF toxin tractor: tracheal toxin: dirt road: trachea cutting grass: damages ciliated cells in respiratory epithelium catarrhal phase: 1-2 weeks, conjuctival injection and lacrimation whoop airhorn and coughing: paroxysmal stage: 2 weeks to months, cough convalescent stage: 3 months, gradual reduction of symptoms 100 day's war: "100 day cough" crows: macrolide DTaP vaccine: diptheria and tetnus as well as acellular pertussis

Brucella

Bruce Farms Gram negative rod Cattle and farm animals direct contact with animals such as vet milk bucket: consumption of milk or cheese open cage: facultative intracellular skinny and hot farmer: fever, chills and anorexia hills: undulate fever spots on cow: spleen, liver, and lymph nodes fish bones: osteomyelitis windmill with bicycle wheel: doxycyline rifle: add rifampin

Vibrio cholerae

Colonel cholera's base cAMP gram negative rod southeast asia: endemic to underdeveloped nations Mustache: comma shaped mustache rice patties in water: watery diarrhea, 10 to 20 liters a day, looks like rice water outhouse: transmitted through fecal orally poor water systems raft: one bacteria rope: cholera does not invade mucosa, uses fimbraie to attach to intestinal wall and secretes cholera toxin Base cAMP map: toxin increases cAMP GS bottles: activates Gs pathway, binds to and activates adenylate cyclase colonel drinking water: oral rehydration lemon slices: grows in alkaline media, acid labile blue ring: oxidase positive

Corynebacterium diphtheriae

Corazon de la corrida: gram positive rod non spore forming club shape, Y or V formation, moracas: analine dye stains metachromatic granules red and rest blue exotoxin A (active subunit) and B (binding subunit) green bow:ADP-ribosylation elongating accordian: elongation factor-2, inhibits ribosomes and protein synthesis kids eating gray cotton candy: pseudomembranes over oropharynx transmitted by respiratory droplets bull's neck: thickening of the neck due to lymphadenopathy heart shaped cape: myocarditis, arrthymias and heart block man eating sausages: toxin damages nerve fibers, local paralysis in pharynx Tele screen: tellurite agar kid laughing watching show: loeffler's medium bull licking matador: elek's test, in vitro assay on filter paper, if toxin binds there is a reaction spain: immigrants green DTaP: toxoid vaccine

E. coli

E. cola's Soda Fountain Gram negative rod pink milk: ferment lactose, pink on macconkey agar capsule surrounding cake: K antigen capsule green coasters: metallic green on EMB agar hair braids: fimbriae cat: catalase positive UTI glass: number 1 cause of UTI's strawberry milkshake: number 1 cause of gram negative sepsis, LPS endotoxin meningitis helmet: only can cause neonate meningitis if is positive for K factor EHEC hamburger: undercooked meat spilling ketchup: bloody diarrhea sorbitol free soda: only e. coli that does not ferment sorbitol shigorilla happy meal toy: inhibits 60s ribosomes, shiga-like toxin Hemolytic Uremic Syndrome damage glomerular cells : glomerular straw dirty sticky plates: platelet aggregation and decrease platelet count popped balloon: hemolysis E Cola Burger for $1.57: serotype that causes massive outbreaks: 0157:H7 ETEC truck: traveler's diarrhea water delivery: transmitted via water sources eL Agua: heat labile toxin that increases cAMP, similar to cholera toxin San Gabriel: heat stable toxin increases cGMP standing on stool with water: watery diarrhea EPEC P for pediatric infant diarrhea in developing countries adhesins for tight adherence: intimin binds to enterocytes via bundle-forming pilus induce loss of microvilli and enterocyte death food borne ingestion, 1-2 day incubation watery diarrhea, fever, vomiting, malnutrition type 3 secretion EIEC diarrhea, dystentery bacteria spread in cytoplasm and destroy epithelium, colonic ulceration fecal-oral, 2-3 day incubuation initial watery diarrhea, then fever abdominal cramps blood and leukocytes in stool EAEC persistant watery diarrhea in children bacteria in stacked brick arrangement over small bowel epithelium, biofilm watery, secretory diarrhea with inflammatory cells, fever, nausea, vomiting, abdominal pain

Bacillus

Gram positive rod King Anthra's Axe Bacillus anthracis Black center with fire flames around: black eschar wound ships: in chains armor: capsule leather: capsule made of protein D belt buckles: polyD-glutamate (protein) aerabello: obligate aerobe Walnuts: forms spores: sent in envelopes Two toxins: must both be present to cause symptoms LF shield: lethal factor exotoxin that acts as protease, cleaves map kinase which controls cell growth -tissue necrosis map: map kinase burn: black eschar EF shielf: edema factor -functions as adenylate cyclase, ups cAMP, fluid goes into extracellular space, edema inhibits host defenses and prevents phagocytosis Sheep's wool: woolsorter's disease/pulmonary anthrax: spores germinate in lungs dry cough large ax in blood: pulmonary hemmorrhage, almost 100% mortality rate large rope on ship: widened mediastinum flower: flouroquinolones bicycle tire: secondary is doxycycline Bacillus cereus also aerobic and spore forming guy eating rice: food poisoning, vomiting and diarrhea after eating reheated fried rice

Helobacter pylori

Helicopter Pilot helical shape Gram negative rod helicopter wings: flagella, motile mustache: curved ammonia bottle: urease positive urea breath test, swallow urea with radioactive carbon, if exhale radioactive carbon then urease positive organism in stomach biospy during endoscopy, test with rapid test blue ring: oxidase positive bullet holes: 95% duodenal ulcers caused by this pathogen crab: 50% adenocarcinomas linked to pathogen pile of tissues: lymphoma of mucus associated lymphoid tissue (MALT), maltoma will go away if you treat h. pylori triple therapy: gasoline pump to helicopter, proton bomb is blocking pump: proton pump inhibitor ammo box: amoxicillin crows: amacrolide keep clear: clarithromycin

Actinomyces israelii

Israeli Soldier Gram positive branching rod tree branches: branching rod gas mask: obligate anaerobe normal flora of oral cavity jaw wrap: cervicofacial actinomyces infection canal storm drain: non-tender lump on jaw, abscess, yellow pus from infection yellow rocks: pus has yellow sulfur granules in it pencil: penicillin G

Pasteurella multocida

Louis Pasteur's Lab gram negative rod Dog bite: respiratory tract of small mammals like cats and dogs cellulitis in first 24 hours, possible osteomyelitis lymphdenopathy and spread systemically in people with predisposing conditions cat: catalase positive blue ring: oxidase positive capsule: capsule sheep's blood: grows on 5% sheep's blood agar safety pin: penicil: penicillin use penicillin with beta lactamase inhibitor: amoxicillin and clavulanic acid

Nocardia asteroides

No Card Game for Old Men gram positive branching rod erobella: obligate aerobe cactus pot: found in soil cowboys shawl with chaps and tassels: mycolic acids pink gun: light acid fast staining, carbol fuschin stain cat: catalase positive ammonia spray bottle: urease cane: affects immunocompromised patients, HIV, transplant, glucocorticoids affects men more than women coughing, bullet hitting badge: pulmonary, pneumonia with lung abscess bullet in hat: CNS: brain abscesses red cowprint: pyogenic response, lesions, cutaneous rotten eggs: sulfonamides

Neisseria

Noir Series Bright red handcuffs: Gram negative diplococci Blue ring: Oxidase positive cannot grow in blood agar due to certain inhibitors, if you heat the agar it makes the inhibitors inactive chocolate bar: chocolate agar/heated blood agar VPN: special agar enriched with vancomycin, polymixin, and nystatin Thayer Martin: alternative name for VPN agar Mac the Private Eye: complement deficiencies of C5 to C9, can't form membrane attack complex (MAC), leading to increased neisseria infections 5 to 9 pm: C5 to C9 Virulence: pocket watch chains, different metals: Pillis allows attachment to mucosal surfaces and antigenic variation, prevents lasting immune response Ace card: IgA protease

Shigella

She-Gorilla's Circus Gram Negative Rod green tutu: hektoin agar green colonies, used to differentiate from salmonella chain: shigella is immobile tight rope walker over acid: acid stable, doesn't need many organisms to cause problems M cannon: induces M cells to phagocytose them, but then escapes before broken down Shoot out of cannon: in cytoplasm use cytoskeleton to make a tail to go from one cell to the other facultative intracellular red stool around flames: fecal blood and leukocytes (inflammatory) turkey baster: type 3 secretion system to create inflammatory cytokines Shigella dysenteriae SHIGA TOXIN hourglass: binds to 60s ribosomes and inhibits translation infection can precipitate hemolytic urea syndrome signs of acute renal failure red balloons: hemolysis glomerular whip: glomerular damage plates: drop in platelet count, platelet aggregation young ring master: HUS under 10 years of age usually

Mycobacterium tuberculosis

Shootout at the TB Corral gun slinger: acid fast, carol fuchsin stain tassels: meicholic acids 2 to 6 weeks for growth Lowenstein general store: lowenstein-jensen medium: starch, egg, inhibit other bacteria erobella: obligate aerobe respiratory droplets cage: proliferates in macrophages lasso: glycolipids that clump bacteria into serpentine shape (cord factor), increases TNF-a, creates granuloma dust clouds near spurs: sulfatides preven phagocytosis fusion cactus: primary infection leads to three different outcomes: lower to middle lobes fibrotic calcified lesion = Ghon complex kids sleeping in burlap sack: prolonged fever, found in children, becomes latent 1. healed latent infection millet seeds: 2. systemic infection (miliary TB) bacteremia 3. reactivation TB TNF barrels: inhibition of TNF-a upper lobes screen with PPD before giving someone a TNF-a inhibitor prisoner coughing blood: cough, night sweats, hemoptysis stack of cracked pots: Pott's disease= TB affected spinal column, demineralization of the bone hat shot off: meningitis or cavitary lesion in brain RIPE taters: rifampin, isoniazid, pyrazinamide, ethambutol prophylaxis: rifampin and isoniazid used for 9 months

Borrelia burgdorferi

Spirochetes Spiral Shaped bacteria The Bows and Arrows of Borrelia lyme disease: northeastern united states robin of ixodes: ixodes scapularis tick white footed mouse: reservoir, tick larvae white tailed deer: obligatory host, adult ticks feed do not gram stain contestants: wright and giemsa stain 3 stages: Stage 1 bulls eye target: bulls-eye rash, within month of tick bite Sir Wright: flu like symptoms Stage 2 heart shield: heart block caused by myocarditis Bells: bilateral facial nerves bells palsy Stage 3: straw man swinging in front of target: migratory polyarthritis arrow in knee: arthritis of large joints arrow through head: encephalopathy confused Sir giemsa: confusion unicycle: doxycycline three axes: ceftriaxone, for later and worse stages

Staph Aureus

Staff of Moses: Staph Aureus purple robes: gram positive cat: catalase positive parting the red sea: coagulase positive red "B" lightbulb: beta hemolytic tall man: ferments mannitol yellow clothes on tall man: yellow agar plate A binding to antibody on staff: Protein A, binds FC portion of immunoglobulins and prevents complement from binding, stops opsonization and phagocytosis nose: colonizes in nose kneeling camel and man in patchy clothing: patchy x ray of pneumonia kneeling: #1 cause of septic arthritis red camel humps: abscesses, furuncles, carbuncles, impetigo (80% of cases), cellulitis spooked camel with lady clutching chest: acute bacterial endocarditis mortar and pestle with three pyramids behind: happens to IV drug users and effects tricuspid valve fish bones: #1 cause of osteomyelitis Toxin diseases: Sunburnt man: Scalded skin syndrome: Toxin: protease Symptoms: skin peels off my small touch, red lightning bolt cape: toxic shock syndrome toxin: TSST, superantigen that causes nonspecific binding of MHC Class 2 molecules and TCR leading to cytokine storm Symptoms: purpuric rash Running camel with puking lady: rapid onset food poisoning, 1 to 8 hours symptoms: vomiting, due to meats and cream based foods left out for too long (picnics or buffet lines) pharaoh showing mercy: MRSA altered pyramid building people: altered PBP's (penicillin binding proteins) van: use vancomysin Pencil Staff: MSSA, use nafcillin

gardnerella vaginalis

The Fish Garden bacterial vaginosis fishy odor purple and red graffiti: gram variable rod: can stain as either lactobacilli, some gram negatives increase in anaerobic flora= better for gardnerella overgrowth of venus fly trap: bacterial overgrowth that disrupts the flora discharge out of venus fly trap: thin, greyish white fish discharge price is 4.5 and up: pH between 5 and 6.5 detective dog whiffing: 10% KOH prep: positive whiff test detective looking at blue stains: epithelial clue cells coated with bacteria metro train: metronidazole

Mycobacterium leprae

The Good, the Bad, and the Lion Faced leprosy/ hansen's disease icycles: leprae thrives in cool temperatures gun slinger: acid fast tassels: mycolic acids armadillo: main U.S. reservoir tuberculoid leprosy 1: TH1 prisoner: contain bacteria in macrophages mild symptoms bald spot: well demarcated hairless skin plaque shovel: lepromin skin test, positive test= patient can fight bacteria deputy: dapsone rifle: rifampin dapsone and rifampin for 9 months lepromatus leprosy 2: TH2, promote humoral response prisoner breaking out: bacteria not contained in macrophages laughing: humoral response long johns: glove and stocking neuropathy skin lesions: numerous poor demarcated lesions all over body lion bandana: facial deformity=loss of eyebrows and eyelashes, collapse of nose and earlobes, lion face white cloth: dapsone, rifampin, clofazimine for 2 to 5 years

Chlamydia

The Pirates of Chlam Island stuck on island: obligate intracellular white sand: poor gram staining can't create it's own ATP no mermaids: no muramic acid pearls: bacteria outside cell, elementary, infectious clams: cell pearls in clams: reticular body, can multiply by binary fission, active stacks of pearls: inclusion bodies gems: GIAMSA stain nats: NAAT= nucleic acid amplification test, PCR chlamydia trachomatis: A-C: blindness trachoma= leading cause of blindness in whole world captain with two eye patches: blind hand to eyes: hand to eye contact D-K: STI most common STD in US leak in ship: watery discharge skull and crossbones: PID baby mermaid covered eyes: neonatal conjunctivitis and pneumonia 1 to 2 weeks later slapping knee: Reiter syndrome monkey with telescope: uveitis monkey can't pee: urethritis monkey falling: reiter arthritis "can't see, can't pee, can't climb a tree' L1-L3: LGV, lymphogranuloma venerium painless genital ulcer barnacles around mermaid: weeks to months later lymphadenompathy chlamydophila pneumoniae atypical pneumonia, walking pneumonia, more common in elderly clam shell bra with algae: pneumonia chlamydophila psittaci parrot: transmitted by birds, parrots Treatment: crows: amacrolides such as azithromycine captain steering wheel: doxycycline Mac's hat, tri axes: coinfection with gonorrhae, give ceftriaxone

Salmonella

The Salmon Dinner flopping fish tail: motile black plate: H2S positive, grows black colonies on hektoen agar plate capsule: capsule lemon: acid labile Salmonella typhi: human origin seagull: chronic carriers harbor in their gall bladder apron: typhoid Mary the chef red spots: rose colored macules on abdomen bones of salmon, sickle in seagull's hand: number 1 cause of osteomyelitis in sickle cell disease patients bird droppings: constipation or pea soup diarrhea flower: fluoroquinolone syringe: vaccine Salmonella enteritidis: animal origin left chicken: eating undercooked chicken, main reservioir lit candle: inflammatory diarrhea turkey baster: type 3 secretion system, protein detects eukaryotic cells and secretes protein that helps with infectivity open cages: facultative intracellular within macrophages

Psudomonas aeruginosa

The Suitors of Pseudo Mona Gram negative rod tub: thrives in aquatic environments blue ring: oxidase positive cat: catalase positive, CGD patients at high risk green residue on tub: blue green pigment when plated, due to pyocyanin and pyoverdin, makes wound blue grapes: fruity grape like odor arobello: obligate aerobe Chloride into tub: most common cause of respiratory failure in CF patients nurse: number 1 cause of gram negative nosocomial pneumonia Fish bones: IV drug users and diabetics, osteomyelitis mortar and pestle and candy capsule: capsule maid on fire: burned patients chamber pot: nosocomial UTI hot tub: pruritic papular pustular/hot tub folliculitis dalmation: toxin causes cutaenous necrosis, echthyma gangrenosum noisy maid with ear trumpet: otitis externa/swimmers ear Green man: exotoxin A (same mechanism as diptheria) big bow: ribosylates target playing accordian: elongation factor 2, inhibits protein synthesis anti-pseudomonal penicillin: Piper: piperacillin and tazobactam aminoglycosides (in combinatino with beta lactam) and flouroquinolones (UTI) flower: flouroquinolones sigh: aminoglycosides

Neisseria gonorrhoeae

The Violinist's Las Clap main virulence: LOS and blebs Gonzo's Night Club: gonorrhoeae Mac flirting with woman: STD two red pillows: gram negative diplococci white chair with weird shape: invade neutrophils broken glass: NOT ENCAPSULATED males: urethritis Chandelier: pelvic inflammtory disease which causes infertility or ectopic pregnancies dripping hot wax: thick white purulent discharge Piano Band: Fitz hugh curtis syndrome/infection of peritoneum violin: adhesions that form to liver, violin string adhesions cracked statue knee: polyarthritis, asymmetric mother holding baby and shielding eyes: early onset conjunctivits Three axes: Ceftriaxone clam shells: Coinfection with chlamydia

Leptospira interrogans

The surfer's oasis spirochetes: small, thin spiral shaped endemic in tropical regions: hawaii surfer riding yellow tide: rodents and dogs, excreted in urine and swim in contaminated water surfer sweating: flu like symptoms rose colored sunglasses: conjuctival suffusion, no inflammatory exudate whale breaching: weils disease raft in air: kidney disfunction, high creatinine levels and fever, renal disfunction yellow swim suit: jaundice from liver damage inner tubes: red blood cells, goes everywhere

Treponema pallidum

causes syphillus Pallidum Observatory darkfield galaxy: darkfield microscopy needed for direct visualization VDRL: screening test, tests for antibody reactivity RPR: screen mono, rheumatoid factor, lupus, IV drug user, or leprosy can read as false positive A-Ab: FTA antibody test primary: sun dial poking astronomer ***********: painless genital shanker a few weeks after inoculation secondary: solar system: systemic astronaut's red gloves and shoes: maculopapular rash occurs on palms and soles weeks to months after infection bumpy planet: condyloma lotta kids with telescopes in hands: visual spirochetes with darkfield microscopy tertiary: bright cratered moon: gummas/soft growths with firm necrotic center barked tree: aortitis, aneurysm roots of tree: vasa vasorum destroyed columns: damage to posterior column of spinal cord greeter in argyll sweater: argyll robertson pupils, reacts to accommodation but no reaction to light constellation: congenital syphillis: sword:saber shins, anterior bowing of tibia saddle: saddle nose shivering kids: hutchinson's teeth and mulberry molars (enamel outgrowths) earmuffs: deafness pencil: penicillin tetracyclines or try to desensitize and use penicillin jarisch-herxheimer comet viewing: jarisch herxheimer reaction after treatment with penicillin, fever chills and headache due to dead LPS being relased

vibrio vulnificus

colonal cholera's base cAMP gram negative rod oysters: contaminates seafood, especially oysters

vibrio parahaemolyticus

colonel cholera's base cAMP gram negative rod oysters: contaminate seafood, especially oysters

coxiella burnetti

curly q the ram gram negative white goat: no rash Curly Q horns: Q fever inside barn with lock: obligate intracellular walnuts: spores in animal droppings dust cloud: aerosol transmission farmer coughing and hit head: headache and pneumonia hot barn: sweating liver cowspot: hepatitis endocarditis from Q fever

Moraxella catarrhalis

gram negative diplococci, aerobe URT children: upper respiratory tract sinusitis, otitis media 3rd most common cause of AOM, acute otitis media (s. pneumo, h. influenzae) Bronchitis, bronchopneumonia: elderly with COPD dry colonies on chocolate agar no capsule b-lactamase

bacteroides fragilis

gram negative rod gas mask: anaerobe does not form pores strong, foul smell from wounds pleomorphic GNR on gram stain bile-containing agar capsule, fimbraie, SCFA, heat labile zinc metalloprotease toxin/ b. fragilis toxin: enterotoxin that induces chloride and water secretion intra-abdominal infections gynecological infections myonecrosis bacteremia: abscesses in many sites gastroenteritis: self limiting watery diarrhea mainly in children under 5 treatment: metronidazole, carbapenems

listeria monocytogenes

gram positive rod pregnant women 20 times more likely to get it pregnant women can't eat soft cheeses Santa's LIST b hemolysis lightbulb: narrow zone of hemolysis, beta hemolytic facultative intracellular ornaments on christmas tree: flagella look like tumbling motility toy rocket: actin filaments intracellularly, actin rocket cat: catalase positive icycles: survive in cold temperatures millk and soft cheeses: contamination early termination or disease in newborn helmet: 3rd more common cause for newborn meningitis can cause meningitis in adults over 60 treatment: vancomycin and ceftriaxone to treat gram negatives and positives, in elderly also add ampicillin to cover listeria elderly: Santa Claus guitar and amp: ampicillin

Propionibacterium acnes

gram positive rods, non spore forming normal flora of skin acne, infects sebaceous glands treatment: topical benzoyl peroxide

haemophilus influenza

phyllis's chocolate covered cherries gram negative rod candy machine: coccobacilliary shape chocolate: chocolate agar 5 cents, nickel: Factor V, NAD (nicotinamid adenine dinucleotide) 10 cents: Factor X, hematin aerosal spray: spread by aerosal transmission screaming child: epiglottitis cherry: cherry red epiglotis kid plugging his ears: otitis media astronaut and helmet: meningitis with capsular form, type B strain Bee flying around capsule: type b capsule sepsis and septic arthritis in patients with no spleens sickle: patients with sickle cell at greater risk Special for sugar dipped cherries: polysaccharide conjugated to diptheria toxin cost $2.18: 2-18 months vaccine Three axes: beta lacatam, ceftriaxone rifle: rifampin used for close contacts