01 Gm Positive Cocci

_..

• beta, clear halo

• alpha, green halo, from oxidation of hemoglobin

Staph Aureus

_..

• Purple cloth: gram positive

• Egyptian cat: Catalase Positive

• Moses parting sea: Coagulase positive

• Light bulb red: Beta hemolytic

• Tall man: Ferments mannitol salt, turns yellow

_

A staph: Protein A binds Fc portion of IgG.,

_

Egyptian nose: Colonizes nares.,

_..

• Running camel and mortar/pestel: acute rapid onset tricuspid endocarditis in IV drug users

• Running camel with women nauseating: Fast onset food poisoning, meats/mayonnaise

• Fish bones: Osteomyelitis

• Red camel humps: Abscess formation

• 2 dices: Icosahedral shaped virus, post viral URI pneumonia

• Coughing and patchy clothes: Pneumonia: patchy infiltrate on CXR

• Bald man burned: Scalded skin syndrome: exfoliative toxin

• Lightning cape with shock: TSST (acts as super antigen) causes toxic shock syndrome

• Kneeling, joints: Septic arthritis

_..

• Pharoah: MRSA (mercy)

• Altered PBP workers: Altered penicillin binding protein (allows methicillin resistance)

• Caravan: Vancomycin for treatment if MRSA

_..

• Pencil: Nafcillin for Staph infections (not MRSA)

Staph Epidermis and Sapro

_..

• Purple curtains: Gm +

• Bowl of jelly untouched: Coagulase negative

• Cat: Catalase positive

• NH3 bottle: Urease positive

• Navel exposed: S. epidermidis is novobiocin sensitive

• Navel not exposed: S. saprophyticus is novobiocin resistant

_..

• Plumber working: staph epidermis associated with prosthetic joint infection and catheters

• Heart shaped valve: Associated with prosthetic valve infection

• Green gunk: Staph epidermis produces thick biofilms that adhere to prosthetic surfaces

• Dirty pan: Staph epidermis commonly contaminates blood cultures

• Dirt on plumber's hands: staph epidermis part of normal skin flora

_..

• Van: Vancomycin may be used to treat staph epidermis

_..

• Sexy girl with UTI cup: S. saprophyticus is a common cause of UTI in sexually active females

Strep Pyogenes

_aka GAS.,

_..

• Hot Apple under container: Hyaluronic Acid capsule

• B bulb: Beta hemolytic

• Baci hound eating bread: Bacitracin sensitive

S pyogenes are catalase-negative, β-hemolytic, gram-positive cocci in chains. S pyogenes is unique among β-hemolytic streptococci as it is susceptible to bacitracin. Because the bacitracin test is not very specific for S pyogenes, it has been replaced in many laboratories by the pyrrolidonyl arylamidase (PYR) test; S pyogenes is PYR-positive.

_..

• Honey crusted lemon pie: Impetigo

• Red gloves: cellulitis and erysipelas

• Red bandana: Pharyngitis

_..

• scarlet fever: erythrogenic toxin

• Strep-TSST (acts as super antigen) causes Streptococcal Toxic Shock Syndrome

• Burnt ginger with legs falling off: Necrotizing Fasciitis (Exotoxin B)

_..

(erythrogenic toxin)

• Sticking tongue out and lick strawberry: Strawberry tongue

• Red bandana: Pharyngitis

• Ginger: diffused rash sparing face

_..

• rheumatic fever: master chef with M

• PSGN: post strep glomerulonephritis: chef on phone

Rheumatic Fever

_..

• M hat and prevent stealing: M protein: prevents phagocytosis

• Mitral hat: Endocarditis: affects mitral valve; M protein molecular mimicry with muscle myosins. Mitral stenosis

• anti-M protein antibodies cause Rheumatic Fever

• Red bandana: Pharyngitis precipitates RF, especially in children

Jones criteria

_..

• Jones criteria for RF: Joints (polyarthritis). Frosting on elbow

• Jones criteria for RF: heart (carditis). Valvular, myocarditis, pericarditis

• Jones criteria for RF: Nodules (Subcutaneous nodules)

• Jones criteria for RF: Erythema Marginatum, rash with thick red borders

• Jones criteria for RF: Sydenham's Chorea, rapid involuntary movement of hands and face

• erythema marginatum

PSGN

_..

• Post-strep glomerulonephritis (PSGN)

• Chef talking on phone: glomerulonephritis from antigen-antibody deposition (type III )

• Facial puffs: Facial swelling seen in PSGN

• Cola: Cola colored urine with PSGN

• Calendar: PSGN occurs 2 weeks after Strep infection

RF Vs PSGN

_..

• red bandana: both can happen with strep pharyngitis

• honey crumbs: PSGN most common after superficial skin infection (impetigo). In contrast to Acute RF which requires Strep pharyngitis.

• Pencil: Early penicillin for treatment (prevents RF but not PSGN). Even though chef has pencil, he still has symptoms

_..

• O shaped doughnuts leaking: Streptolysin O, lysis RBC, beta hemolytic

• Twisted bread: DNAse, dornase

• Muffins with phosphate: Streptokinase, converts plasminogen to plasmin, fibrinolytic

_..

• Lady with antibody tongs: Check ASO titer

Group B Strep

_aka strep agalactiae.,

_..

• Beta light bulb: Beta hemolytic

• Baci hound licking helmet; baby resistant from being licked: Bacitracin resistant

• GBS: Hydrolyzes sodium hippurate, positive hippurate test

• Helmet on hippo: Encapsulated

• Space camp with golden staff: Positive CAMP Test Enhances hemolysis by Staph aureus

• Red arrow head: zone of hemolysis on petri dish

_..

• Meningitis helmet on baby: Meningitis in newborns

• Red baby cloth: Sepsis in newborns

• Baby coughing: Pneumonia in newborns

_..

• Tunnel: baby gets GBS via vaginal delivery

• 35 wk: Screen pregnant mothers at 35 weeks

_..

• Pencil stabbing into mother ship: Treat mother with intrapartum penicillin

Strep pneumo and viridans

_..

• green a knight tournament: Alpha hemolytic

Strep pneumo

_..

• armor: polysaccharide capsule

• chin not protected: optochin sensitive

• 2 lances: Gram positive cocci, "lancet shaped"

• mud on horse legs: Bile sensitive

_..

• shield with IgA dimer: IgA protease is major virulence factor

_..

• esquire mopping: Causes "MOPS" -meningitis -otitis media -pneumonia -sinusitis

• #1 sign: #1 cause of mops

• armor covered with rust: Produces lower lobal pneumonia with "rusty sputum"

_..

• sickle: Increased risk in sickle cell population or if asplenic

_..

• 3 axes: Ceftriaxone may be used for treatment

• crows: Macrolides commonly used for uncomplicated cases

_..

Adult M, children G:

• Polysaccharide vaccine in adults. Produces IgM response, T independent response

• Conjugate vaccine for children. Produces IgG response

Strep viridans

_..

• no armor: no capsule

• protect face with mask: Optochin resistant

• bile resistant boot: Bile resistant

_..

• strep mutans and bovis

_..

• donkey with yellow teeth: Causes dental carries

• pope's damaged hat and plate on arm: Adheres to fibrin-platelet aggregates in damaged heart valves (mitral valve)

• deck of cards: Synthesizes dextrans from glucose, glue sticks to platelets

Enterococcus

_..

• formerly part of Group D Strep

• Enterococcus: intestine, coccus; different from enterobacter, gm - rod

• Resist bili club, bile resistant boots: bile resistant

• 6.5%: grows on 6.5% NaCl

_..

• California sign, more people: E. Faecalis - More prevalent, less pathogenic

• Fees, buffer guy: E. Faecium - Less prevalent, more pathogenic/dangerous

_..

• Do U heart trees: May cause of endocarditis, UTI, and biliary tree infection (insoluble in bile)

_..

• Resist van: Vancomycin resistant nosocomial infection

• Police line, department, tiger strip: daptomycin, linezolid, tigecyclin