02 Gm Positive Bacilli

Bacillus anthracis and cereus

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• Air bellow : obligate aerobe

• Large ships in chain: Large gram positive rods in chains

• Leather armor with buckles: Protein capsule composed of poly-D-glutamic acid

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• Walnuts, like seeds: Spore forming

• Sheep: "Wool sorters disease"- classically causes pulmonary infection in those who work with wool. Spores stay in wools for long time

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• Black ground and flame: Most common manifestation of infection is cutaneous black eschar

• Large axe with blood: Pulmonary infection may lead to pulmonary hemorrhage

• Ship with wide mast: Widened mediastinum on chest x-ray if pulmonary infection.,

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• Shield with EF: Edema factor

• viking tent: Edema factor acts by causing elevation in cAMP

• LF shield: Lethal factor

• Burning map: Map kinase, burned and turned into eschar. Lethal factor responsible for tissue necrosis

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• Pink flower: Flouroquinolone treatment

• Bicycle: Tetracycline treatment

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• Viking reheating rice and vomiting: B.cereus classically causes vomiting after eating reheated rice.,

Clostridium Tetani

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• purple color: gram positive

• Walnuts: Spore forming

• Gas mask: Obligate anaerobe

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• Pots of earth on ground: Spores found in soil

• Nails: Endospores transmitted via puncture wound from rusty nail (construction zone)

• Barbed wire: Endospores transmitted via puncture wound from barbed wire (construction zone)

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• Evil monkey smiling: Lock jaw symptoms and facial spasms (risus sardonicus (evil grin))

• Monkey extend back: Opisthotonus, muscle spasms cause arched back

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• Orange syringe: Vaccine consists of deactivated toxin (same color orange), not the bacteria

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• Scissors on pulley: Tetanus toxin (not the organism) migrates to CNS via retrograde axonal transport

• Snare trap: Tetanus toxin cleaves SNARE

• G and G labs: Tetanus toxin cleaves SNARE preventing release of inhibitory neurotransmitters GABA and Glycine, inhibit inhibitors = uncontrolled firing

• Wrench and saw: Tetanus toxin inhibits inhibitory neurotransmitter release from Renshaw cells in spinal cord

Clostridium Botulinum

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• violet color: gm +

• mechanical nuts: Spore forming

• gas mask: Obligate anaerobe

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• Canned robot shape: Transmitted by improperly canned, insufficient heating of home canned food, allow spore survival and heat production (family developing neuro symptoms)

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• Robots heads and torso going limp: Descending flaccid paralysis (Guillian Barre ascending) (multiple people with symptoms = botulism)

• Only affects PNS, not CNS because can't cross BBB

• Droopy robot eyelids: Ptosis

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• Oil: Infantile bolulism transmitted via honey ingestion

• Baby robot flaccid: "Floppy baby"

• Adults ingest spores directly ok because anaerobes outcompete in GI. Babies have low GI anaerobe flora

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• Ach power supply: Botulism toxin prevents acetylcholine release (excitatory) at neuromuscular junction

• Scissor cutting: protease cutting SNARE

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• Adults symptoms by ingest toxins; baby symptoms by ingest spores

Clostridium Difficile

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• Gas mask: Obligate anaerobe

• Walnuts: Spore forming

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• Apples: Exotoxin A

• Brushing apple: Exotoxin A attaches to brush border

• Chocolate syrup: Watery diarrhea

• Shoe from chocolate syrup: Toxin detected in stool

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• Clean hand sign: Clindamycin: C. Diff infection after antibiotic use

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• B sign: Exotoxin B

• Kid picking apart actins: Exotoxin B disrupts cytoskeleton by depolymerizing actin. Inactivates Rho regulatory protein. Loss of intracellular tight junction = cell rounding

• Membrane on right: Pseudomembranous colitis

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• Tongue looking van: Oral vancomycin for treatment

• metro train: IV metronidazole for treatment

Clostridium Perfringes

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• Gas mask: Obligate anaerobe

• double fine zone: Double zone of hemolysis when plated in anaerobe environment

Anaerobic culture of Clostridium perfringens on blood agar. The characteristic double zone of clear beta-hemolysis around a colony is clearly seen (arrow).

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• Walnut and pots : Spores found in soil

• Private fell of motorcycle: Infection associated with motorcycle accidents and other major trauma

• Private: Infection associated with deep penetrating military wounds

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• Slow sign in puddle: May cause slow onset diarrhea; spores have to germinate first before cause diarrhea, not preformed

• Gas from motor cycle: Causes "gas gangrene", causes crepitus when palpate. Metabolizes carbohydrates, producing the gas.

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• alpha flag on bob pins: Alpha-toxin, lecithinase (phospholipase), disrupts cell membrane function

• tomatoes on ground smashed: Alpha-toxin also has hemolytic activity

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• Pencil: Penicillin treatment

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Cornyebacteria diptheria

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• purple hue: gram positive

• Guy playing with toys, zig zag lines: Metachromatic granules (red and blue). Club shaped rods in V or Y formation

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• Guy with bow tie playing elongating piano: ADP ribosylation of elongation factor 2, inhibits protein synthesis, cell death, pseudomembrane

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• Candy with plastic wrap: Pseudomembrane on throat and tonsils

• Bull: Bull neck

• Heart shaped cape block bull: Cardiotoxic effects: myocarditis, arrhythimia, heart block

• Guy eating sausages shaped like nerves: Demyelination causes nerve deficits starting in posterior oropharynx

• Fibrinous exudate → systemic circulation → cortical neurons: This is the route that diphtheria toxin takes from the pseudomembranous exudate it forms in the pharynx to the bloodstream and subsequently to cardiac and cerebral cortical tissues.

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• Droplets from bull's mouth: Transmitted by respiratory droplets

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• Tele screen: Plated on Tellurite agar

• Kid watching and laughing: "Plated on Loeffler's medium"

• Bull licking: Elek's test, differentiate toxin variant

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• Syringes: Inactivated pertussis toxoid vaccine, IgG

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• Treatment: administer IVIG

Listeria monocytonegenes

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• Cat: Catalase positive

• Falling tree: Tumbling motility

• Beta bulb: Beta hemolytic

• Actin rocket half in and out: Facultative anaerobic bacterium

• Ice on window: Motile with flagella at 30 degrees and below

• Actin rocket: At body temperature, motile by actin polymerization, or "actin rockets"

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• Pregnant woman: May be acquired transvaginally- pregnant women may be advised not to eat soft cheese

• Milk: Transmitted from dairy products

• Cheese: Transmitted by consumption of certain of cheeses

• Santa: Infection also prevalent in elderly population

• Baby with helmet: Common cause of neonatal meningitis

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• Amplifier: Treatment with ampicillin

Actinomyces israeli

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• gas mask: Obligate anaerobe, nocardia is aerobe

• Tree branching, violet wrap: Gram positive filamentous rod

• Yellow rocks: Yellow sulfur granules

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• Canal draining: Formation of sinus tracts. Draining sinus tract

• Jaw wrap: Infection associated with jaw trauma

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• Pencil: Treat with penicillin

Nocardia

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• NH3 spray bottle: Urease positive

• Branching tree: Gram-positive branching filamentous rod. - Similar to actinomyces

• air bellow: Obligate aerobe

• Cow boy cloth with tails: Mycolic acids with two tails

• cat: Catalase positive, pts with CGD at increased risk

• Fast drawing of gun: Partially acid fast, carbo fuscia stain

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• Cactus pot broken: Found in soil

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• Cane: Immunocompromised especially affected

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• Coughing: Pneumonia like symptoms

• Bullet hitting chest: Associated with cavitary lesions in lung

• Bullet leaving hole in hat: Brain abscess formation

• Cow print with red around: Cutaneous symptoms- indurated lesions and inflammatory reaction

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• Rotten eggs: Treat with sulfonamides