04 Gm Negative Enteric Bacilli

Klebsiella, Enterobacter, Serratia

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• O2 mask: Pneumonia

• bag of urine: Urinary tract infection

• Pills on ground: Multidrug resistant, treatment with carbapenem

• hospital room: nosocomial infections, thus multi drug resistance

• milk: Lactose fermenter

• pink milk cartoon: Pink on MacConkey Agar

Enterobacter cloacae

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• enterodactyl

• flying: motile

Serratia marcescens

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• triceratops

• charging with arm up: Motile

• red color: Produces red pigment on culture

• catalase positive

Klebsiella pneumoniae

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• ankylosaurus with clubbed tail/ kleb tail

• mucous on back: polysaccharide capsule

• NH3 bottle spraying kleb: Urease positive

• all 4 feet: Immotile

• clear zone and thick capsule

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• 3 A's: Alcoholics, abscesses, aspiration (started from aspiration)

• knocked over jar of currant jelly: "Currant" jelly sputum

• Xray: Cavitary lesion, may look like TB

• Liver abscess via ascending cholangitis

• The hallmark of Klebsiella pneumonia is a thick, mucoid, blood-tinged sputum (currant jelly sputum) and lung tissue necrosis with early abscess formation.

Salmonella

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• macrophage cage: Facultative intracellular within macrophages

• fish tail floppy: Salmonella is motile

• lemon cut: Acid-labile

• black plate: H2S positive, black colonies on Hektoen Agar plate

• fish bone: Osteomyelitis

• capsule: vi Capsule, inhibit phagocytosis

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• flower: Fluoroquinolones treatment (ie Cipro)

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• syringe: Live attenuated vaccine

Enteritidis

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• left chicken: The reservoir for Salmonella enteritidis is the chicken

• match: Inflammatory diarrhea

• syringe bulb: Type III secretion system

Typhi

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• right: Salmonella typhi

• sickle: In Sickle Cell disease

• seagull: Salmonella typhi in the gallbladder of chronic carriers

• cook drape: Typhoid Mary

• drape: Rose colored macules

• Green pea: "Pea soup" diarrhea

Shigella

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• standing on acid: Acid stable

• green shirt: Green colonies on Hektoen agar

• chained to stone: Immotile

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• actin projectile: Use of actin filaments

• M: Invasion of M cells

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• Flame all around: Inflammatory diarrhea

• Red stool: blood in stool

HUS:

• whip: Glomerular damage first

• plates: thrombosis with platelet, drop in platelet counts

• popped balloon: platelet aggregation lyse RBC, Red blood cell hemolysis

• young kid: HUS common in young children

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• 60a timer: Toxin binds to 60S subunit of ribosomes

• syringe with bulb: Type III Secretion System

E. Coli

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• cat: Catalase positive

• milk bottle: Lactose fermenter

• pink milk bottle: Pink on MacConkey Agar

• capsule with cake: Encapsulated

• K cake: K Antigen

• green drink holder: Green on EMB agar

• type III secretion

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• milkshake with red strawberry: leading cause of sepsis via LPS

• hair bow: Fimbriae, pili like, cause for UTI

• UTI cup with #1: Most common cause of UTI

• neonate with helmet: Neonatal meningitis

• neonate points to cake: Only if it has K antigen

EHEC

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• shiga toy: Shiga-like toxin can cause HUS

• Only $1.57: O157:H7 antigen is associated with outbreaks

• hamburger: Transmitted by eating undercooked meat

• ketchup on table and red stool: Bloody diarrhea

• sorbitol bottle: Does NOT ferment sorbitol

• balloon string: Damages endothelial cells in the glomerulus

• plates: Platelet aggregation follows and decrease in platelet count

• Popped balloon: Red blood cell hemolysis via the thrombosis

ETEC

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• traveller truck: Traveler's diarrhea

• water truck: Transmitted via water

• LA: L = Labile, A = cAMP

• SG: S= Stable G = cGMP

• water truck: Watery diarrhea

Yersinia

Yersinia Enterolitica

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• English terrier: yersinia enterolitica

• ice on window: Resistant to cold temperatures

• Safety pin: Bipolar staining, sometimes described as having a safety pin appearance

• glass capsule: Encapsulated

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• poop in cage: Y. enterocolitica transmitted through puppy feces

• milk bottle: May be transmitted through contaminated milk products

• baby: Toddlers are commonly affected by Y. enterocolitica

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• red stool: bloody stool

• right abdomen toddler : Infection can mimic appendicitis symptoms

Yersinia Pestis

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• Pink color: Gram negative organism

• Rodents in cage: Prairie dogs main reservoir in United States

• flea sign: Transmitted by flea bites

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• sai: Streptomycin (with tetracycline) for treatment

• mouse wheel: Tetracyclines (with streptomycin) for treatment

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• syringe bulb: Yops (yersinia outer protein) secreted via type III secretion systems, stops phagocytosis

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• guy with buboes: Characteristic buboes form on skin

• Uncontrolled spread can cause organ abscess, cutaneous hemorrhage, and tissue necrosis

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• killed vaccine sign: Killed vaccine can be used to prevent transmission

Campylobacteria Jejuni

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• curved moustache: Curved/spiral gram negative rod

• flame: Grows at 42 degrees C

• chicken roasted: Poultry reservoir. Can be transmitted from domestic animals (pet dog)

• ring: Oxidase positive

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• red stool: Causes bloody diarrhea

• bear cub invading cooler: Invasive, bacteremia, sepsis

• slapping knee: Reactive arthritis, seronegative

• bear playing with sausages: Guillain-Barre syndrome - Ascending paralysis

Vibrio

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• blue ring: Oxidase positive

• comma mustache: Comma shaped

• red boat: Gram negative

• lemon sliced: Acid labile because grows on alkaline media

• base camp map: Grows on alkaline media

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• boat attached: Fimbrae attachment, does not invade

• Base camp map: Increases cAMP

• Gs bottle: Toxin activates Gs pathway and cAMP, increase water secretion

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• bathroom: Fecal-oral transmission

• rice farms: Rice water stools

• water: Watery diarrhea

• general drinking water: Oral rehydration therapy

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• Vibrio vulnificus/parahemolyticus: oysters on plate, contaminated sea food

Helicobacter

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• ammonium bottle: Urease positive, splits urea into ammonia and CO2, reduce acidity for invasion (urease breath test)

• helicopter blade: Motile, spins around with flagellum

• curved mustache: Curved/spiral gram negative rod

• blue ring: Oxidase positivex

• silver headphones: silver stain

• catalase positive

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• bullet holes and duodenum letters: Duodenal ulcers

• crab: Increased risk of gastric adenocarcinoma

• pile of tissues with mucous: Mucosa associated lymphoid tissues (MALT)

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• gasoline pump: Proton Pump Inhibitor (PPI)

• ammo box: Amoxicillin

• keep clear crows: Clarithomycin

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Pseudomonas

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• cat: Catalase positive

• red bathtub: Gram negative rod

• blue ring: Oxidase positive

• glass capsule: Encapsulated

• grapes on table: Produces fruity grape odor

• air bellow: Obligate aerobe

• water in red tub: Thrives in aquatic environment

• blue/green residue: Produces blue-green pigment (from pyocyanin and pyoverdin)

• motile

• type 3 secretion

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• Nurse coughing and pouring Cl water: Nosocomial pneumonia and respiratory failure in cystic fibrosis patients due to Cl mutation

• fish bone next to candy and mortar: Osteomyelitis in diabetics (traumatic injury) and IV drug users (directly introduce via needles)

• maid on fire: Infection associated with burn patients

• chamber pot: Nosocomial urinary tract infections

• Hot tub folliculitis: red, itching, pustular folliculitis association with hot tub

• dog with black spot: Ecthyma gangrenosum - black necrotic lesions on skin (from toxins)

• Maid listening with trumpet outside ear: Otitis externa. Swimmer's ear

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• Guy wearing green with bow: Toxin inactivates EF-2 by ribosylation (Same mechanism as Diphtheria toxin)

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• Piper: Piperacillin for treatment

• flower: Fluoroquinolones, great for UTI

• sai: Aminoglycosides, good with tetracycline

Proteus mirabilis

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• red: gm negative

• NH3: Urease positive, makes ammonium/CO2, alkaline environment, responsible for struvite stones precipation

• octopus: Swarming motility when plated

• Fish all around: Fishy odor

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• horn of stag: Forms staghorn calculi in renal stones

• Stone in hand: Alkaline environment can cause struvite stone production

• Guy urinating: May cause UTI

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• Eggs: Treat with sulfonamides