Midterm Flashcards
Staphylococcus Aureus
- Violet robes - Staph aureus is a gram positive cocci (appears violet on gram stain)
- cat - Staph aureus is catalase positive
- Parting of “red” sea -Staph aureus coagulase positive (converts fibrinogen to fibrin)
4.Red glowing light - Staph aureus is beta hemolytic will look like it has a halo of light on a plate
5.Tall man - Staph aureus ferments when plated on mannitol salt agar and this causes the plate to turn yellow (otherwise would turn pink)
6.A on staff connected to Ab - Staph. aureus has protein A in cell wall that binds Fc region of IgG → prevents complement from binding
7.Sphinx missing nose - Staph aureus colonizes nares
8.Dude and camel coughing Patchy quilt Icosahedral lamps - Staph aureus can cause pneumonia
9.Camels with bandages on knees - Staph aureus is most common cause of septic arthritis
10.Red robes on humps - Staph aureus can cause skin abscesses - Woman clutching chest on fast camel Mortar and pestle with drugs Three pyramids in background - S. aureus can cause rapid acute endocarditis often occurs in an IV drug user
the endocartitis is often a right-sided heart infection on tricuspid valve - Dry fish bones - osteomyelitis
- Dude getting sunburned/scalded - Scalded Skin Syndrome
- Dude wearing cape with lightning bolt - TSS
- Woman looking sick (about to vomit) on fast camel Meats and jars of cream - S. aureus can cause food poisoning due to preformed enterotoxin that starts acting within 1-8 hrs, vomiting often due to meats or cream-based foods
- Pharoah showing “mercy” - MRSA due penicillin-binding protein
- Cara”van” - use vancomycin to treat MRSA
- Pharoah holding pencil-staff - use Nafcillin for Methicillin-sensitive Staph aureus
No Vaccines, Gram stain and culture for diagnosis, Treatment: vanco, bac, clinda, doxy Methichilin sensitive nafcilin
LIke grapes
Staphylococcus epidermidis
- Lots of violet in the kitchen - gram positive
- Plumber working on lots of hardware and tubes - Staph epidermidis infects prosthetic joints and other implanted hardware (“enemy of orthopaedic surgeons”); indwelling catheter tubes also a source of Staph epidermidis
- Heart-shaped valve - Staph epidermidis is most common cause of endocarditis in implanted heart valves
- Lots of gunk in the sinks - Staph epidermidis produces massive biofilms composed of polysaccharides that help it stick to metal and plastic surfaces and acts as a coating to protect from antibiotics and immune cells
- Van outside - use vancomycin to treat Staph epidermidis endocarditis
- **Gunk all over plumber’s hands and red-looking drip pan **- Staph epidermidis is normal skin flora and can easily contaminate blood cultures
- Navel is exposed, plumber is sensitive about weight - Staph epidermidis is Novobiocin-sensitive
No Vaccines, Gram stain and culture for diagnosis, Treatment: vanco, bac, clinda, doxy
Streptococcus type A
1.Hot apple pie in glass capsule -Heating lamp above the pie - is encapsulated, made of hyaluronic acid which our body has a lot of (thus cannot be immunogenic) Heating lamp above the pie -> beta hemolytic
2. Honey-crusted lemon pie - Strep pyogenes can cause impetigo (skin infection) that looks honey-crusted
3. Red piece of cloth around baker’s throat - Strep pyogenes can present with pharyngitis (strep throat), erythemetous and inflamed throat
4. Red mittens - Strep pyogenes can present with cellulitis and erypsipelas
5. Pink tongue, Red handkerchief around neck, Gingerbread man covered in red except for face - Streptococcal pyrogenic exotoxin (SPE) can cause scarlet fever, with three following symptoms:
Pink tongue -> strawberry tongue
Red handkerchief around neck -> pharyngitis
Gingerbread man covered in red except for face -> diffuse rash that spares the face
6. **Cape with lightning bolt - (SPE) can cause toxic shock-like syndrome (TSLS), mediated by a superantigen
7. Burnt gingerbread man with leg falling off **- Strep pyrogenic exotoxin B (SpeB) can cause necrotizing fasciitis (true emergency condition requiring surgery) ‘SpeB causes necrotizing fasciitis ‘SpeA and SpeC cause TSLS
8.Master chef with “M” hat preventing another chef from stealing cupcake Hat is a mitre hat (hat that pope wears) - Group A strep have highly antigenic protein M in cell wall, virulence factor as it interferes with opsonization and is anti-phagocytic (main virulence factor responsible for rheumatic fever), “M” protein mimics myosin in our heart, causes Abs to attack our heart –> mitral valve most commonly damaged in rheumatic fever (mitral stenosis)
9. **Red handkerchief on master chef - Red handkerchief on master chef -> pharyngitis precipitates rheumatic fever
10. JONES - JONES criteria used to categorize symptoms of rheumatic fever
J, spillage of frosting on elbow -> joints, polyarthritis
O, heart shaped -> heart problems, valvular damage, myocarditis, pericarditis
N -> subcutaneous nodules, most commonly appears on forearms or elbows and knees
E -> erythema marginatum, rash with nice, thick, red borders
S -> Sydenham’s chorea, rapid involuntary movements, especially of hands and face
11. Talking on the phone, cord shaped like glomerulus
Stuff on chef’s face and coca-cola bottle - Talking on the phone, cord shaped like glomerulus -> Strep pyogenes can cause post-streptococcal glomerulonephritis (PSGN)
Stuff on chef’s face and coca-cola bottle -> glomerulonephritis accompanied by facial edema and coal-colored urine
12.Honey-crusted crumbs only on chef talking on phone, not master chef - Honey-crusted crumbs only on chef talking on phone, not master chef** -> pharyngitis can precipicate rheumatic fever and PSGN, but impetigo can also precipitate PSGN (not rheumatic fever)
13. Chef on phone and with coca cola bottle has pencil - use penicillin to treat rheumatic fever, but not PSGN [even though the chef has the pencil, he still has PSGN]
14. **O-shaped doughnuts **- O-shaped doughnuts -> Streptolysin O, virulence factor that allows Strep pyogenes to lyse red blood cells and be beta hemolytic
ASO is the Ab produced against streptolysin O
15. **P’s attached to cupcakes **- P’s attached to cupcakes -> streptokinase is another virulence factor for Strep pyogenes, converts plasminogen to plasmin which is fibrinolytic (lyse clots)
16. Cinnamon twists - DNAses, another virulence factor for Strep pyogenes
17. Bassett hound munching on cinnamon twists - Bassett hound munching on cinnamon twists -> Group A strep are bacitracin-sensitive (group B strep are bacitracin-resistant)
18. Lady with certain shaped tongs, picking up pie rolls - ASO (anti-streptolysin O Ab) titers help determine if recently have had group A, Pyrrolidonyl arylamidase (PYR)-positive [pie rolls]
*Cellulitis = an infection of the inner layers of the skin. It specifically affects the dermis and subcutaneous fat. Seen as an area of redness which indolent (increases in size over a few days). The borders of the area of redness are generally not sharp and the skin may be swollen.
*Erypsipelas = infection of the upper dermis and superficial lymphatics; more superficial than cellulitis and is typically more raised and sharply demarcated. Very acute. Involvement of the ear is a distinguishing feature in contrast to cellulitis, as the ear does not contain deeper dermal tissues.
Diagnosis : rapid antigen test; Culture, Nec fasciitis/toxic shock: Penicillin + Clindamycin
Streptococcus type B
S.agalactiae
- A galactic baby - Strep agalactiae causes really serious infections in newborns
- Stuffed hippo - Strep agalactiae has positive hippurate test (hydrolyzes sodium hippurate)
- Clear helmet around hippo’s head - Strep agalactiae has a polysaccharide capsule
- Camp with golden pole - Strep agalactiae tests CAMP positive (note: NOT cyclic AMP), distinguishes from other strep; has increasing zone of hemolysis when plated with Staph aureus
- Red lightbulbs for the tents - beta hemolytic
- **Basset hound with helmet **- Strep agalactiae is bacitracin-resistant
- Helmet to protect the baby - Strep agalactiae is number one cause of meningitis in neonates
- Baby also in red and coughing - Strep agalactiae causes sepsis and pneumonia in neonates
- Space ship with red arrowhead - CAMP test “arrowhead” zone of hemolysis is arc that forms at point of intersection between plated Group B strep and Staph aureus
- 35 WK - neonate gets infected with Strep agalactiae while passing through vaginal canal during birth; pregnant women should be swabbed at 35
- Pencils for mother ship’s legs - give intrapartum penicillin to pregnant woman to prevent infection of baby with Group B strep (prophylaxis)
IV ceftriaxone, menigitis van and ceftriaxone
Step pneumoniae and strep viridans
1.Alpha knight tournament, green sign - Strep pneumoniae and Strep viridans are alpha hemolytic, produce green hue around colonies due to oxidation of Hgb
2.Encapsulated numero uno knight Only exposure is “chin” - Strep pneumoniae is encapsulated by polysaccharide coat, Strep pneumo is Optochin-sensitive
3.Two lances - lancet-shaped, diplococci
4.Horse’s feet in bile - Strep pneumo is bile-soluble, cannot grow in bile
5.Rust colored lobe on knight’s armor - trep pneumo is number one cause of community-acquired pneumonia in adults, associated with lower lobes and “rust-colored” sputum
6.Squire mopping up stuff Fan holding up #1 sign- Strep pneumo causes meningitis, otitis media, pneumonia, and sinusitis, Strep pneumo is #1 cause of MOPS
7.Cracked shield with IgA dimer symbol - trep pneumo has a protease that cleaves IgA
8.Sickle - sickle cell patients susceptible to Strep pneumo due to spleen’s importance in fighting infections
9.Crows, Flag with three axes - Crows -> ma-“crow”-lides -> use macrolides e.g. Erythromycin for treatment
Flag with three axes -> Cef-“tri-ax”-one -> can also use third generation cephalosporin like Ceftriaxone
10. Sign telling adults and kids where to sit - 23-valent pneumococcal vaccine 13- valent pneumococcal ( see foot notes)
11. No armor on Strep viridans - Strep viridans has no capsule
12. Mask on Strep viridans - Strep viridans is Optochin-resistant
13. Relaxed donkey with green shoes - Strep viridans is bile-insoluble
14. Foul teeth on donkey - Strep viridans species like Strep sanguinis and Strep mutans can cause dental caries
15.** Jester wearing hat with heart** - if Strep viridans gets into blood, can cause subacute endocartitis, likely to infect damaged mitral valve (due to mitral valve being most likely to be already damaged, due to things like mitral valve prolapse and rheumatic fever)
16. Plate Deck of cards - pathogenesis of Strep viridans: can stick to fibrin platelet aggregates at damaged tissue
sticks to fibrin-platelet aggregates by creating dextran from sucrose
23-valent pneumococcal vaccine (polysaccharide w/o protein; Pneumovax PPSV23) is given to adults
- produces IgM Ab (T-cell-independent response) [adults are independent]
- protects against a wider range of serotypes, but Ab levels decline over ~ 5 yrs (not long lasting)
- not immunogenic in children age < 2 due to their relatively immature humoral Ab response; recommended for all adults age > 65 & pts age 2-64 w/ certain medical conditions (e.g. diabetes, chronic pulmonary or cardiovascular disease)
13-valent pneumococcal vaccine (polysaccharide conjugated to diphtheria protein; Prevnar PCV13) is given to children
- T-cell-dependent response; produces IgG Ab [children are dependent]
- development of memory B cells
- higher & longer-lasting Ab levels
- less mucosal carriage (herd immunity)
- part of routine childhood vaccinations (strongly immunogenic in infancy)
- also recommended for immunocompromised pts & adults age > 65
- 10% Penicillin resistant +/- other β-lactams
- IV Ceftriaxone (3 rd generation cephalosporin)
- Meningitis à Vancomycin + Ceftriaxone
Prevention and Treatment
Enterococcus faecalis and faecium
- Protest caucus, California caucus, Protestor with “stop the fees” sign, So many more people under California caucus sign - California caucus -> fae-“cali”-is -> E. faecalis So many more people under California caucus sign -> E. faecalis is more common, Protestor with “stop the fees” sign -> “fee”-cium -> E. faecium
- Super buff protestor - E. faecium is like a super bug
- Resist 6.5% No-Cal sign -both E. faecalis and E. faecium can grow in 6.5% sodium chloride (both pretty tough)
- Police trying to stop protestor with billy club and boots - E. faecium is bile-insoluble
- Do you heart trees signs - U -> urinary tract infections
Heart -> endocartitis
Tree -> biliary tree
Enterococcus can cause urinary tract infections, endocartitis, and biliary tree infections
6.Buff dude resisting police vanPolice line Tiger-striped police line - Linezolid Tigecycline
S. gallolyticus group
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Bacillus anthracis
Bacillus cereus
- Ring of fire from recently sacked and razed village - Bacillus anthrasis presents with black eschar, which is a black necrotic cutaneous lesion with surrounding erythematous ring
- Viking ships with rod-like sails, all lined up - like large gram-positive rods in chains
- Vikings wearing armor made of leather with D-buckles - Bacillus anthrasis is encapsulated by a protein coat made of poly-D-glutamate antiphagocytic
- Viking using an air bellow to stoke flames - Bacillus anthrasis is an obligate aerobe (needs oxygen to survive)
- Walnuts roasting - Bacillus anthrasis are spore-forming
- Viking holding a shield with initials EF Viking camp - Edema Factor acts as adenylate cyclase to increase intraellular cAMP which causes fluid to go into extracellular space to cause edema, which inhibits host defenses and indirectly prevents phagocytosis
- Viking hold a shield with initials LF inscribed and burning a map - Viking hold a shield with initials LF inscribed -> Lethal Factor is an exotoxin that acts as a protease and cleaves “MAP” kinase, causes the necrosis seen in black eschar
- Sheep and vikings with sheep’s wool on their armor - Bacillus anthrasis can manifest as pulmonary anthrax (“Woolsorter’s disease”); spores can survive for long periods of time in soil and wool of animals, can be inhaled by people and cause pulmonary symptoms
- King viking holding a large, lung-shaped axe dripping in blood - pulmonary anthrax can progress to hemorrhagic mediastinitis (when the pathogen spreads to mediastinal lymph nodes); this has a near 100% mortality rate
- Viking ship with widened mast - hemorrhagic mediastinitis characterized by widened mediastinum in the x-ray
-
Viking ship with flower shield and bicycle wheel shield - use fluoroquinolones to treat Bacillus anthrasis (anthrax); second line of treatment is doxycycline
12.** Viking vomiting after reheating rice** - Bacillus cereus associated with food poisoning, classically after reheating and eating fried rice
on microscopy, it forms long chains that are described as being “serpentine” or “medusa head” on appearance
Vaccine - toxin (protective antigen) only in high risk
Corynebacterium diphtheriae
- Violet stadium - Corynebacterium diphtheriae is gram positive
- Dude playing with blue and red maracas with zigzag design - Diphtheriae is club shaped in a Y or V formation, and contains metachromatic granules that stain with aniline dyes
- Guy with bow tie playing accordion that can elongate - Corynebacterium’s Diphtheria toxin (exotoxin) causes ADP-ribosylation of elongation factor-2 (EF2), which inhibits ribosome function & protein synthesis
- Kids eating gray cotton candy in plastic wrap - toxin inhibiting protein synthesis -> cell death -> formation of pseudomembranes - thick, gray exudates over mucosal surface of oropharynx
-
Bull sweating some droplets - transmitted by respiratory droplets; pseudomembranes can spread to larynx and trachea and cause airway obstruction, and cause lymphadenopathy known as “Bull’s neck”
6.** Matador with heart-shaped cape** - systemic infection and have cardiotoxic effects (potentially lethal), including myocarditis, arrhythmia, and heart block - Dude eating a ton of sausage links - local paralysis that begins in posterior oropharynx and can lead to other cranial nerve defects; results from toxin damaging the myelin of nerve fibers
- Kid laughing at “TELE” screen - by plating onto Loeffler’s medium and then plating onto tellurite agar
- Bull’s tongue sticking out - Elek’s test, an in vitro assay on filter paper that has anti-toxin on it, to distinguish toxic strains from non-toxic strains of diphtheria
- Green syringes in the bull - Diphtheria toxoid vaccine produces a powerful IgG response against the exotoxin B subunit, effectively preventing disease by preventing binding of the exotoxin, - routinely administered in developed countries
- the A subunit is the active component the B subunit binds & triggers uptake (endocytosis) of the A component
- Route of diphtheria toxin: fibrinous pharyngeal exudate (coalescing pseudomembranes in pharynx) → systemic circulation (bloodstream) → cardiac tissue & cerebral cortical neurons (from UW)
Listeria monocytonegenes
1.Santa has a long list B light bult at top of Christmas tree - Listeria is beta hemolytic (has a very narrow zone of hemolysis)
2.Purple ornaments tumbling down Christmas tree - Listeria are gram positive bacilli Characteristic tumbling motility in broth (extracellularly)
3.Cat - Listeria is catalase positive
4.Icicles, it’s cold Christmas eve - survives & multiplies in freezing temperatures (a unique feature that allows it to grow well in refrigerated foods)
5.Milk and soft cheese - ontaminate refrigerated items, like unpasteurized milk, soft cheeses, packaged/undercooked meat, & even unwashed raw vegetables
6.Pregnant mom and baby with helmet - Pregnant women 20x more likely to be infected by Listeria, may pass on to fetus (early in pregnancy→ early termination; later → disease in newborn), third most common cause of meningitis in newborns
7.Santa is old & holding his head - meningitis in older adults (esp. elderly) & immunocompromised pts
8.A guitar and amp for a present - use ampicillin to treat
9. Toy rockets, one inside Santa’s bag - Forms “rocket tails” via actin polymerization that allow intracellular movement and cell-to-cell spread across cell membranes, thereby avoiding antibody.
adults - vanycomycin and cephtriaxone, elderly add ampilicin
Diagnosis: blood/CSF culture or CSF PCR
Haemophilus influenza
Start of respiratory infections
- Red and pinkish hues - Haemophilus influenzae is a gram negative bacteria
- Candy machine in certain shape - Candy machine in certain shape -> H. influenzae is coccobacillary in shape
- Chocolate shop 5 cent candies (nickle) 10 cent chocolates - H. influenzae needs chocolate agar to grow. H. influenzae needs Factor V (NAD) to grow, H. influenzae needs Factor X (hematin) to grow
- **Aerosol spray **- H. influenzae spread through aerosol transmission, produces IgA protease which helps it to adhere to mucosal surfaces
- **Chocolate covered cherries & drooling, screaming kid **- epiglottitis, may have physical exam finding of cherry-red epiglottitis & “thumb-print” sign on xray, Symptoms include inflamed epiglottitis, inspiratory strider, & drooling
- Kid plugging in his ears - cause otitis media, Nontypeable strains do not form a polysaccharide capsule, thus, immunity is not conferred by vaccination with the H. influenzae type B vaccine
- Kid with helmet pointing at capsulated chocolate cherries with bee flying around - type B capsule (this type only) causes meningitis
- Kids with sickle play weapons - sickle cell patients or asplenic patients at increased risk
- Space kid with syringe gun, Special for sugar “dip”ped cherries, Coat of sugar dipped cherries = $2.18 - Space kid with syringe gun -> vaccine available for type B capsule Haemophilus, has all but eradicated H. meningitis Special for sugar diped cherries -> vaccine = polysaccharide bound to Diphtheria toxoid that increases immunogenicity and thus IgG response vaccine ideally administered between 2 and 18 months
10.** Kids with three axes** - Generally use beta lactam, use Ceftriaxone for meningitis or systemic disease - Kid with rifle in close contact with the other kids - use Rifampin for prophylaxis treatment fo H. meningitis in close contacts
- Haemophilus influenzae is a “blood-loving” organism that requires X (hematin) & V (NAD+) factors for growth.
This can be accomplished by growing H Influenzae in the presence of Staph aureus & demonstrating the “satellite phenomenom,” whereby H influenze grow only near the β-hemolytic Staph aureus colonies that produce the needed X & V factors. - capable of causing epiglottitis in both unvaccinated & fully vacinnated children!
- the type B capsule is the most invasive strain due to it’s polyribosylribitol phosphate (PRP) capsule (virulence factor), which inhibits complement-mediated phagocytosis & allows it to invade tissues/survive in the bloodstream (binds factor H, a circulating regulator protein that normally prevents complement/C3b deposition on cells)
Bordatella pertussis
- Streamers for welcome home party - Bordatella pertussis attaches to respiratory epithelium using pili called filamentous hemagglutinin
- Disabled soldier in bow tie and GI uniform with camp outside - Bordatella pertussis toxin ribosylates G inhibitory protein, disabling it and leading to increase in cAMP
- Overflowing popcorn - Bordatella pertussis toxin disables chemokine receptors for lymphocytes, making them unable to enter lymphoid tissue and leading to lymphocytosis (overabundance of white cells)
- **Viking EF shield **- ribosylation (inactivation) of Gi protein subunits → overactivation of adenylate cyclase → ↑cAMP
- Tractor on road - tracheal toxin in its peptidoglycan cell wall that damages the ciliated cells of the respiratory epithelium
- Soldier is coughing and holding an air horn - paroxysmal stage of Bordatella infection is associated with whooping cough and lasts anywhere from two weeks to two months
- Victory banner on 100 Days War - convalescent stage of Bordatella infection is associated with gradual reduction in symptoms and can last for months
-
Crows, with one covering her beak - treat Bordatella infection early with macrolides; Bordatella is highly contagious and transmitted by respiratory droplets
9. Old school cellular phone next to syringe - DTaP vaccine has acellular Pertussis antigens Acellular Pertussis is a subunit vaccine
Legionella pneumophila
- Red/rusty ship that has been mostly painted over w/ silver,ship is in water - gram negative, but needs silver stain to visualize Legionella is acquired via exposure to contaminated water not transmitted from person to person
- Ship is called SS Cysteine, needs coal - charcoal yeast extract with addition of cysteine and iron to grow
- Steam coming out of old car - Pontiac fever – self-limited and characterized by fever and malaise
- Sailor looking at map of ship Sailor is smoking - patchy infiltrate in x-ray and consolidation in one lobe Legionnaires’ disease more common in smokers
- Salt spilling into the sea - may present with hyponatremia (< 130)
- Sailor spills paint can onto another sailor - may present with neurologic symptoms such as headache and confusion
- Brown paint spilled onto another sailor - disease may present with diarrhea Diarrhea + hyponatremia = sufficient to diagnose for
- Sailor scooping coal into furnace of the ship - Legionnaires’ disease may present with high fever & “relative” bradycardia
-
Sailor urinating into the water - use rapid urine antigen test to diagnose for Legionnaires’ disease, Also culture respiratory sputum, more sensitive though this will take longer
10.** Crows** - use macrolides to treat Legionella - Sailor handing a woman a flower - fluoroquinolones
- Girl has a blue ring - Legionella is oxidase positive
Mycoplasma pneumoniae
- **open pond **- no cell walls
- goal net 4 rings - cell membrance contains cholesterole
- patchy clouds - x ray shows reticulonodular/ patch infiltrate
- ref walking on ice - present as walking pnemonia ( fine not bedridden)
- goalie with military jersey - common in military and close quarters
- **<30 on jersey **- occurs in young adults
- Red blood puck with IgM snowflakes binding pucks - IgM cold aggulatinins cause agglutination of RBC and lyse of RBC
- Do not eat on Ice - grows on Eaton’s agar
- crows - Macrowlides treat bc no cell walls
Also levofloxacin will work
Fusobacterium
- gram negative
- obligate anaerobe
- normal flora of mouth but prevalent in mouth disease
- lemierre syndrome
a. Thrombophlebitis - neck swelling and require longer therapy
b. Pneumonia
c. speticemia - blood posining - occurse after Fusobacterium necrophorum occurs
- mostly spotaneus but sometiems from dental procedure
- Virulence factors
a. Leukotoxin for abscess formation
b. hemaglutinin - thrombus formation
c. platelet aggregation
C. Diff
- Chocolate factory - cluster with DIFF flavours
- Purple rod shaped candy and gas mask - gram positice rod shaped and obigate anaerobe
- walnuts - spore forming and hard to kill ( heat radiation and many chemical elements)
- Normal flowers - C. diff part of normal flora
- Eating chcocolate walnuts near first aid kit - can aquire by ingestion of spores and is nosocomial ( hospital aquired infection), increase in community too
- hand wash - resitance to alcho so need to wash hands
- gown and gloves - c diff. require precaution
- Abx candy disrupting worker - 2nd way to get is destruction of normal gut flora
- purple pencil, squid, keep clean sign, pink flower, purple umbrella - all can cause c diff. ( cephalosporins, penicillin, fluoroquinolones, clindamycin, PPI)
- A and B kids - c diff. only from toxic form, b more virulent than a
- gummy bear, licorice skeleton and gummy junction - a and b disrupt cytokeleton and intracellular tight junctions
- gummy bear wrapping - a and b trigger neutrophils eating and createing pseudomembrancous
- smelly chocolate waterfall - it smells bad and high volume of diarhea
- white birds roasting - fever and leukocytosis
- giant pipe colon - can cause mega colon
- Gnaats detecting toxin kid in chocolate - Naat test for toxin encoding genes
- antibodu stick detecting toxin kid - EIA of stool to dectect toxin
- Gluten free mystery box - glutamate dehydrogenase in all c. diff org and cant distingish between toxin and not ( never used alone only(
- Van with toungue - oral vnayco first line bc poor systemic absorption
- Fiddler - fidaxomicin (macrocidic family) - bad systemic absorption
- metro with ivy - c diff. blocks drug oral route into colon, give metronidazol to kill enough and let med in
- bacterial pants in colon pipe - fecal microbiota transplant ( other peoples poo) bc antibotic failure, stool from healthy individual helps treat
Clostridium tetani
- Violet hues to the research room - is gram positive
- Researcher wearing gas mask - obligate anaerobe
- **Walnuts **- spore forming
- Barbed wire and rusty nails on ground with pots of soil - ound in soil, generally infects through puncture wounds by rusty nails or barbed wire
- Rhesus monkey with evil grin - has classic symptom of Risus sardonicus (“evil grin”) or lock jaw symptoms
- Monkey with arching back - opisthotonus (exaggerated arching of back)
- Monkey pulling on a pulley with scissors - infects and vegetates at wound site, releases tetanospasmin (the tetanus toxin) which travels retrograde from motor neurons to spinal cord
- Monkey with scissors about to cut snare to trap researchers from G&G labs - acts as protease and cleaves SNARE protein, which inhibits release of GABA and glycine which normally inhibit motor neurons (causing uncontrolled firing of neurons, spasm)
- Monkey with wrench and saw - Renshaw cells = inhibitory cells whose axons have the GABA and glycine that would inhibit motor neurons
- Researcher holding syringe with same color as scissors - Tetanus vaccine is comprised of toxoid (toxin conjugated to protein to increase immunogenicity)
Clostridium botulinum
- Violet room, robots look like cans - is gram positive and often transmitted by improper canning of food, multiple family members sharing food with similar neurosymptoms
- Mechanical nuts - C. botulinum is spore forming
- Dude wearing gas mask - obligate anaerobe
- Droopy eyelids on robots - C. botulinum presents with eye symptoms, e.g. ptosis or diplopia
- Robots struggling to stand upright, lights starting to go off at the top - presents with descending flaccid paralysis (lack of muscle contraction) that starts superiorly and moves inferiorly
- Dude with scissors cutting wires on “AC”h power station - protease that cleaves SNARE, prevents release of stimulatory (ACh) signals at neuromuscular junction → flaccid paralysis
- Baby robot gone limp - infection in babies (due to ingestion of spores, usually from honey) causes floppy baby syndrome (flaccid paralysis)
- Robot pouring honey all over baby robot and mechanical nuts - thus infantile botulism commonly transmitted through ingestion of honey, ingestion of SPORES, NOT TOXINS (different from adults)
Clostridium perfringens
- Injured military soldier on a motorcycle accident - infection associated with deep, penetrating military wounds and motorcycle accidents
- Walnuts - spore forming
- Pots of soil knocked over - spores found in soil
- Private was carrying a gas mask - obligate anaerobe
- Gas rising from motorcycle Alpha flag - cause necrotic gas gangrene (organism producing gas under infected tissue), which can present as crepitus or crackling sound on palpation, degradation of phospholipids → myonecrosis
- Tomatoes on ground and double fine zone sign - perfringens acts causes hemolysis in red blood cells; in vitro, this shows as double zone of hemolysis on blood agar plates
- Shopkeeper holding a pencil - use IV penicillin G to treat C. perfringens
- Private knocked over slow sign and made a brown mess - can cause slow onset watery diarrhea due to spore ingestion (ingested, germinates in gut and produces toxin); diarrhea is transient, usually doesn’t require antibiotic treatment
Neisseria Gonorrhea
1.** Mac flirting with woman at bar** - Neisseria gonorrheae is an STI
2. Two red pillows inside curved white chair - gram negative diplococci, are facultative intracellular in PMNs (polymorphonuclear leukocytes)
3. Broken glass - does not have a capsule
4. Chandelier that looks like uterus with fallopian tubes and ovaries, has candles - cause PID (pelvic inflammatory disease) in females
5. Wax melting from candles - gonorhea associated with white, thick purulent discharge in both men and women (contrast with discharge from chlamydia, which is thin and watery)
6. **Fitz-Hugh-Curtis band and violinist crushed by statue - Fitz-Hugh-Curtis syndrome: PID spreading to peritoneum, can lead to “violin string” adhesions (long and thin) to capsule of liver
7. Crack on one of the knees of the statue - Gonococcal arthritis, triad of polyarthralgia, tenosynovitis
8. Mother quickly shielding baby’s eyes from gruesome scene (crushed violinist) - gonorrhea can be passed to baby and cause early onset conjunctivitis
9. Statue with three axes and sign of three axes on the wall - use Ceftriaxone to treat N. gonorrhea
10. Napkins folded into clam shells -assume co-infection chlamydia (very common), which you treat with a macrolide like azithromycin or doxycycline (applies to neonatal conjunctivitis as well) ** NOT RECOMNDED ANYMORE
- triad of polyarthralgia, tenosynovitis (e.g. hand), dermatitis (e.g. pustules on trunk and extremities)
- Nucleic acid amplification test (NAAT)
- Modified Thayer Martin medium
Chlamydia trachomatis
Chlamydia pneumoniae
Chlamydia psittaci
1.Ship on white island - Obligate intracellar bacteria (can’t create its own ATP) Lack of staining with gram stain (white sand)
2.Lack of mermaids - lack of muramic acid in cell wall, makes penicillin and other certain antibiotics useless
3.Single pearls entering island and into clams - Elementary body = infectious form Reticulate body = replicating form (via binary fission) Elementary body releases from “clams” (reticulate bodies), cycle repeats
4.Pink pearls - inclusion bodies found under microscopy; they represent reticulate bodies actively dividing
5.Gems in a treasure chest - Stains well under Giemsa stain
6.Gnats around treasure chest - Diagnose Clamydia with NAAT
7.Sexy mermaid Water discharge - chlamydia trachomatis D-K causes STI, D-K characterized by watery discharge
8.Flag with skull - Chlamydia trachomatis D-K can lead to pelvic inflammatory disease (PID)
9.Mermaid holding baby, Covering eyes, Clam-shaped bra on lungs - Pregnant woman can pass D-K serovars to fetus (neonatal) neonatal conjunctivitis (presents 1-2 weeks later) neonatal pneumonia characterized by staccato coughs
10.Mermaid with belt-like thing - L1-L3 serovars cause lymphogranuloma venereum (LGV) characterized by tender inguinal lymphadenopathy
11.Captain with two eyes patches Hand to eye - A-C serovars is leading cause of blindness transmitted by hand to eye contact, or fomites (e.g clothing)
12.**Dude slapping knee Monkey can’t see through telescope Monkey can’t pee Monkey can’t climb **- Reactive arthritis (a seronegative spondyloarthritis; formerly known as “Reiter syndrome”):
- conjunctivitis
- urethritis
- arthritis
13. Mermaid wearing bra with algae - Chlamydophila pneumoniae results in “walking” pneumonia in adults
14. Parrot pooping on mermaid’s lungs - Chlamydophila psittaci also causes pneumonia, transmitted by bird droppings
15. Crows - Macrolides (e.g. Azithromycin) are useful for treatment against Chlamydia trachomatis oral form for babies
16. Steering wheel - doxycycline (treatment for C. trachomatis) Treat C. pneumoniae with tetracyclines as first line or macrolides as second line
17. Pirate with hat and flag with three axes - treat Chlamydia with ceftriaxone to treat for both chlamydia and gonorrhea at the same time
- PID can lead to cervicitis, salpingitis, pelvic pain, abscess formation, scarring of tubes that cause infertility and ectopic pregnancies
- LGV: Doxycycline 100 mg orally BID x 21 days
Treponema pallidum
1.Swirling galaxy and spiral staircase - palldium is a spirochete
2.Galaxy is called Darkfield galaxy and astronomer looks through telescope - need Darkfield microscopy to directly visualize T. pallidum
3.Video Display Research Laboratory on TV screen - VDRL is best initial test; detects nonspecific Ab that reacts with beef cardiolipin; quantitative, inexpensive, & widely available; sensitive but not specific
4.List of random galaxies - false positives for syphilis, due to diseases like mono, rheumatoid factor, lupus, leprosy
5.Field Telescope A-Ab - FTA-ABS is a specific test to confirm positive a screening result; is specific to Treponema
6.Sundial - primary syphilis characterized by painless genital chancre (due to damage of small vessels); can heal within 3-6 weeks but progress to secondary if left untreated
7.Solar “system” and astronaut all white except for hands and feet, Bumpy planet, Bunch of kids watching with telescopes - secondary syphilis is systemic; maculopapular rash occurs on palms and soles weeks to months after infection, condyloma latum (flat top lesions on genitals) may occur on mucous membranes, can visualize within condyloma latum using Darkfield microscopy
8.Cratered moon Barking tree with roots -
tertiary syphilis characterized by formation of gummas - soft growths with firm necrotic center (necrotizing granulomas) on the skin, mucosa, subcutaneous tissue, & bones
aneurysm of ascending (thoracic) aorta with “tree-barking” appearance (irregular wrinkling); destroys vaso vasorum that supplies aorta with blood
9.Columns in the back, cracked and damaged Greeter with argyle sweater and dealing with light in his eyes - tertiary syphilis characterized by damage to posterior (back) column of spinal cord, Argyll Robertson pupils reacts to accommodation but no reaction to light
10.Orion like constellation, hunter with saber that ends near his shins Saddle on pegasus - saber shins, an anterior bowing of tibia, saddle-shaped nose
11. Shivering kids showing teeth; Ear muffs - congenital syphilis charaterized by Hutchinson’s teeth (notched incisors), Mulberry molars (several enamel outgrowths) & congenital deafness
12.** Purple pencils** - use penicillin for treatment, always; even if allergic, desensitize the patient, then use penicillin
Use especially if they’re pregnant
13. Jarisch-Herxheimer Comet viewing - Jarisch-Herxheimer reaction, fever, chills, headache characterize Jarisch-Herxheimer reaction
Escherichia coli
- Pink milk carton and milk in milkshakes - lactose fermenters, grow pink colonies on MacConkey agar
- “K” cake in glass case - have K antigen on capsule (important for serotyping)
- Cake and milkshakes on green coasters - Eosin-Methylene blue (EMB) agar produces a metallic green sheen
- Girl with fimbriae-like bow and #1 glass with yellow drink - has fimbriae (pili), a virulence factor, and is #1 cause of urinary tract infections (UTIs) bc it allows adherence to target tissues
- **Cat **- catalase positive
- **Strawberry milkshake **- #1 cause of gram negative sepsis (virulence factor is LPS endotoxin)
- Baby in helmet reaching out for “K” cake - neonatal meningitis
- Kid on red stool eating raw hamburger with spilled ketchup - EHEC commonly transmitted by eating raw hamburgers, causes bloody diarrhea
- Sorbitol-free soda with real cane sugar - EHEC O157:H7 does not ferment sorbitol
- Boy has she-gorilla happy meal toy - shiga-like toxin (verotoxin) that can bind 60S subunit of ribosomes, halting protein synthesis & causing cell death
- Straw popping red balloon with dirty plates nearby - shiga-like toxin (verotoxin) halts protein synthesis by disabling the 60s ribosomal subunit → damages endothelial cells in intestine & kidney glomerulus → platelets aggregate, resulting in decrease in platelet count → platelet clumps lyse red blood cells as they pass through the capillaries (schistocytes)
- E-Cola burgers selling for $1.57 - E. coli O157:H7 (a serotype) is associated with outbreaks
- Truck transporting water from San Gabriel, Mexico - traveler’s diarrhea,” classic case is drinking water from Mexico
- **L and A highlighted S and G highlighted **- L and A highlighted -> labile and AMP -> heat-labile toxin, S and G highlighted -> stable and GMP -> heat-stable toxin of ETEC increases cGMP
- Truck driver holding water bottles and standing on brown stool - ETEC causes watery diarrhea (not bloody)
- **Treatment **- cipro and triaxone
- EPEC - person to person shit and doesn’t produce shiga toxins, watery diarrhea with mucus and vomiting
- K capsular antigen prevents recognition of bacterial antigens, complement deposition, & subsequent phagocytosis - give E. coli the ability to cause meningitis
- the ability to cause menigitis is mediated by K capsular antigen (prevents recognition of bacterial antigens, phagocytosis & complement-mediated lysis)
`
anti-K1-capsular antibodies are protective against repeat infection
Vibrio cholera
Vibrio parahaemolyticus
Vibrio vulnificus
- Setting is southeast Asia - Vibrio cholera is endemic to developing countries
- Dictator has curved, distinct mustache - vibrio genus is comma shaped and curved gram negative rod
- Outhouse overlooking river and rice paddies - watery diarrhea with consistency of rice water, transmitted fecal-orally\
- Red raft connected to side of river by rope - does not invade mucosa but rather uses fimbriae to attach ganglioside receptors in intestinal wall and then secretes cholera toxin
- Base cAMP map and GS cannisters - activates GS pathway (constitutively activates adenylyl cyclase), which causes ↑cAMP → ↑Cl- efflux,↓Na+ absorption, mucin ejection by goblet cells → secretion of water & mucus into intestinal lumen → massive, watery diarrhea
- Colonel drinking water - treatment of Vibrio cholera is oral rehydration with electrolytes
- “Base” cAMP, lemon slices - acid labile
- Colonel wearing blue ring - Vibrio cholera is oxidase positive
- Seafood - Vibrio vulnificus and Vibrio parahaemolyticus (non-cholerae) can contaminate seafood, especially oysters
- hemorrhagic/necrotic wound infection and
invasive sepsis vulnificus
Campylobacter jejuni
- Campfire - Campylobacter is thermophilic, grows at 42C
- Chicken rotisserie - Fecal-oral via person-to-person contact, ingestion of undercooked contaminated poulty/meat (resides in intestinal tract of animals; often contaminates meat when slaughtered), unpasteurized milk, or contact w/ infected animals (e.g. dogs, cats, pigs)
- Red stools - bloody diarrhea
-
Camping guy with curved mustache - curved gram negative rod
5.** Blue ring **- oxidase positive - Bear cub invading cooler - enters gut, penetrates mucosa into bloodstream, can result in bacteremia
- Camping guy slapping knee in laughter - reactive arthritis or reiter’s syndrome
- Cub bear tripping over sausage links - Guillain-Barre syndrome: symmetric ascending paralysis & depressed/absent DTRs, beginning in lower extremities (can progress to respiratory failure) autoimmune response (e.g. molecular mimicry) → demyelination of peripheral neurons & endoneural inflammatory infiltrate
Salmonella
- Salmon’s tail flopping around - is motile
- Salmon on black plate - lack colonies on Hektoen enteric agar, meaning it’s H2S positive
- Salmon in glass dish - encapsulated (capsule is it’s virulence factor that protects it from phagocytosis)
- Lemon with the salmon - Salmonella is acid labile, degrades more easily in the stomach
- Chicken on the side - chicken is main reservior for Salmonella enteritidis; we get infected by eating undercooked chickens
- Seagull on the side - chronic carriers of Salmonella typhi harbor the organism in their gall bladder
- Seagull with apron with rose-colored spots - Typhoid Mary, and patients with enteric fever get rose-colored macules on abdomen (25% of the time)
- Skull of salmon exposed and seagull holding sickle - Salmonella typhi is number one cause of osteomyelitis in sickle cell patients
- Pea soup colored bird droppings - constipation, but can cause diarrhea, which resembles pea soup
- Flower in the glass next to the salmon and seagull - use fluoroquinolone to treat Salmonella typhi (not enteriditis)
- Syringe in the leg of the seagull - there is a live attenuated vaccine for Salmonella typhi (not enteriditis)
- Chicken lighting candle - inflammatory diarrhea
- Turkey baster - type III secretion system, a protein that detects eukaryotic cells and secretes a protein that helps with infectivity (thus it’s a virulence factor)
- Chicken and seagull have M phi bird cages - Salmonella (both subspecies) are facultative intracellular in macrophages (passes through stomach, small intestine, colon, then invades lymphatics and is taken up by macrophages)
- Salmonella (similar to Shigella) can invade the GI tract via the M cells of Peyer patches, eventually causing bloody diarrhea due to intestinal ulceration and perforation)
11.Injectable Vi capsular polysaccharide vaccine (ViCPS)
− 2 years of immunity
2) Oral live-attenuated vaccine for Salmonella Typhi (Ty21a)
− 5 years of immunity
Shigella
- **She-gorilla wearing green tutu **- green colonies on Hektoen agar
- **She-gorilla chained to a weight **- Shigella is immotile
- **She-gorilla walking over pool of acid **- cid stable, thus only needs a few organisms (10-100) to cause infection
- She-gorilla launched from rocket into M pad, white propelling streaks - Shigella penetrates the mucous membrane by passing through M cells via endocytosis. It then lyses the endosome, multiplies, & spreads laterally to other epithelial cells (via actin filaments [white propelling streaks]). This results in denuding & ulceration of the mucosa & subsequent leakage of blood, inflammatory elements, & mucus into the intestinal lumen → frequent stools mixed w/ blood & mucus.
- **She-gorilla sitting on red stool surrounded by flames **- inflammatory, bloody diarrhea
- Whip in a knot and She-gorilla spinning plates and red balloons being popped by the whip Young boy - Shiga toxin, which causes endothelial damage within glomerulus of kidney → aggregation of platelets, leading to drop in platelet count and protruding out of endothelium to lyse RBCs into schistocytes (look like helmets) as they pass by HUS most commonly occurs in patients under 10 years of age
- 60 second timer for the act - the 60S subunit of ribosomes to inhibit protein translation
- Ringmaster holding a turkey baster - type III secretion system (virulence factor) that allows it to detect eukaryotic cells and secrete inflammatory cytokines that help with infection
- Shigella cannot bind to all intestinal cells; it exhibits specificity for the M (microfold) cells [M pad], at the base of mucosal villi within a Peyer patch region of the ileal mucosa
M cells sample gut lumen contents & transfer antigens to their basal lamino within endosomes. At the base of the cell, macrophages & lymphocytes ready to mount an immune response await within a special pocket (microfold).
Five Fs – fingers, flies, food, fomites and feces
Antibiotics not indicated in mild cases but may reduce duration of symptoms
– First line: Fluoroquinolones (i.e. Ciprofloxacin) in severe cases
– Second line: Bactrim (first line in children)
Yersinia pestis , Yersinia enterocolitica
- Yersin’s pet store has a lot of red and pink hues - Yersinia is a gram negative organism
- Dog pooped everywhere in its box - Yersinia enterocolitica primarily transmitted via puppy feces
- Baby toddler holding a milk bottle - toddlers are common demographic infected by Yersinia enterocolitica; also infected via contaminated milk products
- Icicles outside the pet shop - is resistant to the cold
- Safety pin on toddler - exhibits bipolar staining, can appear like a “safety pin”
- Glass dome - is encapsulated
- Toddler sitting on red stool - infection results in invasive, bloody diarrhea
- Dog licking lower right quadrant of toddler - infection can mimic appendicitis (pseudoappendicitis; right lower abdominal pain due to mesenteric adenitis and/ or terminal ileitis)
- Prairie dogs in capsule - Prairie dogs & rats = reservoir of Yersinia pestis
- Sign for flea spray - pestis transmitted by flea bites
- Dude buying flea spray with buboes - (bubonic plague) can cause buboes, which are tender, swollen lymph nodes
- Store worker using turkey baster to give prairie dog water - pestis secretes Yersinia-associated outer proteins (YOPS) via type III secretion system -> causes macrophage and neutrophil dysfunction by inhibiting phagocytosis and cytokine production, allowing organism to rapidly replicate and spread
- **Worker using sai to clean up poop Mouse wheel **- use aminoglycoside (e.g. streptomycin) for treatment
Mouse wheel -> use tetracycline for treatment Use aminoglycoside such as streptomycin in combination with tetracycline - “Vaccinate your pet before they’re killed” sign - can use killed vaccine to help prevent Yersinia pestis (not common)
- Motile at 25°C but not 37°C
Proteus
1.Proteus is a half-man, half-octopus in a red bathroom - Proteus mirabilis is a gram negative, facultative anaerobe and demonstrates swarming motility when plated
2.Proteus is a helmet with stags - form staghorn calculi
3.Proteus’s job is to clean the restroom with an ammonia bottle - urease-positive
4.Proteus about to throw a stone at someone - CO2 from urea, resulting in alkaline environment, which allows precipitation of struvite stones; this causes pain and kidney damage, and can act as nidus for Proteus for recurrent infections
5.Dude peeing in the stall - cause urinary tract infections
6.Random fish strewn over the bathroom - have a fishy odor
7.Rotten eggs in the bathroom - treat Proteus mirabilis infection with sulfonamides
Klebsiella pneumoniae (Enterobacter, serratia group)
1.Hospital patient wearing gas mask and hooked up to urine bag - all infections result in pneumonia and urinary tract infections (UTIs)
2.Pills lying on the ground in the hospital - all infections are nosocomial (hospital-acquired) and multidrug resistant (treat witih a carbapenem/ 3rd to 4th gen ceph)
3.Pink milk carton - form pink colonies on MacConkey agar This really helps differentiate these three from other bacteria (only other one that can do this is E. coli)
4.Entero-dactyl is flying - Enterobacter is motile
5.Red tri-serra-tops is charging w/ cat - motile, catalase-positive, & produces red pigment
6.Ankylosaurus with club tail with three A spikes Anklyosaurus with spikes on body - alcoholics, abscesses, aspiration - Klebsiella commonly infect alcoholics, commonly create abscesses, and commonly get started from aspiration
Anklyosaurus with spikes on body -> Klebsiella has polysaccharide capsule
7.Ankylosaurus spilling currant jelly and getting stuck - Klebsiella produces currant jelly sputum and is immotile
8.X-ray with something in right lobe - Klebsiella can create abscess that looks like TB on an x-ray
9.Patient spraying ankylosaurus with ammonia - Klebsiella is urease positive
Pseudomonas
- **Red tub with water in it **- gram negative rod that thrives in aquatic environments
- Blue ring - oxidase positive
- Cat - catalase positive
- Green pigment on floor and tub - produces a blue-green pigment (even turns wounds blue) from pyocyanin and pyoverdin pyocyanin generates ROS to kill competing pathogens → tissue damage & tissue response
- Grapes - a fruity, grape-like odor
- Servant using air bellow to stoke fire to heat water for the bath - obligate aerobe
- Coughing nurse pouring chlorine into the bath - #1 cause of gram negative nosocomial pneumonia, and is a common cause of respiratory failure in cystic fibrosis patients
- Fish bones next to jar of candy and mortar and pestle - cause osteomyelitis, particularly in diabetics and IV drug users
- Candy in jar - encapsulated
- Maid caught on fire - increased risk for Pseudomonas infection
- Chamber pot next to nurse - cause nosocomial urinary tract infections
-
“Pseudo-mona” in hot tub - “hot tub folliculitis” (pruritic, papulopustular rash; infection of hair follicles), commonly due to exposure to under-chlorinated hot tubs, pools, spas, etc
13.** “Pseudo-mona” has a dalmatian** - Pseudomonas can cause ecthyma gangrenosum - Maid using ear piece to be nosy - cause otitis externa (infection of outer ear)
- Suitor in green bow tie and with accordion - ADP-ribosylation of elongation factor-2, which inhibits protein synthesis and causes cell death
- Piper playing music - use Piperacillin + Tazobactam
- **Suitor with a flower and sai **- fluoroquinolones (especially for UTIs) or aminoglycosides + beta-lactams
- (black necrotic skin lesions; due to perivascular bacterial invasion & release of tissue-destructive exotoxins, causing vascular destruction & insufficient blood flow to patches of skin that become edematous and subsequently necrose)
Helicobacter pylori
- Helicopter with propellors - Helicobacter pylori spins and whips its flagella to move around stomach, is motile
- Helicopter pilot has a mustache - curved gram negative rod (note that it’s more helical than Campylobacter and Vibrio)
- Pilot holding ammonia bottle - urease positive; urease splits urea into ammonia and CO2, which reduces acidity of stomach (necessary for H. pylori to invade stomach)
- Pilot wearing blue ring - oxidase positive
- Bullet holes in helicopter - often leads to duodenal ulcers
- **Sign of crab on helicopter **- astric adenocarcinoma (crab is sign for cancer)
- Discarded tissues - associated with lymphoma of MALT (MALToma), which generally goes away when infection is treated
- Proton bomb inhibiting a pump, Ammo box, Crows and one on a “keep clear” sign - Triple therapy for Helicobacter pylori: (1) proton-pump inhibitor - counters acid production caused by chronic H. pylori(2) amoxicillin(3) a macrolide, specifically clarithromycin
- This is target of two screening tests:
* urea breath test → swallow urea with radioactive carbon, see if radioactive isotopes are detected in exhalation (would indicate urease-positive organism)
* biospy during endoscopy and directly check for urease with rapid test
Borrelia burgdorferi
1.Northeast archery competition in forest - northeastern United States, often associated with hiking/camping trip in the woods
2.Tick on the sign - ick-borne disease, transmitted by Ixodes scapularis
3.Robin of Ixodes as first contestant - tick transmitting Borrelia is Ixodes scapularis, transmits three diseases: Lyme disease, ehrlichiosis (bacterial), babesiosis (protozoal)
4.White-footed mouse White-tailed deer - White-footed mouse = reservoir, host of tick larvae (smalller) White-tailed deer = obligatory host, host of adult tick (larger) Tick is the vector
5.Sir Wright and Sir Giemsa as contestants -can use Wright stain and Giemsa stain to stain Borrelia
6.Arrow splitting another arrow on target Spiraling arrow Sweating, regretful Sir Wrigh - “bull’s eye” rash, Borrelia is a spirochete Sweating, regretful Sir Wright -> flu-like symptoms
7.Dude holding shield with heart Bells on both sides of the guy’s face - heart block caused by myocarditis, bilateral Bell’s palsy (facial palsy)
8.Arrow in knee of swinging straw man Arrow in head of straw man and confused Sir Giemsa - migratory polyarthritis of large joints, subtle encephalopathic or CNS effects
9.Robin of Ixodes doing all this on a unicycle Shield with three axes - use doxycycline in stage 1 of disease, use ceftriaxone for more severe, later presentations of disease
- e.g. memory loss, cognitive slowing, lymphocytic menigitis)
positive result is confirmed with a Western blot
Rickettsia rickettsii
-
Event happening inside arena, crowd all in white - Rickettsia rickettsii is obligate intracellular and has no gram staining
Know that R. rickettsii causes Rocky Mountain Spotted Disease
2.Coaching holding energy drink - needs CoA and NAD+ from eukaryotic host to grow and replicate
3.Ad by Ricketts Tires - use doxycycline to treat
4.Holds up to the top of the climbing structure Event happening in Derma-Center arena - rickettsii spread by ticks (dermacentor ticks, distinct from Ixodes ticks)
5.Climbers get rash as they climb the wall via touch - no rash in early stages (2-14 days after infection), then starts at extremities (e.g. hands and ankles) and spreads centrally
6.Climber at top sweating and holding head - R. rickettsii results in headache, fever, and myalgias (non-specific)
Rickettsia prowazekii
- **Inside tennis stadium and crowd all dressed in white **- obligate intracellular and stains poorly on gram stain
- **Coach with energy drink **- needs CoA and NAD+ from eukaryotic cells
- Ricketts tires is sponsor of tournament - use doxycycline for treatment
-
Football play with players moving outwards - rash starts at trunk, and spreads outwards towards extremities
5.Players are all in red except hands, feet, and head - rash spares hands, feet, and head
6.Coach dressed like a general - military camp recruits and prisoners of war particularly at risk of infection by Rickettsia prowazekii (close contact and poor hygiene)
7.Look at the footballs - R. prowazekii spread by louse, which usually feasts on bleeding sites
8.Play is called the “Outbreak” - causes epidemic typhus
9.Player rocked hard, and coughing up dirt - myalgia (muscle pain), arthralgia (joint pain), and pneumonia
10.Player knocked really hard, feeling head - encephalitis, with dizziness and confusion, and even coma
Leptospira interrogans
- Surfer scene - highest incidence in U.S. is in Hawaii; associated with water sports
- Spiral shaped connector Question on surf board - is a spirochete - thin, short, spiral shaped Question mark on surf board -> Leptospira interrogans is also question mark shaped
- Yellow wave - found in animal urine, contaminates water that we may be exposed to
- **Surfer is sweating Surfer rubbing his eyes and rose-colored sunglassesz - flu-like symptoms in early leptospirosis (fever, intense headache) conjunctival suffusion (diffuse reddening around the eyes but lack of inflammatory exudate [pus])
5. Whale **- leptospirosis in most severe form is called Weil’s disease - Red inner tubes - leptospirosis can spread hematogenously (via blood stream) to various organs
- Big rubber dingy - Leptospira can cause kidney dysfunction
- Surfer’s suit changed to yellow - Leptospira can cause liver dysfunction and jaundice
- Mild disease: oral doxycycline, ampicillin, or amoxicillin Moderate or severe disease: IV penicillin, ampicillin, or ceftriaxon
erology: most common modality (Abs appear 3-10 days after sx
onset)
* Screening: IgM assays (e.g. ELISA)
* Confirmatory: microscopic agglutination test (MAT)
* Dark-field microscopy
* PCR (negative test does not rule out disease)
* IHC staining of tissues (kidney preferred
Brucella
- **Red barn **- gram negative
- Cow and pig - farm animals are reservoir of Brucella
- Spilled milk on the ground - transmission of Brucella occurs via direct contact with farm animals or ingestion of unpasteurized dairy products
- Gate that can open or close - facultative intracellular, can live inside or outside cells
- Skinny, sweating farmer - non-specific symptoms, including fever, chills, and anorexia
- Rolling hills in the background - rises and falls in some Brucellosis patients in what is called undulant fever
- Cow with certain patterns - ravel to multiple organs in reticuloendothelial system, including spleen, liver, and lymph nodes, and replicate intracellulary to enlarge the organs; this causes cell lysis and then systemic spread
- Leftovers for the pig with fish bones - can present with osteomyelitis’
- Windmill with bicycle wheel and farmer holding a rifle - doxycycline for treatment of Brucellosis, plus rifampin for adjuvant treatment
Francisella tularensis
- Rabbit - rabbits are the main reservoir of Francisella tularensis
- **Ticks **- can be transmitted by direct contact with rabbits but is more
- Francis the rabbit likes red radishes - s a gram negative coccobacili
- Open cage - facultative intracellular, thus recovery from infection depends on cell-mediated immunity
- Hole in the ground - causes a painful ulcer at the site of infection
- Rabbit hole leads to tunnel to store of rotting radishes - spreads from site of infection through lymph to reticuloendothelial organs (i.e. lymph nodes) and causes granulomas with caseating necrosis
- Rabbit mounds - lymph nodes can cause regional lymphadenopathy (swelling)
- Sais for gardening - use streptomycin, an aminoglycoside
Pasteurella multocida
- Louis Pasteur’s lab(rador), Ella, biting him - reservoir of Pasteurella multocida is small mammals like cats and dogs, thus common mode of transmission is cat or dog bites
- Erythematous area at site of bite - Cellulitis may occur within 24 hours of infection of Pasteurella multocida
- Pasteur holding fish bones - infection can spread to the bones and cause osteomyelitis
- Cat - Pasteurella multocida is catalase positive
- Pasteur wearing a blue ring - oxidase positive
- Swan-neck flask in glass casing - is encapsulated, which serves as a virulence factor
- Sheep’s blood - grows on 5% sheep’s blood agar
- Safety pin on Pasteur’s coat - bipolar staining, described as a “safety pin” under light microscopy
- Pasteur holding some pencils - Pasteurella multocida: beta-lactam antibiotic + beta-lactam inhbitor (amoxicillin/clavulanate)
- mouse in Pasteur’s lab - has a “mouse-like” odor (indole-positive species)
Bartonella henselae
- Bart the leopard sitting on a red pillow - Bartonella henselae is gram negative
- Starry night background (Van Gogh painting) - requires the Warthin-Starry stain (type of silver stain) to be visualized
- Princess owner has been scratched by the leopard and has clothing bunched into balls around her axilla - can cause cat-scratch disease and lead to fever and enlarged lymph nodes (axillary lymphadenitis); transmitted by cat scratches
- Dude scratched on hand with spotted garb - nfection can lead to bacillary angiomatosis with raised red vascular lesions; transmitted via cat scratches
- Dude holding cane - Bacillary angiomatosis occurs in immunocompromised
- Random wheel in the middle of the drawing - doxycycline to treat bacillary angiomatosis
- Crows - use macrolides to treat either cat-scratch disease or bacillary angiomatosis
Niserria Minigitidis
Coxsackie
1.Cockatiel with baby -> Coxsackie is a picornavirus
2.Warm, yellow colors and daylight - Coxsackie is a positive sense RNA virus
3.Statue of David - Coxsackie is a naked virus
4.Statue of David in cage A with red bird seed at mouth, hands, and feet - A causes hand, foot, and mouth disease, which manifests as a red vesicular rash
5.Kid with space helmet at cage A - Coxsackie A causes aseptic meningitis
6.Little girl in swimsuit - Coxsackie infection commonly occurs in the summer
7.Loose bags of red seed, shaped like hearts, in cage B - Coxsackie B virus can cause dilated cardiomyopathy
8.Zookeeper grasping cockatiel in cage B by the neck - Coxsackie B causes Devil’s grip aka Bornholm’s disease/pleurodynia,
HSV1 and HSV2
