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