01 Gm positive cocci
- 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
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
- 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