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