02 Gm positive bacilli

• Air bellow : obligate aerobe
• Large ships in chain: Large gram positive rods in chains
• Leather armor with buckles: Protein capsule composed of poly-D-glutamic acid

• Walnuts, like seeds: Spore forming
• Sheep: "Wool sorters disease"- classically causes pulmonary infection in those who work with wool. Spores stay in wools for long time

• Black ground and flame: Most common manifestation of infection is cutaneous black eschar
• Large axe with blood: Pulmonary infection may lead to pulmonary hemorrhage
• Ship with wide mast: Widened mediastinum on chest x-ray if pulmonary infection.

• Shield with EF: Edema factor
• viking tent: Edema factor acts by causing elevation in cAMP
• LF shield: Lethal factor
• Burning map: Map kinase, burned and turned into eschar. Lethal factor responsible for tissue necrosis

• Pink flower: Flouroquinolone treatment
• Bicycle: Tetracycline treatment

• Viking reheating rice and vomiting: B.cereus classically causes vomiting after eating reheated rice.

Clostridium Tetani

• purple color: gram positive
• Walnuts: Spore forming
• Gas mask: Obligate anaerobe

• Pots of earth on ground: Spores found in soil
• Nails: Endospores transmitted via puncture wound from rusty nail (construction zone)
• Barbed wire: Endospores transmitted via puncture wound from barbed wire (construction zone)

• Evil monkey smiling: Lock jaw symptoms and facial spasms (risus sardonicus (evil grin))
• Monkey extend back: Opisthotonus, muscle spasms cause arched back

• Orange syringe: Vaccine consists of deactivated toxin (same color orange), not the bacteria

• Scissors on pulley: Tetanus toxin (not the organism) migrates to CNS via retrograde axonal transport
• Snare trap: Tetanus toxin cleaves SNARE
• G and G labs: Tetanus toxin cleaves SNARE preventing release of inhibitory neurotransmitters GABA and Glycine, inhibit inhibitors = uncontrolled firing
• Wrench and saw: Tetanus toxin inhibits inhibitory neurotransmitter release from Renshaw cells in spinal cord

Clostridium Botulinum

• violet color: gm +
• mechanical nuts: Spore forming
• gas mask: Obligate anaerobe

• Canned robot shape: Transmitted by improperly canned, insufficient heating of home canned food, allow spore survival and heat production (family developing neuro symptoms)

• Robots heads and torso going limp: Descending flaccid paralysis (Guillian Barre ascending) (multiple people with symptoms = botulism)
• Only affects PNS, not CNS because can't cross BBB
• Droopy robot eyelids: Ptosis

• Oil: Infantile bolulism transmitted via honey ingestion
• Baby robot flaccid: "Floppy baby"
• Adults ingest spores directly ok because anaerobes outcompete in GI. Babies have low GI anaerobe flora

• Ach power supply: Botulism toxin prevents acetylcholine release (excitatory) at neuromuscular junction
• Scissor cutting: protease cutting SNARE

• Adults symptoms by ingest toxins; baby symptoms by ingest spores

Clostridium Difficile

• Gas mask: Obligate anaerobe
• Walnuts: Spore forming

• Apples: Exotoxin A
• Brushing apple: Exotoxin A attaches to brush border
• Chocolate syrup: Watery diarrhea
• Shoe from chocolate syrup: Toxin detected in stool

• Clean hand sign: Clindamycin: C. Diff infection after antibiotic use

• B sign: Exotoxin B
• Kid picking apart actins: Exotoxin B disrupts cytoskeleton by depolymerizing actin. Inactivates Rho regulatory protein. Loss of intracellular tight junction = cell rounding
• Membrane on right: Pseudomembranous colitis

• Tongue looking van: Oral vancomycin for treatment
• metro train: IV metronidazole for treatment

Clostridium Perfringes

• Gas mask: Obligate anaerobe
• double fine zone: Double zone of hemolysis when plated in anaerobe environment

Anaerobic culture of Clostridium perfringens on blood agar. The characteristic double zone of clear beta-hemolysis around a colony is clearly seen (arrow).

• Walnut and pots : Spores found in soil
• Private fell of motorcycle: Infection associated with motorcycle accidents and other major trauma
• Private: Infection associated with deep penetrating military wounds

• Slow sign in puddle: May cause slow onset diarrhea; spores have to germinate first before cause diarrhea, not preformed
• Gas from motor cycle: Causes "gas gangrene", causes crepitus when palpate. Metabolizes carbohydrates, producing the gas.

• alpha flag on bob pins: Alpha-toxin, lecithinase (phospholipase), disrupts cell membrane function
• tomatoes on ground smashed: Alpha-toxin also has hemolytic activity

• Pencil: Penicillin treatment

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Cornyebacteria diptheria

• purple hue: gram positive
• Guy playing with toys, zig zag lines: Metachromatic granules (red and blue). Club shaped rods in V or Y formation

• Guy with bow tie playing elongating piano: ADP ribosylation of elongation factor 2, inhibits protein synthesis, cell death, pseudomembrane

• Candy with plastic wrap: Pseudomembrane on throat and tonsils
• Bull: Bull neck
• Heart shaped cape block bull: Cardiotoxic effects: myocarditis, arrhythimia, heart block
• Guy eating sausages shaped like nerves: Demyelination causes nerve deficits starting in posterior oropharynx
• Fibrinous exudate → systemic circulation → cortical neurons: This is the route that diphtheria toxin takes from the pseudomembranous exudate it forms in the pharynx to the bloodstream and subsequently to cardiac and cerebral cortical tissues.

• Droplets from bull's mouth: Transmitted by respiratory droplets

• Tele screen: Plated on Tellurite agar
• Kid watching and laughing: "Plated on Loeffler's medium"
• Bull licking: Elek's test, differentiate toxin variant

• Syringes: Inactivated pertussis toxoid vaccine, IgG

• Treatment: administer IVIG

Listeria monocytonegenes

• Cat: Catalase positive
• Falling tree: Tumbling motility
• Beta bulb: Beta hemolytic
• Actin rocket half in and out: Facultative anaerobic bacterium
• Ice on window: Motile with flagella at 30 degrees and below
• Actin rocket: At body temperature, motile by actin polymerization, or "actin rockets"

• Pregnant woman: May be acquired transvaginally- pregnant women may be advised not to eat soft cheese
• Milk: Transmitted from dairy products
• Cheese: Transmitted by consumption of certain of cheeses
• Santa: Infection also prevalent in elderly population
• Baby with helmet: Common cause of neonatal meningitis

• Amplifier: Treatment with ampicillin

Actinomyces israeli

• gas mask: Obligate anaerobe, nocardia is aerobe
• Tree branching, violet wrap: Gram positive filamentous rod
• Yellow rocks: Yellow sulfur granules

• Canal draining: Formation of sinus tracts. Draining sinus tract
• Jaw wrap: Infection associated with jaw trauma

• Pencil: Treat with penicillin

Nocardia

• NH3 spray bottle: Urease positive
• Branching tree: Gram-positive branching filamentous rod. - Similar to actinomyces
• air bellow: Obligate aerobe
• Cow boy cloth with tails: Mycolic acids with two tails
• cat: Catalase positive, pts with CGD at increased risk
• Fast drawing of gun: Partially acid fast, carbo fuscia stain

• Cactus pot broken: Found in soil

• Cane: Immunocompromised especially affected

• Coughing: Pneumonia like symptoms
• Bullet hitting chest: Associated with cavitary lesions in lung
• Bullet leaving hole in hat: Brain abscess formation
• Cow print with red around: Cutaneous symptoms- indurated lesions and inflammatory reaction

• Rotten eggs: Treat with sulfonamides