03 Gm negative cocci

• pink handcuff: Gram negative diplococci
• blue ring: Oxidase positive
• ferments glucose. Meningiditis also ferments maltose

• Vice City Private Investigator: Growth on VPN agar
• Thayer Martin: Alternate name for VPN agar
• Chocolate bar: Growth on chocolate agar

The commonly used antibiotics are vancomycin to inhibit gram-positive bacteria, colistin (i.e. polymyxin) to inhibit gram-negative bacteria (commensal Neisseria species but not N. meningitidis or N. gonorrhoeae), nystatin to inhibit yeast, and trimethoprim to inhibit the Proteus species.

• Mac: Patients with C5-C9 deficiency are unable to form MAC complex, leading to increased infections
• 5-9PM: C5-C9 deficiency

• chains: Pili demonstrate antigenic variation. Fimbriae
• card: IgA protease - cleaves IgA at hinge region

Neisseria Meningiditis

• Dorm room: Easily spread in close quarters like college dorms
• Communist flag: Sickle cell and asplenic patients at higher risk of infection

• Malt liquor: Ferments maltose in addition to glucose. Compare with neisseria gonorrhea
• plastic bags on floor: Polysaccharide capsule inhibits phagocytosis

• Q tip: Colonizes nasopharynx first. Transmitted by respiratory secretions.

• Syringe, A, C, D: Vaccine contains polysaccharide capsule
• No syringe: Type B capsule not included in vaccine

• Envelope burning: LOS envelope proteins cause inflammatory response
• Water leaking: Inflammation leads to leaky capillaries
• Electric circuit: Capillary leakage can lead to hypovolemia and shock
• Underwear with red dots: Characteristic petechial rash indicates thrombocytopenia
• Wet floor spots: Petechial rash from thrombocytopenia. Risk of DIC
• Petechial rash from thrombocytopenia. Risk of DIC
• Water house: Waterhouse-Friderichsen syndrome, characterized by hemorrhage of adrenals (adrenal insufficiency, low bp, shock, DIC)

• Ceftriaxone treatment
• Rifampin prophylaxis in close contacts

Neisseria Gonorrhea

• Red pillows in white chairs: Gram negative diplococci, facultative intracellular in PMNs
• Broken glass: not encapsulated

• chandelier: Causes Pelvic Inflammatory Disease in females
• white on table: Characteristic white purulent discharge
• Band name: Fitz Hugh Curtis Syndrome: spread of PID into peritoneum
• violin: Violin string adhesions form to capsule of liver
• covering baby's eyes: Early onset conjunctivitis in newborns
• cracked knee: Asymmetric arthritis, commonly in knee

• Ceftriaxone treatment
• clam: Chlamydia coinfection, doxycyclinen and macrolide

• woman at bar: Sexually Transmitted Infection (the sexual tension is palpable)

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