Micro Cheat Sheet

(PASS Videos)

Staining Clues Gram (+) cocci staph/strep Gram (-) cocci Niserria/Moraxella Gram (+) rods Bacillus, Clostridium, Listeria, Cornybacterium Gram (+) Branching rods Nocardia, Actinomyces

Exotoxins (G-) LPS/LOS Lipid A (toxic) Increased # Macrophages Increased # Cytokines

Exotoxin (G+ &G-) A-B Component A = Toxin B = Binding

Nickolskys Sign

Virulence Gram (-) pilli or fimbriae Gram (+) teichoic acid IgA proteus Capsules largest capsule is in Neiserria Antiphagocytic Surface (Ex: S.pyogenes M protein ; N. gonorrhea pili ; S. aureus protein A

Neurotoxins C. tetani painful spasms C. botulinum flaccid paralysis

Evade Killing Mycobacterium TB cord factor (macrophages cannot breakdown bacteria so T cells surround and create granulomas) Listeria jumps from cell to cell

Media MacConkeys ferments lactose EMB eosin methylin blue fecal stool (E.coli) Buffer Charcoal Yeast Agar legionella Chocolate agar Neiserria, Haemopolis o X factor = Heme ; V factor = NAD ***Anytime you see this, choose Chocolate agar

TCBS Vibrio cholera ferments sucrose turns orange

***Staph. pyogenes = Staph. aureus ***Strep. pyogenes is #1 cause for:

(Old name for it)

o Lymphangitis (see red line going up arm), Impetigo, Necrotizing fasciitis, crysipelas (no blanching), and Scarlet Fever ( rash that spares palms and soles)

Skin Infections Cellulitis: flat, red, blanches Mastitis: cellulitis around the breast (mothers should continue to breast feed) Balanitis: infection at the head of the penis Panniculitis: cellulitis around the abdomen

Periorbital cellulitis: infants, trauma (little kid with swollen eye) o S. aureus Orbital Cellulitis: proptosis, older pt. o S. pneumonia Carbuncle: nodular induration with infection Furuncle: hair follicle in the middle of the carbuncle; no pus Carbunculosis: deep skin infection o S. aureus Furunculosis: many infections of the hair shafts o Common areas nap of neck, chest, legs Fasciitis: inflammation of the fascia o Plantar or necrotizing Folliculitis: infection of the hair shaft Blepharitis: infection of the eyelid

Mouth Flora S. pyogenes (GAS) S. pneumonia H. influenza IgA protease N. catarrhalis o N. gonorrhea o N. meningitides Peptococcus Low yield Peptostreptococcus Fusobacterium o Trench Mouth- pus from gums o Vincents Angina painful ulcers at the back of the neck Actinomyces o Draining fistulas o Sulphur granules S. viridians o S. mutans ferments glucose Dental Subacute bacterial endocarditis o S. sanguis o S. salivarius

Stomach Flora H. pylori use campylobacter-like test to diagnose (positive turns green)

Urease (+) Bugs -

P PUNCHeS B

Proteus Pseudomonas Ureoplasma Nocardia Cryptococcus H. pylori S. saprophyticus Brucellosis

Curved Rods Vibrio Camphlobacter Listeria H.pylori

Small Intestinal Flora 95% E.coli processes vit. K production of factors 2, 7, 9, 10 in liver

Small Intestinal Infections Cholecystitis Ascending Cholangitis Appendicitis Spontaneous bacterial peritonitis Abdominal abscess

***If there is a perforation, blame anaerobes put in a draining site

E.coli makes... 90% of vit. K Biotin cofactor Folate for rapidly dividing cells and for purine/pyrimidine synthesis o All pregnant mothers should be on folate 30-90 days prior to conception

E.coli Helps your body absorb Vit. B12 use Schillings Test to determine B12 deficiency o Procedure: give B12 I.M. then give B12 radio-labeled) o If B12 is found in urine, then B12 deficiency Then give radio-labeled intrinsic factor. If in urine, then deficiency and rule out pernicious anemia

Distal ileum and Colonic flora Proteus 2nd line in UTI Klebsiella 3rd line in UTI Serratia marscencens Citrobacter infant with meningitis with cerebral abscesses Acenetobacter immunosurpressed pt. on ventilator E.coli

Big MaMa Anaerobes Bacteroides fragilis obligate anaerobe of GI S. bovis big cause of colon cancer C. melanogosepticus less big cause of colon cancer C. difficile pseudomembrane colitis

Rectal Flora

GBS E.coli Listeria monocytogenes really old/really young

BUZZWORDS Staph gram (+) in clusters Aureus Gold pigment lactamase Coagulase + MSA ferments mannitol #1 Osteomyelitis Epidermitis White Pigment Deep to Skin Novobiocin Sensitive Prosthetic devices Saprophyticus n/a Skin Novobiocin Resistant UTI; honeymoon cystitis

S. aureus o Catalse + - breaks down H2O2 o lactamase always garage door o Coagulase & staphlokinase eats through clots o MCC of Acute Endocarditis o MCC of osteomylitis o MCC of death in burn pt. in first week After first week is pseudomonas o Toxins: Scalded Skin Syndrome Exfoliating (Nikolski Sign), red rash all over body except for palms and soles Toxic Shock Syndrome Traid (high fever, hypotension, rash); retained tampon, palms and soles Lecithinase causes skin infections (subcutaneous fat) Enterotoxin causes food poisoning (dairy products- gastroenteritis; Fast- 2-6 hours)

Enzymes Continued: o Lipase (breaks down fat) panniculitis, folliculitis, mastitis o Elastase (breaks down elastin) Bullous Emphysema (pneumatocelle) Comes from neutrophils Elastin + collagen = CT

 A1Antitrypsin (liver) inhibits elastase Panacinar (panlobular) aging Centriacinar (centrilobular) smoking Distal (periceptal) - bullous o Collagenase (skin & bone breaks peptide bonds) MCC of osteomyolitis (2nd is Salmonella) Type IV (BM) Type III (endothelium arteries affected) Type II (CT)

S. epidermidis o Catalase + o White pigment o Resides under the skin o MCC of Shunt infections and central line infections o Tx: Vancomycin Linezolid for vancomycin resistance Keep pt in a negative pressure room

S. saphrophyticus o Catalase + o No pigment o Frequent cause of UTI Ages 5-10 and 18-24 (post coital UTI, no circumcision) E.Coli is MCC of UTIs

Strep gram + cocci in chains o Lancfield Groups A, B, C, D o Types of helolysis: hemolysis partial (green zone) hemolysis complete (clear zone) hemolysis no hemolysis (red zone) o Streptokinase responsible for the hemolysis (clear zone) Breaks clots converts plasminogen to plasmin

If ANY past Strep infection, it will NOT work use tPA Converts plasminogen to plasmin breaks clots Binds fibrinogen will not clot again

Thrombolytics o Urokinase opens fistulas and grafts o Streptokinase Beta hemolytic acute MI o Tissue Plasminogen Activator (tPA) acute MI, acute Stroke (within 3hrs) ***Antidote for all three = aminocaproic acid

S. pneumonia (pneumococcus) o Gram + diplococcic o Alpha hemolysis (green zone) o 80 Strains o Pneumococcal vaccine (pneumovax) covers 23 strains (98% coverage) Who should be on it: >65y/o ; >2y/o with Sickle Cell (spleen-encapsulated organisms) End Organ Failure PSGN (post strepto glomerulo nephritis) - skin and throat can cause this o Strain 12

S. pyogenes (GAS) o Beta hemolytic (clear zone) o 70 Strains o MCC for throat infections Can lead to rheumatic fever nd o 2 MCC of Skin infections

S. agalactiae (GBS) o MCC of neonatal Sepsis o Beta hemolytic (clear zone)

S. viridians (GDS mutans, saguis, salivarius) o Alpha hemolytic (green zone) o MCC of Subacute Bacterial Endocarditis Septic emboli to brain Roth Spots emboli to retina Osler nodes emboli to fingers (painful) Splinter hemorrhages emboli to nail beds Pitting on nail beds = psoriasis ; spooning on nail beds = iron deficiency Janeway lesions emboli to toes o Previous Damage to heart valve predispose to SBE this is why dentists ask if have a past history of rheumatic fever; damage to valves o Tx: Amoxicillin

Enterococcus (faecalis, faeceum) o Anaerobic o hemolytic (red zone) o likes immunocompromised pt o Nitrite Negative UTI o Tx: Vancomycin MOA: cell wall inhibitor (inhibits phospholipid carrier [irreversible]) and Tx for all gram + Toxicity: Red Man Syndrome, Intense histamine release (not allergic), ototoxicity, nephrotoxicity (tubules and interstitium) Used for: MRSA, S. epidermidis, and enterococcus If MSSA, then switch over to napacillin

Meningitis o 0-2 month GBS E.coli Lysteria o 2mo-10years

 S. pneumoniae N. meningitides o 10-21years N. meningitides S. pneumoniae o >21years S. pneumonia

Cornybacterium Diptheriae o Chinese Letters o Toxin that ADP-ribosylates EF-2 Affects translocation of protein synthesis o Toxin may also cause Heart Block o Intracellular pathogen o Cells die, slough off, and mix with mucus, forming a grey membrane in posterior pharynx o Do NOT scrape: will hemorrhage profusely o DPT: 2m, 4m, 6m, 18m, 5-6y o TX: antitoxin first; antibiotic (toxin is hurting the pt, not the bug)

ADP-ribosylators o Gs: Vibrio Cholera, ETEC o Gi: Bordatella pertussus o EF2: C. diptheriae, pseudomonas

Cause Heart Blocks o Lyme Disease o Legionella o Typhoid Fever o Diptheria o Chagas Disease What parts of the body does it like to chew on? Ganglia no release of VIP (relaxing hormone) lower esophageal sphincter remains constricted no GURD