STAPHYLOCOCCUS AUREUS (GOLDEN STAFF OF MOSES)

- Gram (+)
- Catalase (+)
- Coagulase (+)
- Beta Hemolytic
- Ferments Mannitol – turns agar to Yellow
- Protein A – main virulence factor – binds to antibody
- Colonizes the Nares (Nose)
- Causes Inflammatory Diseases :
o PNEUMONIA – with patchy infiltrates; POST-viral bacterial Pneumonia; patchy infiltrates
o SEPTIC ARTHRITIS – most common cause is S. Aureus in adults
o Skin Infections - ABSCESSES
o ACUTE BACTERIAL ENDOCARDITIS – rapid onset (Right-sided on Tricuspid Valve)
o ENDOCARDITIS in IV Drug users
o OSTEOMYELITIS – most common cause is S. Aureus
- Causes Toxin-Mediated Diseases:
o SCALDED SKIN SYNDROME – protease
o TOXIC SHOCK SYNDROME – leaving a gauze for a long period
 Toxic Shock Syndrome Toxin (TSST) acts as SUPERANTIGEN
o STAPH FOOD POISONING – rapid onset from preformed toxin (cream-based foods &
meat)
o Methicillin-Resistant S. Aureus – resistance from PENINCILLIN-BINDING PROTEIN;
treated with VANCOMYCIN
o Methicillin-Susceptive S. Aureus – treated with NAFCILLIN

STAPHYLOCOCCUS EPIDERMIDIS
- Gram (+)
- Enemy of Ortho surgeons, infects prosthetic joints
- from indwelling catheters.
- Most common cause of endocarditis in artificially implanted heart valves.
- Treated with VANCOMYCIN, and replace infected implants/prosthesis
- Normal skin flora
- Contaminates blood culture
- NOVOBIOCIN sensitive

STAPHYLOCOCCUS SAPROPHYTICUS
- NOVOBIOCIN Resistant
- Common cause of UTI in sexually active females.

STAPHYLOCOCCUS EPIDERMIDIS & STAPHYLOCOCCUS SAPROPHYTICUS (BEAUTY AND THE PLUMBER)

- Catalase (+)
- Urease (+)
- Coagulase (-)
STREPTOCOCCUS PYOGENES (GAS) (PIE GENIE’S BAKERY)
- Encapsulated
- Hyaluronic Acid
- Beta Hemolytic
- Pyogenic Infections it can cause:
o IMPETIGO – but can also be caused by S. Aureus
o PHARYNGITIS – (Strep Throat)
o CELLULITIS & ERYSIPELAS – most common cause is S. pyogenes
- Toxin-mediated Infections (STREPTOCOCCUS PYOGENIC EXOTOXIN):
o SCARLET FEVER – causing Strawberry tongue, Pharyngitis, and diffuse rash that spares
the face
o TOXIC SHOCK-LIKE SYNDROME – mediated by a SUPERANTIGEN
o NECROTIZING FASCIITIS (speB)
- Complications:
o RHEUMATIC FEVER – M-proteins- main virulence factor – antiphagocytic action; mimics
MYOSIN in the heart valves (MITRAL valves – causing MITRAL STENOSIS);
 commonly from Strep Pharyngitis;
 JNES Critieria:
1. J- Polyarthritis
2.  - Valvular Heart Diseases, Myocarditis, Endocarditis
3. N – Subcutaneous Nodules
4. E – Erythema Marginatum
5. S - Sydenham’s Chorea
o POST-STREP GLOMERULONEPHRITIS
 Cola-colored Urine
 Puffy Faced – from edema
 Occurs 2 weeks after the onset of the initial strep infection.
 Treated with PENICILLIN
- Virulence Factors:
o STREPTOLYSIN O – allows hemolysis;
o STREPTOKINASE – converts Plasminogen to Plasmin (Fibrinolytic)
o DNase
- BACITRACIN Sensitive
- Antistreptolysin O (ASO) Titer

STREPTOCOCCUS AGALACTIAE (GBS) (GALACTIC BABY)

- Gram (+)
- Usually causes serious infections in Newborns
- Hippurate (+) – hydrolyzes sodium hippurate
- Polysaccharide Capsule
- CAMP test (+) – distinguishes from all other strep.
- Beta Hemolytic
- BACITRACIN Resistant
- Number one cause of Meningitis in Neonates.
- Common cause of Neonatal Sepsis
 - causes Pneumonia
- CAMP test “arrowhead” ZONE OF HEMOLYSIS
- Neonates get infected upon Vaginal Delivery of infected mothers. (tested at 35 weeks AOG).
- Infected mothers are given Penicillin (intrapartum) to avoid transmission to the neonate.

STREPTOCOCCUS PNEUMONIAE & STREPTOCOCCUS VIRIDANS (THE ALPHA KNIGHT TOURNAMENT)

- Alpha Hemolytic (Partial Hemolysis)

STREPTOCOCCUS PNEUMONIAE
- Encapsulated with Polysaccharide Capsule
- OPTOCHIN Sensitive – inhibits growth of S. pneumonia.
- Lancet-shaped Diplococci
- Bile-soluble
- Most common cause of Community-Acquired Pneumonia in adults
- LOBAR PNEUMONIA – generally infiltrates the lower lobe; rust-colored sputum
- Most common Cause of the ff: (MOPS)
o MENINGITIS
o OTITIS MEDIA
o PNEUMONIA
o SINUSITIS
- IgA Protease – virulence factor; cleaves IgA
- Sickle Cell Disease (Asplenia) – particularly susceptible
- Treated with Macrolides; 3rd Gen Cephalosporin (Ceftriaxone)
- Pneumococcal Vaccines :
o Adults – 23-valent Polysaccharides Vaccine ; cause IgM RESPONSE
o Children – 7-valent Polysaccharide conjugated with a Protein; IgG RESPONSE

STREPTOCOCCUS VIRIDANS
- No capsule
- OPTOCHIN Resistant
- Bile Insoluble
- Strep Mutans – causes dental caries; when taken into the blood stream, can cause subacute
endocarditis and damage heart valves (most commonly affected Mitral Valve)
- Adheres to platelets (through Dextrans)

ENTEROCOCCUS (PROTEST AT THE CAUCUS)

- Gram (+)
o E. Faecalis – more common, can grow in medium of 6.5% NaCl;
o E. Faecium – more dangerous, bile resistant.
- Main Infections caused:
o UTI
o ENDOCARDITIS
o BILIARY TREE INFECTIONS
- VANCOMYCIN Resistant
 - LINEZOLID or TIGECYCLINE are the alternative antibiotics

BACILLUS ANTHRACIS & BACILLUS CEREUS (KING ANTHRA’S AXE)

- Black Eschar
- Large Gram (+) Bacilli in chains
- Protein Capsule instead of polysaccharide.
- Poly-D
- Obligate Aerobes
- Spore-forming
- Toxins:
o EF (EDEMA FACTOR) – increase cAMP
o LF (LETHAL FACTOR) – cleaves MAP Kinase (control of cell growth); responsible for tissue
necrosis as seen in Black Eschar
- Pulmonary Anthrax (Wool Sorter’s Disease) – can cause Pulmonary Hemorrhage from widened
Mediastinum
- Treated with Flouroquinolones and secondary Doxycycline

BACILLUS CEREUS
- Associated with Food Poisoning from reheated fried rice.

CLOSTRIDIUM TETANI (RHESUS RESEARCH REVOLUTION)

- Obligate Anaerobe
- Spore-forming; spores found in soil and in rusty nails
- Gram (+)
- Causes:
o Spastic Paralysis,
o Risus sardonicus (evil grin) or Locked-Jaw Symptoms,
o Opisthotonus – exaggerated arching of back
- Retrograde transport of the toxins, which acts by cleaving SNARE protein, resulting to inihibition
of release of GABA and Glycine from RENSHAW cells
- TETANUS TOXOID VACCINE – toxin is conjugated to a protein to increase immunogenicity

CLOSTRIDIUM BOTULINUM (ROBOTULISM)

- Gram (+)
- Transmitted by improper canning of food
- Spore-forming
- Obligate Anaerobe
- Causes:
o Flaccid Paralysis – in a descending manner; early symptoms include ptosis and diplopia
 Toxin cleaves SNARE Protein, prevents fusion of vesicle at the presynaptic
terminal, and attacks motor neurons, inhibiting release of Acetylcholine, causing
flaccidity.
- Infection in babies causing Floppy Baby Syndrome; usually ingested Honey with spores.
CLOSTRIDIUM DIFFICILE (FIELDTRIP TO THE CHOCOLATE FACTORY)
- Spore-forming
- Gram (+)
- Obligate Anaerobe
- Nosocomial Diarrhea
- CLINDAMYCIN – associated with Clostridium dificile infection
- Toxins:
o EXOTOXIN A – targets the Brush Border Enzymes, causing Watery Diarrhea
o EXOTOXIN B – depolymerisation of actin filaments causing pseudomembrane formation
resulting to pseudomembranous colitis.
- Treated with ORAL VANCOMYCIN and METRONIDAZOLE

CLOSTRIDIUM PERFRINGES (PRIVATE RINGEN’S MOTORCYCLE ACCIDENT)

- Gram (+)
- Infection associated with motorcycle accidents
- Associated with Military Combat Wounds
- Spore-forming; spores usually found in soil
- Obligate Anaerobe
- Causes:
o GAS GANGRENE (Clostridiomyonecrosis) – Soft Tissue Infection; organism produces gas
under the tissue. Myonecrosis involves ALPHA TOXIN or Lecithinase by damaging
phospholipids. Lecithinase can cause red blood cell hemolysis, forming double zone of
hemolysis on blood agar.
o Food Poisoning – late onset; slow onset watery diarrhea caused by spore ingestion and
germination inside the gut.
- Treated by PENICILLIN G

CORYNEBACTERIUM DIPHTHERIAE (CORAZON de la CORRIDA)

- Gram (+)
- Club shaped
- Metachromatic granules
- V or Y Formation
- Exotoxins: inhibits Ribosylation of elongation factor 2 (EF-2) to inhibit protein synthesis resulting
to Pseudomembrane Formation.
o A – active subunit
o B – binding subunit
- Transmitted via respiratory droplets
- Causes:
 o BULL’S NECK – due to lymphadenopathy
o CARDIOTOXIC EFFECTS – Myocarditis ; Arrhythmias ; Heart Block
o LOCAL PARALYSIS
- Diagnosis – swab is plated on TELLURITE AGAR or LOEFFLER’S MEDIUM
- ELEK’S TEST – to differentiate between toxic and nontoxic strains of Diphtheria.
- Diphtheria Toxoid Vaccine – IgG response.
- Treatment is PASSIVE VACCINATION.

LISTERIA MONOCYTONEGENES (SANTA’S LIST)

- Common in pregnancy, causing early termination or disease in newborn
- Forms narrow zone of hemolysis
- BETA HEMOLYTIC
- Tumbling motility extracellularly
- Gram (+)
- Actin Rockets
- Catalase (+)
- Cold environment/ near-freezing conditions
- Contaminate milk and cheese.
- Causes:
o MENINGITIS – 3rd most common cause
- Treated with VANCOMYCIN and CEFTRIAXONE, in elderlies, AMPICILLIN is added.

ACTINOMYCES ISRAELII (ISRAELI SOLDIER)

- Gram (+), filamentous, branching rod
- Obligate Anaerobe
- Normal flora of oral cavity
- Infection associated with jaw trauma
- Formation of sinus tract that drains yellow sulphur granules.
- Treated with PENICILLIN G

NOCARDIA SPECIES (NO CARD GAME FOR OLD MEN)

- Gram (+), filamentous, branching rod
- Obligate Aerobe
- Found in soil
- Nonspore-forming
- Weakly stains ACID FAST since it has MYCOLIC ACID in its cell wall.
- Catalase (+)
- Urease (+)
- Primarily affects immunocompromised individuals with impaired cell-mediated immunity.
- Causes:
 o PULMONARY (PNEUMONIA ASSOCIATED WITH CAVITARY LESIONS IN LUNG)
o CNS (BRAIN ABSCESS FORMATION)
o CUTANEOUS (INDURATED LESIONS AND INFLAMMATORY REACTION)
- Treated with SULFONAMIDES – smells like rotten egg

NEISSERIA SPECIES (NOIR SERIES)

- Gram (-) Diplococci
- Oxidase (+)
- Unable to grow on blood agar, but grows in heated blood agar, CHOCOLATE AGAR
- Grows in VPN (Vancomycin, Polymexin, Niastatin) Agar / Thayer Martin Agar
- Complement deficiency of C5 AND C9 are unable to form MAC Complex, leading to increased
infections
- Virulence Factors:
o PILI or FIMBRIAE – demonstrate antigenic variation.
o IgA Protease – cleaves IgA at hinge region

NEISSERIA MENINGITIDIS (SHOCKING DEATH ON CAMPUS)

- Ferments MALTOSE in addition to glucose
- Colonizes nasopharynx first, transmitted by respiratory secretions
- Polysaccharide capsule which inhibits phagocytosis
- Type B capsule is not included in the vaccine
- Sickle cell and asplenic patients are at higher risk of infection
- LOS envelope proteins cause massive inflammatory response
- Inflammation leads to capillary leak leading to purplish petechial rash / purpura
- Characteracteristic petechial rash indicates thrombocytopenia
- Capillary leakage can lead to hypovolemia then shock.
- Waterhouse-Friderichsen Syndrome, characterized by haemorrhage of adrenals from prolonge
shock.
- Treated by 3rd generation Cephalosporin
- Prophylaxis for close contacts used is Rifampin.

NEISSERIA GONORRHEAE (THE VIOLINIST’S LAST CLAP)

- Facultative intracellular in PMN
- No capsule
- Sexually Transmitted Infection; in male – Urethritis; female – Pelvic Inflammatory Disease
- Characteristic white purulent discharge
- Fitz-Hugh-Curtis Syndrome – spread of PID into the peritoneum
- “Violin String” adhesions for to capsule of liver
- Cause:
o Asymmetric arthritis, commonly at knee
o Neonatal Conjunctivitis – early onset in newborns
- Treated by CEFTRIAXONE
- Assume coinfection with chlamydia when treating.
ENTEROBACTER CLOACAE, SERRATIA MARCESCENS, KLEBSIELLA PNEUMONIAE (ENTERODACTYL,
TRISERRATIATOPS AND THE KLEB-TAILED DINOSAUR)
- Pneumonia, UTI – most common nosocomial infections
- Patient in hospitals are with increased risk of MDR.
- Ferments LACTOSE, slow fermenter is Serratia
- Stains pink on MacConkey Agar
ENTEROBACTER
- Motile

SERRATIA
- Motile
- Produces red pigment in culture

KLEBSIELLA
- Nonmotile
- Has kleb-tails
- Has a polysaccharide capsule
- Urease (+)
- Commonly infect Alcoholics, forms Abscesses, and infects by Aspiration
- Coughs up “currant jelly sputum”
- Sometimes misdiagnosed as PTB

SALMONELLA TYPHI AND ENTERITIDIS (THE SALMON DINNER)

- Motile
- H2S (+); Black colonies on HEKTOIN AGAR
- Encapsulated
- Acid-labile
- Susceptible persons are those taking antacids and PPIs.
- Facultative intracellular (within macrophages)

SALMONELLA ENTERITIDIS
- Ingested from undercooked chicken (main reservoir)
- Causes Inflammatory Diarrhea
- Type III secretion system

SALMONELLA TYPHI
- Chronic carriers harbour these organisms in the Gallbladder
- Typhoid Mary – red/rose-colored macules in the abdomen
- Number one cause of Osteomyelitis in Sickle cell disease.
- Resembles pea-soup Diarrhea
- Fluoroquinolones
- Live attenuated vaccine

SHIGELLA SONNEI & SHIGELLA DYSENTERIAE (SHE-GORILLAR’S CIRCUS)

 - Inflammatory Bloody Diarrhea
- Forms Green Colonies on Hektoin Agar
- Nonmotile
- Acid-Stable
- Use of actin filaments
- Invasion of M Cells
- Shigetoxins, which binds to 60s subnit of ribosomes.
- Type III secretion

SHIFELLA DYSENTERIAE
- Glomerular damage
- Activating platelets, causing thrombocytopenia
- Causes RBC hemolysis
- Causes Hemolytic Uremic Syndrome, most commonly occurring in under 10 years old children

ESCHERICHIA COLI, ENTEROHEMORRHAGIC EC, ENTEROTOXIC EC (E. COLA’S SODA FOUNDATION)

- Gram (-)
- Ferments Lactose, grows pink on MacConkey Agar
- Encapsulated
- K ANTIGEN
- Green on EMB agar
- Catalase (+)
- Fimbriae – necessary to cause UTIs
- UTI – most common cause is E. coli
- Sepsis – most common cause if E. coli
- Neonatal Meningitis only if it has the K Antigen

EHEC
- Transmitted by eating undercooked hamburgers
- Causes Blood Diarrhea
- The only E coli that doesn’t ferment Sorbitol
- Shiga-like toxins
- Can cause also HUS
- Damages endothelial cells in glomerulus
- Platelet aggregation and decrease in platelet count
- Also causes Hemolysis
- O157:H7 antigen is associated with outbreaks

ETEC
- Traveler’s Diarrhea
- Transmitted via water
- Heat-labile toxin increases cAMP
- Heat-stable toxin increases cGMP
- Watery Diarrhea