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Gram +/- BACTERIA (GRAM (-) BACTERIA bacters... (*COCCOBACILLI "…

- - - - Branching Filaments
      - Anaerobic
        
        "ANaerobic = ActiNomyces"
        
        *ActiNomyces
        
        "ANaerobic = ActiNomyces"
        
        ACTINO --> not acid fast
        
        Actinomyces = Aspirated food infection
        --> mistaken for lung abcesses, TB and lung cancer, etc.
        
        ACTIN O MYCES PORN SCENE with the DENTIST and ANAROBE ANT IN A ROBE
        
        the low lighting from the HANGING HYPHAE BRANCHES all
        --> branching Hyphae
        
        SET in the LOVE MOUTH BED FULL OF FLOWERS
        --> ACT IN O MYCES PORN SCENE is normal mouth flora
        
        the DENTIST pornstar is doing DENTAL work before the scene
        --> you usually catch ACTIN O MYCES PORN SCENE from DENTAL WORK
        
        the direct = PENICILLIN PENCIL gives the hot ANAROBE AUNT an IUD so she wonlt get pregnant
        --> ACT IN O MYCES can cause infections in IUDS
        
        when the ACT IN O MYCES PORN SCENE is over shit hits the fan because IN A ROBE AUNT gets an infection that SPREADS to her URINARY SYSTEM
        --> common in ACT IN O MYCES infections
        
        YELLOW PUS OOZES everywhere
        
        the PENCIL DIRECT ENDS the scene ao he can jump in for the next one
        --> tx with high dose penicilin
        
        Aerobic
        
        "Aerobic Fillaments = ARABs fill NO CARDS"
        
        *Nocardia
        
        "Aerobic Fillaments = ARABs have NO CARDS to get in"
        
        slightly acid-fast = Ziel Neilson stain
        --> like mycobacteria tuberculosum
        
        note that Nocardia can almost never infect normal people since NO CARDS to play... = no virulence factors to get past the immune system
        --> ONLY infect immunocompromised people
        
        when it does, it is almost always RTI pneumonia
        --> 50% go on to brain abscess and seizures
        
        Acid Fast Staining / Ziel Neilson Stain
        
        only Nocardia and mycobacteria tuberculosis are acid-fast
        
        first stain with analine dye = carbolfuscin = red dye
        --> binds with mycolic acid
        
        then alcohol to wash away non-acid fast cell walls
        
        counterstain blue
        
        1 more item...
        
        NOCARDIA ADVENTURE on PAPER that leads to the
        
        you start to DREAM ABOUT AEROBICS with a STAPH CAT who starts UREASING your notes to distract you
        --> NOCARDIA is STAPH CAT +
        --> NOCARDIA is AEROBICS
        --> NOCARDIA is urease +
        
        you then get distracted by a ACID FAST LEMON
        --> stains + on acid fast stain
        
        the ACID FAST LEMON leads you to the foot of a massive BRANCHING TREE
        
        you start to look around the NOCARDIA BRANCHING TREE until you see a CLUMP OF DIRT that seems to be hiding something
        --> NOCARDIA BRANCHING TREE is found in the soil
        
        you start to dig up the soil until you find a hidden FIRST AIDs KIT with a + cross sign on it with LOTS OF BAND AIDS
        --> NOCARDIA BRANCHING TREE is a gram + branching filament
        --> it affects people with AIDS mostly
        
        you then look up to see some HANGING BEADS
        
        NOCARDIANG BRANCHING TREE looks like beaded filament on microcsope
        
        these beads lead you down a CAVITATING LUNG where you climb down the BEADED ROPE
        
        this was a mistake as it leads you into the layer of BRAIN and LIVER ABSCESS GUY
        --> NOCARDIA BRANCHING TREE causes liver and brain abscesses in AIDS people
        
        Treatment for Gram + BRANCHES = SNAP them
        
        SN = SMX-TMP Sulfonamides --> Nocardia
        
        AP = Actinomyces --> Penecillin
        
        ACTINOMYCES
        Actinomyces = ACTs IN / NOMal / YCES
        
        "ACTs IN" IUDs --> PID
        
        "NOMal" = normal flora of mouth, GI
        
        "YCES" = Aspiration and Abscesses (oral/facial)
        
        NOCARDIA
        Nocardia = ARAB who has NO CARDS to play...
        
        "ARAB" = aerobic
        
        "NO CARDS" = no virulence factors to get past the immune system
  - - - Anaerobic
        
        *Clostridium Family
        
        "C DIFF = C cup TITZ and BOOBZ are DIFFICULT to PERFECT"
        --> TITZ = clostridium tetani
        --> BOOBZ = clostridium botulinum
        --> DIFFICULT = Clostridium dificile (C. dif.)
        --> PERFECT = clostridium perfringens
        
        Clostridium Difficile
        
        "It's DIFFICULT to attach 2 White CAP BOOBY TASSLES"
        
        C. difficile is mostly found in soil but
        --> but also found in a very small portion of the body as normal flora
        
        CAP = CYTOskeleton B toxin , A toxin cAMP, pseudomembranes
        
        note that both normal flora of mouth and anus (Candida and C Diff) have pseudomembrane formation
        
        1 more item...
        
        CLOSTRIDIUM CLASSROOM of DIFFERENTIAL equations
        
        all CLASSROOMS = clostridums have POSITIVE students and are equipped with TEACHING pointer RODS
        --> clostridium family are GRAM POSITIVE RODS
        
        bad kids in the classroom DAYDREAM of BOOBY tassles with 2 WHITE CAPS on them
        
        CAP 1 = toxins of C DIFF
        --> C = cytotoxic b toxin --> cytoskeleton
        --> A = A toxin --> increases cAMP and gives dirrhea
        --> P = pseudomembrane (white) colon
        
        CAP 2 = drugs cause C DIFF
        --> C = clindamycin = chalkboard CLEANING MICE and VAN of MICE
        --> A = ampicillin = PENCIL AMPS
        --> P = PPIs
        
        one student = SUMO fat kid gets in trouble for playing with his PSUDOMEMBRANOUS COLITIS in the middle of class
        --> pseudomembranes in both major microbiota of mouth and colon (candida albicans + c diff)
        
        as punishment the SUMO FAT kid has to show everyone his MEGACOLON
        --> C diff gives megacolon
        
        to get rid of C DIFF / escape from the though of being in the classroom
        
        Kids DAYDREAM again, but this time of how to get TRANSPORTED out of the C DIFF classroom
        --> FIRST by a METRO KNIGHT train drove by a KNIGHT = Metronidazole
        --> after the METRO KNIGHT train doesn't work they need to hire some more dangerous and out of control THUGS
        --> last resort = dream of VAN full of CLEANING MICE = Vacomycin comes to bust them out
        
        2 more items...
        
        Clostridium *Perfringens
        
        C DIFF - PERFECT BOOBZ
        
        cause perforation of the colon
        
        Virulence Factors for Clostridium perfringens
        
        2 main toxins for perfringens
        --> one causes the gas gangrene of necrosis
        --> one causes the "perforating" of cell membrane seen in perfringens
        
        lecithinase = phospholipse C
        
        this is a "dirty version" of our human phospholipase A2 that is used in arachanodonic acid waterfall for cleaving arachanodonic acid from the cell mebrane to make eucosanoids
        
        rapid glucose metabolism of C perf.
        
        this is what causes the characteristic gas gangrene of necrosis in c. perf.
        
        1 more item...
        
        CLASSROOM for PERFUMES with the very hot and sexy (alpha lecithinase) AFRO-LACED THIN teacher
        
        all the SPORE boys in the class DROOL over her and her AFRO
        --> AFRO perfringens creates spores
        --> she sprays them all with perfume and tries to dance for them
        
        BUT her AFRO always gets stuck in the plasma membrane garland above her head
        --> lecithinase PERFORATES plasma membranes
        
        on the wall there is a MUSCLE MAN where the classroom pet MUSCLE NECROSIS CROW sits
        --> the little boy SPORES love to piss off the bird and spray it with gangrene GREEN perfume
        
        1 more item...
        
        *SNARE cleaving clostridium toxins
        
        clostridium botulinism vs clostridium tetani
        
        both cleave SNARE proteins
        
        key difference is tetani travel retrograde (same as Rabies virus) to GABA neurons and prevent GABA inhibition
        
        botulinism stay in the ACh NMJ where they entered, cleave the SANREs and stop ACh release
        --> sustained relaxation of muscles
        
        tetani after retrograde to GABA neurons, cleave the SANREs and stop GABA release
        
        --> sustained contractions of muscles
        --> orthopismus
        
        Clostridium *tetani
        
        blocks inhibitory neurons
        --> blocks GABA and Glycine
        
        trismus = lock jaw
        
        found in mammal GI tracts normally
        
        get deposited in the soil everywhere
        
        release tetani toxin
        --> travels retrograde through axons to block anterior horn inhibition
        
        tetanus of muscles
        
        "BATS with SNARE NAILS = Joker's MUSCLE thugs"
        --> "BATs with SNARE nails" = tetanus cleaves SNARE
        
        2 more items...
        
        Clostridium *Botulinum
        
        BOTULISM = BODulDYSM
        --> 4 Ds = DOUBLE D + 3 DYS
        
        diplopia
        
        Dysarthria
        
        dysphagia
        
        dyspnea
        
        Botulinism freezes the muscles of your face
        --> Muscles = ACh
        
        DYSM = Dysmembered Muscles = ACh
        
        CANNED foods
        --> spores can be present in honey
        
        1 more item...
        
        Tetanus vs Rabies vs Botulism
        
        Tetanus = muslce SPASMS and LOCK JAW
        --> puncture wound Hx / Injection Drugs
        
        Botulism = BODulDYSM double vision and 4 DYSs SPASMS and LOCK JAW
        --> dysphagia, dysarthria, dyspnea
        
        Rabies = hydrophobia, fever, hyperactivity
        --> think animal in HEAT and hyperactive, salivating and hydrophobic
        --> Hx of animal bite
        
        "C DIFF = C cup TITZ and BOOBZ are DIFFICULT to PERFECT"
        C DIFF:
        "ClostridiuNN = It's DIFFICULT to attach 2 White CAP BOOBY TASSLES"
        
        "ClostridiuNN 2 WHITE caps" = neutrophils make up the white caps
        --> Toxin A recruits neutrophils for inflammation
        
        "CAP 1" = neutrophils make up the white caps
        
        "C" = Cytotoxic B toxin = causes bowel wall necrosis and pseudomembranes
        
        "A" = A toxin - causes neutrophils to come and cause inflammation
        
        "P" = pseudomembranes
        --> these cover the mucosa, can't absorb
        --> cause watery diarrhea
        
        "CAP 2" = ABx and PPIs that cause C diff
        
        "C" = clindamycin
        
        "A" = ampicillin
        
        "P" = PPIs
        
        C Tetani:
        "BATS with SNARE NAILS = Joker's MUSCLE thugs"
        
        "BATs with SNARE nails" = tetanus cleaves SNARE
        
        "Joker's MUSCLE thugs" = tetanus block muscle ACh
        
        "Joker" = tetanus presents with unique JOKER FACE
        --> upslanting eyes and grin
        
        C Botulism:
        BODulDYSM
        
        "4 Ds = DOUBLE D check + 3 DYS / Double check your CAN GOODS"
        --> double vision = diplopia
        --> dysarthria
        --> dysphagia
        --> dyspnea
        
        "BOTULISM = BOTTLED honey"
        --> botulism toxins found in can goods
        --> especially honey with children
        
        *Spore formers and boiling temperature survival
        
        both clostridium family and bacillus anthracis can survive boiling temps
        --> reason why you ned autoclaves in hospitals
      - Aerobic
        
        *Listeria Bacillus
        
        C. Diff. = butt vs Lysterine = other holes (mouth + vagina)
        --> Listeria AEROBIC vs C Diff anaerobic
        
        Listeria usually only causes infection in birth infants and HIV/immunocompromised
        
        "Listeria BACILLUS = Lysteria BABIES (mouth + vagina)"
        --> "BABIES mouth" = Lysteria in unpasteurized milk
        --> "BABIES vagina" = Lysteria + GBS in vagina of mother
        --> mother - child transmission at birth
        
        in pregnant women
        --> passed on through placenta, birth or spontaneous abortion
        --> need to be screened at 36 weeks
        --> cause birth canal --> infant transmission
        
        "tumbling G+ rods" + red rocket tails
        --> think "LISTEN for the tumbling LISTERIA in the bottle when you drink KEVS milk"
        --> tumbling G+ rods
        --> unpasteurized milk
        
        LISTERIA LIZARD cowboy INSIDE the COLD CAGED CELL
        
        LISTERIA LIZARD can survive in meats in the cold fridge
        
        LISTERIA LIZARD lives INSIDE the fridge and INSIDE cells of the body
        --> INTRACELLULAR
        
        LISTERIA LIZARD is a COWBOY
        --> so it lives int he desert with TUMBLE WEEDS
        
        LISTERIA LIZARD is a COWBOY that uses his revolver to shoot ACTIN ROCKET TAILS at a STAPH CAT
        
        STAPH CAT blocks the LIZARDS rocket tails with a BETA FISH
        --> LISTERIA LIZARD is both STAPH CAT POSITIVE and BETA HEMOLYTIC
        
        LISTERIA LIZARD serves SOFT CHEESE to the PREGENANT MOM and her entire FAMILY
        
        LISTERIA LIZARD serves soft cheese
        --> Listeria lives in the fridge and will often go in soft cheese like Brie or feta
        
        Pregnant women can get Listeria and pass it on to their infant at birth or during pregnancy
        --> during pregnancy infection = can casue spontaneous abortion
        --> pregnant mothers are screened for Listeria 2 weeks prior to due date to rule out infection
        
        Cytotoxic T cells destruction of Listeria = Key defense
        
        note that listeria is INTRACELLULAR
        --> think of the Listeria lizard = INSIDE the refrigerated cell of the desert
        --> thus listeria like all other intracellular pathogens need cytotoxic T cells to kill the cell and lyse it
        --> exposes the intracellular listeria to activated macrophages
        
        note this is also key that the Cytotoxic t cells also activate macrophages since some intracellular bugs can evade the lysosome destruction if the macrophage isn't activated
        
        *Viurlence for Listeria
        
        able to live in cold temperatures
        --> reason why Listeria can contaminate unpasteurized milk and processed meat in the fridge
        
        *Bacillus Anthracis
        
        "Bacillus Anthracis = BACKS Anthracis" =
        --> backs of animal hydes coomon to get anthrax
        
        bacillus anthracis toxin
        
        "Bacillus AN thra CIS = Bordatella Tuss CYS" = adenylate cyclase CIS
        --> mimics the adenylate cyclase to increase cAMP
        --> inactivates macrophages and evades the immune system
        
        "Bacillus AN thra CIS = Bordatella Tuss CYS" = also has edema factor the same as bordatella pertussis
        
        P/C of Anthrax
        
        main virulence is antiphagocytic D glutamate capsule
        
        divide the presentation into
        --> initial non specific febril illness
        --> vs rapid mediastinal proliferation and shock/death
        
        ANTHRAX TRACK - terrorist trying to blow it up with a SPORE BOMB
        
        the ANTHRAX TRACK train is bringing the president old GRAM + Cracker to rural US to visit a farming community
        
        POLY in a CAPSULE bodyguard that throws D GLUE TOMATOES at the Spore BOMB
        --> D glutamate polypeptide capsule virulence factor
        --> evades phagocytosis
        
        SHIELD ANT GEM body guard blocks the tomatoes and protects the SPORE BOMB
        --> SHIELD ANT GEM = shield antigen
        --> virulence factor that evades the immune system
        
        ANTHRAX TRACK train blows up from the terrorist SPORE BOMB --> explosion next to the SHEEP WOOL FARM
        People affected by the train TRACK SPORE BOMB
        
        SKIN SUIT MAN has NECROTIC BLACK 3rd degree burns on his back and is holding up a sign with a NECROTIC CROW on top of it saying IM OKAY IM NOT HURT I SWEAR
        --> ANTHRAX TRACKS gives necrotic BLACK ulcers on the skin
        --> these necrotic ulcers looks bad but they are PAINLESS
        
        ANTHRAX TRACK explosion at the SHEEP WOOL FARM
        --> anthrax in sheeps wool and other hides
        --> the explosion killed a bunch of sheep
        --> GI GUY didn't want the sheep to go to waste so he ate one and DIED
        
        Anthrax Life Cycle
      - Corneybacterium *Diptheria
        
        are special Gram positive rods
        
        diptheria are BOTH aerobic and Anerobic
        --> G+ rods anerobic = clostridium
        --> G+ rods aerobic = LISTERIA LIZARD
        
        note that diptheria toxin is what is used for the conjugate vaccine of HNS polyssacharride meningitis to give the T cell responsed added to normal vaccine B cell response
        
        DIP YOUR CORNEBACTERIUM at the FAIR
        
        an ADP REDBULL attacks ELONGATED ELVES with TUTUs
        --> ADP rybosylating elongation factor
        
        the ELONGATED ELVES with TUTUs are playing the ALIEN STAINS BLUE game
        
        SUMOPHAROAH also likes to go to the fair
        --> pseudomembranous pharingitis
        
        there is a POLY with NEURON LEGS doing magic tricks at the CORNEYBACTIUM FAIR with MAYO HEART CARDS
        
        Classic Corynebacterium P/C
        
        very unique presentation of Diptheria is the Greyish-White Pharyngeal membrane that forms
        --> like a DIP of CALKING put in the back of your mouth
        
        "Landan Learns the ABCDE's of CORN DIPPING FAIR"
        
        "Landan Learns the CD --> ABCDE's of CORN DIPPING FAIR"
        
        Landan = Grey/white Calking in the back of the mouth
        --> pharingitis membrane is key in P/C
        
        A = ADP of EF = elongation factor 2
        --> EF2 needed for elongating the polypeptide chain of ribosomes for protein synthesis
        --> this is how the diptheria toxin kills cells
        
        B = Beta prophage is what spreads the toxin
        
        C = Corynebacterium
        
        D = Diptheria
        
        EF = Elongation Factor
        
        G = Greyish membrane that forms in the back of the mouth
  - - - "Staph Episode of the Sapranos"
      - -
        
        *Streptococcus
        
        Streptococcal Infections
        
        Acute (PS-GN)
        post-streptococcal Glomerulonephritis
        coca-cola urine, puffy eyes
        
        post 1-3 wks. after pharyngeal (strep. throat) or skin infection (impetigo)
        
        PS-GN TRIAD = Santa gets a sore throat night before Christmas
        
        "fat, puffy eyed Santa"
        --> post Strep. throat/skin infection
        --> fat = HTN
        --> puffy eyed = periorbital edema
        --> Santa = coca-coal urine hematuria
        
        Hemolysis
        Test.
        
        green
        / yellow
        
        Alpha
        Hemolysis
        
        Alpha Optochin "OVRPS"
        --> Optochin viridans = resistant
        --> pneumoniae = sensitive
        
        2 more items...
        
        white
        
        Beta
        Hemolysis
        
        *Bacitracin Sensitivity
        
        note PYR means the same thing
        --> PYR + = bacitracin sensitive
        --> bacitracin Abx attack PYR of Strep Pyogenes
        
        3 more items...
        
        Beta Hemolysis = "bursting"
        
        note that both Group A and B Strep., the main ones are both Beta hemolyis
        --> Bacitracin + = Group A strep.
        --> Bacitracin - = Group B strep.
        
        red
        
        Gamma
        Hemolysis
        
        Growth in 6.5% NaCl
        
        note ALL Gamma hemolysis Bacteria are GUT FLORA
        --> strep BOVIS
        --> Enterococcus fecalis and fecium
        
        1 more item...
      - +
        
        *Staphylococcocus
        
        "*STAPH CAT"
        --> staphylococci are Catalase +
        
        Coagulase Test
        
        -
        
        SoNS = Coag. Negative Staph.
        
        Staph. Epidermidis
        
        Staph. Saprophyticus
        
        "No VIOlent Staph on EPISODES of SLIMY SAPRANOS"
        
        .>80% of CoNS are MR resistant
        --> need Vancomycin or other heavy Abx
        
        Novobiocin
        sensitivity
        
        3 more items...
        
        +
        
        *Staph. Aereus
        
        "Staph Cats ARE COag +"
        
        STAPH CAT
        
        All Staph are catalase positive
        
        Staph A are + for EVERYTHING
        --> Catalase, Coagulase , and Beta hemolysis positive
        
        STAPH CAT variation = virulence factors
        
        "ST-A PH CA" = Fc of antibodies blocked by A protein of STAPH CAT
        
        "MEC CA" = mecA gene mutation = MRSA
        
        STUFFalococcus AFTERus -
        
        "STUFFalococcus" = Staph TSS
        --> comes after prolongue stuffing of tampons or nose bleeds
        
        "AFTERus" = Staph pneumonia usually after Influenza virus infection
        
        STAPH CAT - name 1 infection from EACH ORGAN
        
        "STAPH GI" = 2-6 hour food poisoning
        
        "STAPH Heart" = IE most common cause
        
        "STAPH Lungs" = Pneumonia after Influenza
        
        "STAPH Skin" = Impetigo and Folliculitis
        
        "STAPH blood" = Staph TSS = STAPH CAT MAC PAP
        --> note that Staph TSS has maculopappular rash over entire body
        --> compared to Niesseria = bleeding type rash = petechiae and echymosis
        
        1 more item...
        
        2 more items...
        
        Staphylococcus Infections
        
        osteomyelitis
        --> secondary to sepsis or bacteremia
        
        *GCD = Chronic Granulomatous Disease
        
        deficient in NADPH oxidase complex
        --> can't metabolize NADPH into oxides from the HMP shunt pathway
        
        constant infections from catalase positive organisms mix of bacteria fungi
        
        5 catalase-positive organisms: Staphylococcus aureus, Burkholderia cepacia, Serratia marcescens, Nocardia, and Aspergillus.
- - - - + Lactose Fermentation
        
        WHITE gram negaitves
        
        Fast Lactose Fermentators
        
        EEK
        
        main lactose fermentors on MacConkey Agar
        
        *Enterobacter
        
        *E. Coli
        
        for women, UTIs are caused by E Coli UNTIL PROVEN OTHERWISE
        --> dysuria urinary frequency/urgency, and suprapubic tenderness
        
        4 subtypes
        
        INVASIVE = Shigella like = necrosis and dysentry
        
        eneroTOXIC = Travellers Diarrhea
        
        PEDIATRIC = watery diarrhea in children
        
        HEMORRHAGIC = SHIGA like infection with triad of
        --> anemia
        --> thrombocytopenia
        --> acute renal failure
        
        3 more items...
        
        4 E. Coli Toxins
        Pediatric
        
        Kids lie FLAT when they are sick
        --> E coli P toxin just flattens vili
        --> causes watery diarrhea
        
        Travellers
        
        T toxin is resistant to heaTTT
        
        Inflammatory
        
        INVADES the mucosa and causes necrosis and dyssentry (just like Shiga)
        --> dysentry = blood and mucus in diarrhea
        
        Hemorrhagic
        --> 3 Hs
        
        Hemolytic, hamburgers (and lettuce), HUS
        --> HUS = Hemolytic uremic syndrome
        
        "SHAGGY rugs from the 60s"
        
        SHIGA like toxin IRREVERSIBLY binds to 60s and stops protein synthesis
        
        JUMANJI E COLI board GAME - and the 4 E COLI players
        
        LIP APPLE and SHOCKING SEPSIS SNAKE
        --> LIPS APPLE = LPS polysacharride
        
        PILLARS with FLAMING UTI KIDNEYS on top
        
        K KAP FAMILY
        --> K KAP dad = K KAP MEN IN TIGHTS holding their K KAP BABIES
        --> K KAP wives = K KAP NUDE MONA LISA
        
        ANT GEM FLAGELLA
        --> in most species of JUMANJI E COLI
        
        if you land on T you get thrown into the JUMANJI E COLI RIVER
        --> travellors Diarrhea.
        
        if you land on H you get thrown into the JUMANJI E COLI HEMORRHAGIC HAMBURGER corn HUS fields
        --> HUS = hemolytic uremic syndrome
        
        1 more item...
        
        *Klebsiella
        
        "Alcoholics Aspirate KLEBS SODA and JELLY in their SLEEP"
        --> Klebsiella pneumonia in alcoholics common
        --> aspiration at night = supine = posterior part of right lobe
        
        key features of Klebsiella CLUB soda
        --> can form abscesses, but MOST abscesses, even in alcoholics are multimicrobial --> need Clindamycin
        --> blood tinged currant jelly
        
        3 more items...
        
        Staph. Epidermidis
        Staph. Saprophyticus
        
        Novobiocin
        sensitivity
        
        staph. saprophyticus
      - (-) Lactose Fermentation
        
        WHITE gram negaitves
        
        Oxidase Test
        
        (-) Oxidase Fermentation
        
        H2S production on TSI Agar Test
        
        (-) H2S
        
        *Shigella
        
        Shigella has both the same toxins as E COLI
        --> Infectious Shiga toxin
        --> HUS Shiga toxin in E coli Hamburger, HUS, hemorragic
        
        Shigella always causes dusentry and bloody diarrhea
        
        Note that it only takes 10 Shigella to get an infection
        --> very low threshold for infection
        
        1 more item...
        
        *Yersinia = FAMILY of EAR SCIENTISTS = part of SIGELLY
        
        EARSCIENTIST of ENTER the COLD KINGDOM
        -- Yersinia from pets = puppies usually
        --> Yersinia mimics appendicitis
        
        EAR SCIENTIST of PESTS
        --> yersinia pestis = black plague
        
        2 more items...
        
        (+) H2S
        
        *Proteus
        
        cause UTIs associated with subsequent genertion of renal calculi
        --> Staghorn kindey stones are stones that go up past the renal pelvis and into 2 or more renal cacluli
        --> look like stag horns in the renal calices and pelvis
        
        1 more item...
        
        *Salmonella
        
        salmonella typhi vs salmonella spp.
        
        note that Salmonella = hydrogen sulfate positive (except S. typhi)
        --> way to tell Salmonella vs Shigella
        --> negative for most other things
        
        1 more item...
        
        + Oxidase Fermentation
        
        *Pseudamonas
        
        "PSEUDAMONAS is KEY to the Gram - SHIGELLY tree "
        
        pseudomonas Tx = CAMPFIRE
        
        PSEUDOMONAS
        --> think EXTERNAL and EXCTHYMAS
        --> Pseudomonas are common in water (hot tub skin, swimmer's external ear, )
        
        P = P/C = pneumonia chronic in CF / pyocyanosis
        
        S = Sepsis
        
        E = Ecthyma Gangranosum Ulcers
        
        U = UTIs
        
        D = Diabetes / Drug use infections
        
        O = Otitis EXTERNA (swimmer's ear)
        
        M = Mucoid polysaccharide capsule --> allows for chronic pneumonia in CF
        
        O = Osteomyelitis
        
        N = Nosocomial UTIs etc.
        
        A = Exotoxin A
        
        S = skin infections from HOT things
        --> hot tub folliculitis
        --> burn victim wounds
        
        1 more item...
        
        SUMO MONA LISA is BLIND and sitting in her HOT HOT TUB
        
        SUMO MONA LISA is BLIND and is served by 2 CYSTIC FIBROSIS SISTERS
        --> SUMO MONA LISA infects people with dirty contact lenses
        --> SUMO MONA LISA gives NUDE MONA LISA to CYSTIC FIBROSIS SISTERS
        
        SUMO MONA LISA is a FAT DIABETIC older version
        -->
        
        SUMO MONA LISA stares at her younger NUDE MONA LISA self while CYSTIC FIBROSIS SISTERS serve her IN DONUT CARDITIS
        --> causes endocarditis
        
        SUMO MONA LISA gets infections all over her SKIN and BURNS her skinas well
        
        ENTERAGE OF DRUG AND DIABETICS who are having an INJECTING PARTY in the HOT TUB
        
        the skin infections in SUMO MONA LISA are because of her ENTERAGE OF DRUG AND DIABETICS
        --> IV drug addicts in SUMO MONA LISAs hot tub INJECTION PARTY inject right into their bones
        --> DIABETICS of SUMO MONA LISAs hot tub INJECTION PARTY help the IV drug addicts by injecting drugs and insulin into their INFECTED and DIABETIC FEET
        
        SUMO MONA LISA has a UTI WATER SLIDE going into her HOT TUB straight from the hospital since she is so FAT she NEVER takes out her CATHEDER
        
        SUMO MONA LISA are one of the main causes of UTI from hospital catheders
        
        1 more item...
  - - - GLOSS OX tests in Gram (-)
        "OX"
        
        ALL Gram - comma shaped rods are oxidase positive
        
        Note: All bacteria that are oxidase positive are aerobic, and can use oxygen as a terminal electron acceptor in respiration
        
        "gLOSS = Lactose / Ox / H2S sulfate"
        
        order for the tests in Bacilli
        
        "L of gloss = Lactose"
        
        for the main group = Bacilli
        --> use oxidase test + = EEK main guys
        
        "EEK = Enterobacter = CIT RO BACK down .. and eat your SERRATIA"
        
        slow Lactose compared to the EEKs are:
        --> citrobacter and serratia
  - - - "NICE Double DDs at the MALL rather than at the MOXYs bathroom"
        
        NICE DOUBLE DDs = Diplococci Gram -
        
        NICE DDs at MALL = Neisseria Men. are MAltose agar +
        
        DDS at Moxy's bathroom = Diplococci DDs NOT at the MALL are MALT (-)
        --> they are at MOXYs bathroom
        = moxarella / gonorrhea
      - .+ (Malt)
        
        *Neisseria Meningitidis
        
        N meningitis = meningococcal Meningitis
        
        "Do you see NICE Double DDs at the MALL?"
        --> Neisseria Meningitidis are Maltose positive agar
        
        Niessera recurrent in MAC -deficient patients
        
        MAC end result of circulating antibodies
        
        if MAC not present or working, then Neisseria recurrs in meningitis often
        
        Clinical Cases
        
        Clinical Case
        
        3 more items...
        
        Notes:
        
        for N meningitis there are 2 main vaccines
        
        the 4 serum type is given to all and the serotype B is for only high risk populations
        
        polysaccharides are in the 4 type vaccines
        --> they stopped phagocytosis of the bacteria
        --> think polysaccharides = POLY = MANY times SLIP away = sacharrides
        
        *Virulence for Neisseria Meningitidis
        
        LOS of blood pressure = N men. causes its form of TSS from
        --> LOS = lipopolysaccharide
        --> vs. A toxin of STAPH CAT TSS
        
        hypervariant PILI = way that Niesseria Men and Gonnorrhea latch onto things
        --> Niesseria Men. PILI latch onto the cribiform plate
        --> Niesseria Gon PILI latch onto the vagina
        
        PRP polysacharide capsule evade phagocytosis and also stops the C3b compliment system
        --> PRP polysacharide capsule same capsule for all other major meningitis causes (note even Strep Pneumo of SNH has this capsule - even since it is Gram +)
        
        *LOS virulence factor for TSS - by Niesseria
        
        LOS of blood pressure = N men. causes its form of TSS from
        --> LOS = lipopolysaccharide
        --> vs. A toxin of STAPH CAT TSS
        
        Staph TSS = STAPH CAT MAC PAP
        --> compared to Niesseria = bleeding type rash = petechiae and echymosis
        --> note that Staph TSS has maculopappular rash over entire body
        
        1 more item...
        
        PathoPhys for Neisseria Meningitidis
        
        3 step process that uses its 3 virulence factors:
        --> pili for attatching and invading the oropharynx mucosa
        --> PRP polysaccharide capsule (same as Hib and strep pneumo) for evading the CB3 compliment and macrophages
        --> LOS = lipopolysaccharide for causing hypotension
        
        hypervariant PILI = way that Niesseria Men and Gonnorrhea latch onto things
        --> Niesseria Men. PILI latch onto the cribiform plate
        --> Niesseria Gon PILI latch onto the vagina
        
        PRP polysacharide capsule evade phagocytosis and also stops the C3b compliment system
        --> PRP polysacharide capsule same capsule for all other major meningitis causes (note even Strep Pneumo of SNH has this capsule - even since it is Gram +)
        
        LOS of blood pressure = N men. causes its form of TSS from
        --> LOS = lipopolysaccharide
        --> vs. A toxin of STAPH CAT TSS
        
        .- (Malt)
        
        Moraxella
        
        DDS at Moxy's bathroom = Diplococci DDs NOT at the MALL are MALT (-)
        --> they are at MOXYs bathroom
        = moxarella / gonorrhea
        
        Neisseria *Gonorrhea
        
        DDS at Moxy's bathroom = Diplococci DDs NOT at the MALL are MALT (-)
        --> they are at MOXYs bathroom
        = moxarella / gonorrhea
        
        gonorrhea are INTRACELLULAR gram -
        --> very sneaky bugs
        
        Presentation of Gonorrhea
        
        note that gonorrhea will present with
        --> SEVERE BURNING on urination
        --> creamy and PURULENT penile discharge
        
        *Virulence for Neisseria Gonnorrhea
        
        hypervariant PILI = way that Niesseria Men and Gonnorrhea latch onto things
        --> Niesseria Men. PILI latch onto the cribiform plate
        --> Niesseria Gon PILI latch onto the vagina
        
        1 more item...
        
        Tx Chlamydia and Gonorrhea together
        
        dual therapy of
        --> cephtriaxone (3rd gen ceph)
        --> Azyhtromycin (Macrolide)
        
        *Disseminated Gonnorrhea infection
        
        hypervariant PILI = way that Niesseria Men and Gonnorrhea latch onto things
        --> Niesseria Men. PILI latch onto the cribiform plate
        --> Niesseria Gon PILI latch onto the vagina
        
        1 more item...
        
        .
        
        Gonorrhea Quick Facts
        
        Intracellular UTI
        
        Gonorrhea + Chlamydia
        
        1 more item...
  - - - hEMOPhilis"
        
        E = epligotitis
        
        M = menigitis
        
        O = ottitis media (non-typable H. Inf.)
        
        P = pneumonia
        
        HIB for toddlers = "Hemophilis throat, Influenza ears, B brain"
        
        Hemophilis throat = epligotitis
        
        Influenza ears = ottitis media
        --> ottits media caused by BOTH Hib and Strep Pneumo
        
        B brain = meningitis in toddlers
        --> type B HIB is the strain that has polysacharride capsule
        --> allows it to infect the brain
        --> other non-typable HIb are normal RT flora and don't have a polysaccharide capsule
      - Clinical Cases
        
        Hib = Haemophilis Influenzae B example
        
        Hib is most common cause of epiglottitis
        
        Notes:
        
        children with epiglottitis present with fever, dysphagia, dyspnea
        
        adults have milder symptoms and present with sore throat
        
        many cases of epiglottitis from Hib are prevented by the Hib vaccine, but some still occur
        
        Case presentation:
        
        Clinical Case
        
        Notes:
        
        note that
        
        Clinical Case
        
        *Virulence Factors for Hib
        
        PRP polysacharride
        --> part of HNS bacteria
        
        *EMOP infections from Hib
        
        note that Hib vs Non-typable H. Infl. are very different
        
        Hib is the PRP strain that can cause the EMOP infections
        --> O is OMITTED though
        --> Ottitis media is from NON TYPABLE Hi infections
        --> reason why kids will always have a high rate of H. Influenza ottitis media (no vaccine for it)
        
        Hib (Influenza Ears) Ottitis media
        
        Ear Hib are nontypable
        --> non-typable HIb are normal RT flora and don't have a polysaccharide capsule to infect brain
        --> nontypable are NOT covered by the Hib vaccine
        
        B brain = meningitis in toddlers
        --> type B HIB is the strain that has polysacharride capsule
        --> allows it to infect the brain
        
        Hib (Hemophillis throat) Epiglottitis
        
        thumb print sign on imaging
        
        kids who have not gotten the Hib vaccine
        
        *Tybable B vs Non-typable infections from Hib
        
        note that Hib vs Non-typable H. Infl. are very different
        
        Hib is the PRP strain that can cause the EMOP infections
        --> O is OMITTED though
        --> Ottitis media is from NON TYPABLE Hi infections
        --> reason why kids will always have a high rate of H. Influenza ottitis media (no vaccine for it)
        
        HEME UP IN a FLUTE HEMOPHYLUS takes NUDE MONA out on a DATE
        
        HEMOP causes pneumonia
        
        NUDE MONA she CHOKES on a RED CHERRY EPIGLOTTITIS and is saved by a COPD COP
        
        HEMOP causes epiglottis
        
        HEMOP causes COPD exacerbation pneumonias
        
        meanwhile a group of MEN IN TIGHTS under 18 are routy at the table next to them
        
        HEMOP causes MEN IN TIGHTS for young adults age < 18
        
        CHEF TRIAXONE cooks at this restaurant and REFERREE with AXES is the floor manager who gives a THUMBS UP to the COPD COP for removing the RED CHERRY EPIGLOTITITS from NUD MONA
        
        CHEF TRIAXONE is the treatemnt for HEMOP IN A FLUTE
        
        REFERRE with PRUPRLE AXES is the prophylaxis for people exposed
        
        THUMBS UP from teh manager
    - - BORDETELLA PERTUSIS TEXUS BORDER
        
        can't keep ADP REBULLS out they smash through the thin wall and hit the GI JOE border guards
        --> their cAMP guns fire into the air as they get tackled
        
        ILLEGAL immigrant babies on BOTH SIDES of the border
        
        2 phases of BORDATELLA PERTUSSIS BORDER
        
        1st phase = CAT PHASE
        --> this is on the TEXAS side of the BORDETELLA PERTUSSIS BORDER
        --> where the ILLEGAL IMMIGGRANT babies are being held in deplorable conditions with a CAT infestation
        --> the CATS in the BORDETELLA PERTUSSIS BORDER camp jumps from baby to baby and spreads the infection before they have any sypmtoms
        
        2nd phase = PAROXYSOMAL CHOKING on a PEAR phase
        --> this is on th mexico side of the border where they send the kids and don't care any more
        --> this is the WHOOPING COUGH paroxysmal attacks
        
        LYMPHOCYTIS LIMES stuck in the PERTUSSIS BORDER RIVER
        
        BORDETELLA PERTUSIS BORDER catches LYMPHOCYTE in the bloods stream and stops them from migrating out from the blood
        
        this causes DROVEs of INSULIN INSECTS to come to the BORDER to feed on the SWEET LYMPHOCYTE LIMES
        --> BORDETELLA PERTUSSIS BORDER causes hypoglycemia
    - - Clinical Cases
        
        Clinical Case
        
        Clinical Case
        
        Notes:
        
        note that
  - - - Campylobacter Guillan Bare Syndrome
        
        autoimmune that destroys Schwann cells from most dital to proximal
        
        comes after campylobacter infections (also viruses)
        
        CAMP CAMPYLOACTER 42 DEGREES
        
        the WRITER KING ARTHUR who sits on his THRONE writes home to his mother about how terrible CAMP CAMPYLOACTER 42 DEGREES is
        --> Rieters Syndrome comes after a CAMP CAMPYLOACTER infection
        
        the flag at CAMP CAMPYLOACTER 42 DEGREES is made of a
        --> CORKSCREW shape
        --> the flag is a flagella at CAMP CAMPYLOACTER 42 DEGREES
        
        GREEN BERET camp Counciller
        --> GB syndrome happens after a CAMP CAMPYLOACTER infection
        
        the CHCKEN is served RAW at CAMP CAMPYLOACTER 42 DEGREES
        --> 42 degrees is not hot enough to cook the chicken
        
        the weirdest thing that the WRITER KING ARTHUR has seen at CAMP CAMPYLOBACTER 42 degrees is a dog sucking MILK right from the TIT of a COW and then SHITTING with DIARRHEA everywhere at the camp
        --> campylobacter can be in raw milk
        --> campylobacter can be in dogs diarrhea
        
        WRITERS SYNDROME WRITING KING ARTHUR at CAMP CAMPYLOBACTER 42 DEGREES
        
        writing in the toilet to his mother how much CAMP CAMPYLOBACTER SUCKS
        
        GREEN BERET camp Counciller at CAMP CAMPYLOACTER 42 DEGREES
        
        note that GREEN BERET syndrome has muscle paralysis that ascends from the FEET UP
    - - "sleep on A ROCK in the SUNSHINE STATE = VIBRANT COLORADO"
        
        A ROCK = alkaline
        
        VIBRANT COLORADO = vibrio cholerae
        "If you CAMP for a LONG long time in Colorado, bring an Oxygen Tank, and some RICE WATER"
        
        CAMP for a LONG long time
        --> Cholera entertoxins cause permanent Gs cAMP activation
        --> causes
      - VIBRANT COLORADO RICE WATER COLLY FIELDS controlled by the MEAN ADP REDBULL with APPLE on and B on his SHOULDER
        
        with the border COLLY on the POT IRRIGATION SYSTEM
        
        controlled by ADP REDBULL with APPLE and BEE
        --> ADP Ribosylating AB toxin
        --> turns up Gs --> cAMP levels
        --> diarrhea
        
        pushing the G SPOT button to INCREASE the cAMP
        
        this is the RICE WATER COLLY FIELDS in the low elevation of COLORADO, not the COLORADO ROCKIES
        --> lots of O2 to break down compared to the high elevation hyperventilation
        --> Oxidase POSITIVE
        
        RICE WATER COLORADO COLLY keeps dropping his IRRIGATED COMMA SHAPED SHRIMP from his private ALKALINE COLORADO lake
        
        after a hard days work IRRIGATING THE RICE WATER fields of VIBRANT COLORADO
        
        VIBRANT COLORADO COLLY comes home to relax in his VIBRATING CHAIR
        
        where he is SERVED by the NUN-MILK lady --> milk and his favourite COMMA SHAPED SHRIMP to eat from
        
        the COMMA SHAPED SHRIMP are from his own PRIVATE ALKALINE LAKE
        
        the COMMA SHAPED SHRIMP are what give him enough SALT to shut off the CL- channels and Na+ channels of the IRRIGATION GUT of RICE WATER FILEDS in COLORADO
        --> increase cAMP and give RICE WATER DIARRHEA
        
        ADP REDBULL with APPLE and BEE
        
        ADP Ribosylating AB toxin
        
        pushing the G SPOT button to INCREASE the cAMP
        --> turns up Gs --> cAMP levels
        --> diarrhea
        
        note that the GDP REDBULL with APPLE and BEE on his SHOULDER
        --> ALWAYS increases cAMP
        --> either through increases Gs stimulation
        --> or Gi inhibition
        --> both will increase cAMP levels and cause diarrhea usually
        
        *Stool findings in Vibrio Cholera
        
        NO leukocytes or blood
        
        ONLY mucus from goblet cells
        --> "rice water diarrhea"
        
        Vibrio cholera is very sensitive to stomach acids
        
        needs a very hihg amount of cholera to cause infection due to this
        
        thus cholera can more easily affect people on PPIs, etc.
    - - *PUD and H. Pylori
        
        quadruple = TETRA METRO therapy
        
        2 Abx
        --> "TETRO METRO"
        --> tetracyclines + metronidazole
        
        PPI == omeprazole
        
        bismuth chelate
        
        HELICOPTER TERRORIST
        
        blowing holes in the DUODENUM
        
        HELICOPTER TERRORIST is with his terrorist FRIENDS the ADENOMA and GNOME in a CAR who are drinking MALT LIQUOR
        --> HELICOPTER TERRORIST causes adenocarcinomas
        --> HELICOPTER TERRORIST causes MALT LYMPHOMAS
        
        HELICOPTER TERRORISThas lots of AMMO
        --> can make AMMO ammonia with urease
        
        there are 2 hostages in the DUODENUM of the HELICOPTER TERRORIST
        --> STAPH CAT = cat +
        --> OX DAISY = oxidase positive
        
        it takes 2 ABX soldiers with a PPI gun to take down the HELICOPTER TERRORIST
        
        Dx of H pylori
        
        urea breath test or facal antigen test
        
        note if a patient starts taking any one of the 3 ACP treatments before the test then it will give a false negative test
        --> this is because the bacteria have been snuffed out a little bit but are not completely gone
        --> especially for a PPI
        
        Tx of H pylori
        
        Please Make Tummy Better
        
        Acute = Non-atrophic vs chronic ATROPHI H. Pylory infections
        
        acute H Pylori
        --> start int he antrum
        --> infect G cells and increase gastrin and stomach acid
        --> risk of duodenal ulcers
        
        chronic H pylor
        --> moves up the body and to the fundus
        --> more danger for gastric ulcers
        --> actually get LOWER acid production since they have now killed off alot of the G cells
        --> it is now the inflammation that is causing the ulcers
        --> MALT lymphomas
        
        *Acute Non-atrophic
        
        NON - atrophic
        --> means that the damage or ulcers are from the excess gastric acid production
        --> and NOT from atrophy of the cells and necrosis from H pylory going into the bdy and the fundus
        
        *Chronic Atrophic
        
        chronic = YES - atrophic
        --> means that the damage or ulcers are NOT from the excess gastric acid production
        --> BUT are from atrophy of the cells and necrosis from H pylory going into the body and the fundus
        
        chronic atrophic --> leads to MALT lymphomas
- - - - the EEK bacteria are OXIDASE (-) from the GLOSS algorythm
- - - - Toxic Shock Syndrome Toxins
        
        TSS TSS, say the FRS (Friars)
        --> TSS = FRS = fever, rash shock
        
        major Staph CAT and Rheumital PYTHON
        --> Staph A and StreptO PYO
        
        StreptO PYO
        --> 2 antigens for Rheumitral Python
        --> Peforating cell membrane = O antigen for cell lyse like clostridium Perfringens
        --> toxic shock syndrome = TSS / FRS = A antigen like STAPH CAT
        
        bind the MHC 2 and TCR outside normal area
        --> cause massive cytokine release
        
        LYSE cell membrane toxins
        
        perfringens and StreptO PYO
        --> 2 antigens for Rheumitral Python
        --> Peforating cell membrane = O antigen for cell lyse like clostridium Perfringens
        
        Watery Diarrhea = increase Fluid secretion
        
        increasing either cAMP or cGMP pathways
        
        *cGMP toxins
        "cAMPing outside your BORDERS gives you TRAVELLER's diarrhea"
        
        "Travellors feel LABILE/LIGHT in the AIR, and STABLE on the GROUND"
        
        travellors ETEC BOTH cAMP and cGMP
        
        *cAMP toxins
        "Bacillus Anthraxis = BACKS of Animals ANTHRA - CYS"
        
        "BACKS of Animals" = Anthracis from animal hides
        
        "Bacillis ANTHRA - CYS" = Adenylate Cyclase cys actions
        --> same as bordatella pertus CYS
        
        "cAMPing outside your BORDERS gives you TRAVELLER's diarrhea"
        
        "cAMPing" - increased cAMP = watery diarrhea
        --> less absorption of salt and water
        --> watery diarrhea
        
        "outside BORDERS" = Bordatella pertussis increases cAMP
        
        "TRAVELLERs diarrhea" = ECTC increases cAMP
        
        also increase cGMP like Yersinia
        
        "Travellors feel LABILE/LIGHT in the AIR, and STABLE on the GROUND"
        
        Elongation Factor = EF = Protein synthesis toxins
        "DIP your ELONGATED PSEUDO BULL neck into the apple bob"
        
        Diptheria and pseudomonas inactivate Elongation factor and cause cell death
        
        Diptheria present with a BULL NECK lymphadenopathy and pharyngitis
- - - - Clinical Cases
        
        Clinical Case
        
        Clinical Case
        
        Notes:
        
        note that
- - - - *Rocky Mountain Fever
        
        ROCKY MOUNTAIN FEVER BEAVER from the RICKETTSIA RACKETBALL MATCH
        
        ROCKY MOUNTAIN SPOTTED FEAVER BEAVER from the RICKETTSI RACKETBALL MATCH with the VICTOR = ARTHROPOD PATRICK
      - *Ticks - different types
        
        Ixodes = Borrelia ticks = american DEER TICKS
        
        Lone star ticks = Ehrlichiosis ticks = american white tailed DEER TICKS
        
        dermacentor ticks = american DOG TICKS
        --> you can bring a DOG on the ROCKY MOUNTAINS, but NOT a DEER
        --> cause ROCKY MOUNTAIN FEVER BEAVER disease = rickettsia rickettsi
        --> ROCKY RICKETTSIA in the WRISTS
        --> TYPHUS in the TRUNK
      - MEGA Berry Rickettsia Tick Diseases
        
        ME-GA
        
        ME = monocytes = erhlichia chaffensis
        --> from white tailed deer Lone star ticks
        
        GA = granulocytes = Anaplasma
        --> from mouse tar ticks
        
        *Ehrlichiosis from Lone star white tailed deer ticks
        
        type of ricketssia
        
        Clinical Cases
        
        Clinical Case
        
        3 more items...
  - - - Borrelia Burgdorferi and *Lyme Disease
        
        live in Ixodes ticks
        
        cause Lyme disease
        
        "Key LYME pie to the FACE"
        
        BORRELLI BURGLER stealing from KING ARTHUR ARTHRITIS SPIRAL TOWER CASTLE so he can give the GEM STAIN to his boss the EXOTIC IXODES TICK and his HENCH MAN the WHITE FOOTED MOUSE
        
        BORRELIA BURGLER = Borreli tick
        
        BORRELI BURGLAR steals KING ARTHUR ARTHRITIS SPIRAL STAIRCASE CASTLE
        --> arthritis of FACE
        --> Spiral spirochete bacteria
        
        the EXOTIC IXODES TICK and his HENCH MAN the WHITE FOOTED MOUSE
        --> IXODES TICK = vector for BORRELI BURGLER
        --> WHITE FOOTED MOUSE = host for the BORRELI BURGLAR
        
        the EXOTIC IXODES TICK just wants to STUFF his FACE with ANAPLASMA
        
        EXOTIC IXODES TICKS also carry Anaplasm RICKETTSIA
        
        FACE = facial palsy, arthritis, cardiac block and arythmias, Erythema migrans
        
        "Key LYME pie to the FACE (and heart)"
        
        F = facial nerve palsy
        
        A = arthritis
        
        C = cardiac block (2nd/3rd degree AV block) and arrhythmias
        
        E = Erythema Migrans BULLSEYE rash
        - FACE (and heart) = affects skin and heart mostly
    - - SYPHILLIS SYPHIPHIS on his PODIUM of the GREEKS 1 2 3 POSING for a PICTURE taken by PENICILLIN with his TRIPOD with PENDULUM balance
        
        SYPHILLIS PODIUM of the GREEKS 1 2 3
        --> Syphillis has 3 stages and congenital also
        --> primary secondary and tertiary syphilis
        
        CAMERA TRIPOD with PENDULUM balance
        
        SYPHILIS 1 = holding a PAINLESS CHAIN CAR = Chancre
        
        SYPHILIS 2 = showing off his UNIQUE MAC PAP RASHES oh his PALMS and FEET and offerring the judges some CONDOM LATTE WITH WARTS
        --> UNIQUE MAC PAP RASHES oh his PALMS and FEET should be thought of as SYPHILIS until PROVEN OTHERWISE rule since most rashes stay off the palms and feet if they are systemic
        --> chonylomata latta genital warts are in the groin or on the external genitalia
        
        SYPHILIS 3 = AORTITIS WHALE WITH GUMMAS on his MOUTH and SYPHILIS in his SPINE
        
        SYPHILIS SYSIPHIS is battling the BOULDER of the GODs by using his TORCHeS to make a BABY STONE STATUE to fight off the BOULDER
        
        SYSIPHILIS SYPHILYS causes TORCH infections in babies and is passed on from the mother
        
        SYSIPHILIS makes the BABY STONE STATUE
        
        BABY STONE STATUE
        --> results in still birth
        
        a SABER TOOTH TIGER bites his TIBIA SHINS
        --> SABER SHINS are anterior bowing of the legs seen in syphiliis and look like SABER TOOTHS
        
        the BABY has EARMUFFS SAHDES from his EYES and DROPS FETALIS to put in his eyes after all the CRYING from the SABER SHIN TOOTH TIGER BITE
        --> EARMUFFS = def
        
        SHADES = blind
        --> DROPS FETALIS = collection of fluid in a fetus body
    - - Clinical Cases
        
        Clinical Case
        
        Clinical Case
        
        Notes:
        
        note that
  - - - "Legionella = French LEGION soldier with a SIlver helmet, EVERYTHING SUCKS...urinating and diarrhea in the trench which he drinks from, and SWEATING... wishes he had SALT in his food and air conditioning. Treatment at field hospital for French is BIG MAC and dr. Quin medicine women on VHS"
        
        Legion soldier silver helmet = only seen with silver stain
        
        urinating and diarrhea in trench = only diagnose Legionella with urine bacteria antigens
        --> GI and diarrhea in Legionella
        
        SWEATING and needs cold glass MILK and AC
        --> HIGH fever, LOW sodium (SALT)
        --> PASSED BY ac NOT FROM HUMANS
        
        BIG MAC and dr. Quin medicine women on VHS
        --> treatment for Legionella = macrolides ACE / Quinolones
        
        FRENCH LGIONAIRE SOLDIER gets away from the battle and goes into a bathroom where he finds a POOR STAINER BUM living in there
        
        FRENCH LEGIONAIRE soldier = poor gram stainer
        
        he was suprised the POOR STAINING BUM lived in the bathroom because it was very fancy indeed
        
        it had a SINK with CHARCOAL and a CYSTEINE chapel painting on it
        --> Legionella = charcoal and cysteine
        
        the LEHIONAIRE SOLDIER felt out of place because he had a SILVER STAIN on his UNIFORM
        --> Legionella = silver stain
        
        the FRENCH LEGIONAIRE starts SMOKING and DRINKING
        
        FRENCH LEGIONAIRE = more common in smokers and alcoholics
        
        his SMOKING and DDRINKING then sets off the smoke alarm and turns on the SPRINKLER SYSTEM and A/C
        --> this is how LEGIONAIRES DISEASE spreads
        
        after all his destruction in the fancy bathroom and ruining the POOR STAINING BUMS home the LEGIONAIRE pees out his ANT GEMS into the fancy URINAL
        
        LEGIONAIRES diagnosed by ANT GEMS int he URINE
        
        Legionaires disease presentation
        
        LEGIONAIRES SOLDIER comes home form a hard days work and plans a DINNER for this new french girl he met at WAR = NUDE MONA
        
        he sets the mood by heating things up with FEAVER BEAVER
        
        he makes a nice ELEVATED LFT LIVER and has his own personal butler HIPPO SALT the LIVER
        --> HYPONATREMIA
        
        NUDE MONA starts to eat but is surprised when she gets a text of her ATYPICAL XRAY
        
        NUDE MONA is also surprised because out of nowhere a RENAL with TUBE and LEMON in it reaches up with a 4 FORK to steal her RAISED LFT LIVER
        
        class 4 renal tubular acidosis
        
        then LEGIONAIRES wife barges into the room
        
        she is actually the FLOWER QUEEN of FRANCE and they are in the castle
        --> flouroquinolone
        
        FLOWER QUEEN of FRANCE = LEGIONAIRES wife is the only one who can BEAT HIM UP
        
        she is also an interior decorator and uses her MACROLIGHTs to beat him
        --> Macrolides
  - - - Subtypes of Chlamydia
        
        Trachomatis is what we are worried about in adults
        
        C pneumonia is mostly in kids and young adults with chlamydia
      - *Trachoma under the upper eyelid in Chlamydia trachomatis
        
        can cause scratching of the cornea and blindness if not treated
      - *Chlamydia vs Gonorrhea urethritis
        
        note always treat as if infected by BOTH
        --> dual therapy of
        --> cephtriaxone (3rd gen ceph) = Gonorrhea
        --> Azyhtromycin (Macrolide) = Chlamydia
        
        .#1 STI in the US = Chlamydia
        
        .#2 STI in the US = Gonorrhea
        --> both are intracellular organisms
        
        Tx Chlamydia and Gonorrhea together
        
        dual therapy of
        --> cephtriaxone (3rd gen ceph)
        --> Azyhtromycin (Macrolide)
      - *Urethritis +/- epdydimitis in men
        
        2 causes of urethritis and epdydidmtis are broken into 2 categories
        --> Gonoccal vs NON-Gonoccal
        
        BOTH organisms are intracellular
        --> Gonoccal = Niesserisa gonnorrhea
        --> Non-Gonoccal = Chlamydia traachomatus
        
        Niesserisa gonnorrhea
        --> intracellular
        --> Gram - dipplococci
        
        Chlamydia traachomatus
        --> intracellular
        --> does NOT stain
        
        tx: you normally treat for both Gonoccal AND non-Gonoccal in urethritis or infectious epydimitis
        --> since they are both intracellular and can infect at same time
        
        tx Gonoccal = ceftriaxone (2 weeks)
        
        tx NON-Gonoccal = clarythromycin (1 gram only)
      - CHLAMYDIA CLAM goes on a date with TACOMA TRUCK = trachomatis who tells her call me MAYBE
        
        CHLAMYDIA CLAM = TRACOMA TRUCK
        
        MAYBE have symptoms
        
        TRACOMA TRUCK brings CHLAMYDIA CLAM tot he E-PICK DEAD MOUSE concert where the TRACOMA TRUCK turns into a douch and PEES FIRE on EVRYTHING and sets EPICK DEAD MOUSE ON FIRE
        
        epididymitis
        
        TRACOMA TRUCK then takes CHLAMYDIA CLAM to the dirty bathrooms and tries to have PAINFUL SEX with her with his DISC PIRRANA when she sprays WHITE CHLAM DISCHARGE all over the TRACOMA TRUCK and leave him
        
        painful sex = dyspareurina
        
        white discharge
        
        next CHAMYDIA CLAM leaves TRACOMA TRUCK for a COLL DOG IS CYCLING, but then he gets distracted and leaves CHLYMIDIA CLAM for some ZIPPER MICE
        
        doxicycline = 1st line treatment
        
        azithromycin = 2nd line treatment
        --> note add CHEF WITH TRIAXONE to these for GONORRHIA is suspected also
        
        EVERYONE in the end of this stroy get CHLYMIDIA and has to tell all their parterners and can't have sex for ONE WHOLE WEEK
        
        CHLAMYDIA CLAMS have a lot of ex, but are actually EMPTY INSIDE, they need to replicate INSIDE OTHERS with their SEX and CANNOT see their own emptiness because they LACK a MURAMIC MIRROR for a cell wall to see how empty they are
        
        obligate intracellular organisms
        
        lack cell wall due to no abnormal muramic acid
        
        2 stages of EMPTY CHLAMYDIA CLAMS use to make their GIEMS STAINED GEMS
        
        2 stages
        
        EMPTY CHLAMYDIA CLAM stained by GIEMSA GEM STAIN
        
        first they release ELEMENTARY ELEPHANT BODIES to ENTER their host during sex, second they bring the ELPHANTS back and clamp down on them to turn them into RETICULOCYTE REPLICATING RATS
        
        stage 1 = ELEMENTARY ELEPHANT BODIES
        
        stage 2 = RETICULOCYTE RATS REPLICATE inside the shell
        
        TX = ZIPPER MYC = azythromycin
        
        DOGS IS CYCLING = doxycycline
  - - - GARDNERELLA is forced by her evil stepmother and stepsisters to clean the GARDEN in her CHASTITY BELT = not an STD
        
        the evil stepsisters put PH PHISHY smeeling FISH in the GARDEN for GARDNERELLA that increase the pH of her soil and ruin everything
        
        GARDERELLA then has to WHIFF the smell all day with KOH
        --> PH PHISH = pH increases with GARDNERELLA
        
        the knight in shining armour that rescues GARDNERELLA is METRO KNIGHT who busts through the GARDEN WALL, slide his METRO NIGHT into the garden and wisps her away
  - - - *Mycoplasma Pneumonia = MY COAT Pneumonia
        
        MY COAT Pneumonia in military MEN
        --> MY COAT = My IgM crossreaction with RBCs
        --> think IgM antibodies in BOTH MY COAT PNEUMO and also in RHEUMITRAL PYTHON pyogenes / JONES RHD
        
        causes walking pneumonia in young adults
        
        no cell wall, only ergosterol (cholesterol) in single layer plasma membrane
        
        Tx = ONLY protein synthesis
        --> macrolides and tetracyclines
        
        "military men are COLD when they don't have a COAT"
        --> COLD agglutanins in Myco Pneumo
        --> no envelope of MYCOAT Pneumo
        
        young adult with CXR and ilfiltrates WAY WORSE than clinical symptoms
        --> Mycoplasma pneumonia = walking pneumonia until proven otherwise
        
        Young Adults and Mycoplasma Pneumonia
        
        Mycoplasma is by far the most common form of pneumonia in young adults
        
        Mycoplasma pneumonia gets COLD WITHOUT a COAT!!!
        --> cold aglutinins = IgM antibodies to mycoplasma L-antigens same as RBCs
        --> crossreact = erythrocytosis anema
        --> no COAT = Mycoplasm pneumo has NO CELL WALL
        
        young adult with CXR and ilfiltrates WAY WORSE than clinical symptoms
        --> Mycoplasma pneumonia = walking pneumonia until proven otherwise
        
        Mycoplasma has NO CELL WALL, only single layer with same cholesterol as us
        --> anti NAG-NAM glycosyltransferase / beta lactam PBPs are useless
        
        Tx = protein synthesis inhibition
        --> Macrolides and Tetracyclines
        
        Clinical Cases
        
        1 more item...
        
        Cold Agluttinins in mycoplasma Pneumonia = walking pneumonia
        
        IgM to mycoplasma l-antigens
        --> l-antigens are on RBCs also
        
        cross react with RBC antigen and caus erythrocytosis and possible anemia
        
        1 more item...
        
        Virulence and Tx of Mycoplasma Pneumonia
        
        Mycoplasma has NO CELL WALL, only single layer with same cholesterol as us
        --> anti NAG-NAM glycosyltransferase / beta lactam PBPs are useless
        
        Tx = protein synthesis inhibition
        --> Macrolides and Tetracyclines
        
        1 more item...
        
        NUDE MONA with a MICROPHONE performs for the MILITARY GOBLINS during the WAR of the WORLDS
        
        the MILITARY GOBLINS want to escape the WAR Of the WORLDS just for one night to get a glimpse of the NUDE MONA with MIC
        
        they PEAK inside the ATYPICAL TENT to peak at NUDE MONAS ATYPICAL XRAY
        
        just then the WAR ERUPTS again on the other side of the wall, but the MILITARY GONLINS = IgM were distracted and their GUNS got COLD AGLUTTININS on them
        
        the ERYTHROCYTE ANENAME MONSTER started to attack them
        
        also the EARTH with MULTIFORM MULLET started to attack them continuously too
        --> erythema multiforme
        
        the ONLY thing that saved the MILITARY GOBLINS against the monsters was EARTH riding in on his TETRACYCLINE and EARTH THROWING MICE at them
        
        NUDE MONA MIC tx = tetracyclines and erythromycin
        
        1 more item...
    - - Tx of chlamydia Pneumonia
        
        chlamydia has NO CELL WALL, only single layer with same cholesterol as us
        --> anti NAG-NAM glycosyltransferase / beta lactam PBPs are useless
        
        Tx = protein synthesis inhibition
        --> Macrolides and Tetracyclines
- - - - *Bites from animals and Humans
        
        dog and cat bites = Pasturella
        --> "don't trust dogs on a pasture..."