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Bacteria (Gram + (Bacilli (2.1 - Bacillus anthracis & cereus (King…

- - - - Runny chocolate:
        Clostridium difficile (a gram-positive, spore-forming bacillus)
      - Purple hues:
        Clostridium difficile bacteria are gram-positive
      - Walnuts:
        Clostridium difficile bacteria have the ability to form metabolically inactive spores, which are resistant to environmental stressors such as heat, chemicals, and radiation
      - "Clean":
        prior exposure to antibiotics (particularly clindamycin) is the most significant risk factor for Clostridium difficile infection
      - Hand washing sign:
        contact precaution and infection control measures (hand hygiene with soap and water, use of gloves) help prevent spread of Clostridium difficile (and is especially important for protection of patients who are taking antibiotics, such and clindamycin)
      - Brushing apples:
        toxin A (enterotoxin) of Clostridium difficile binds the brush border membranes of the gut → damage to the mucosal lining of the colon → diarrhea
      - "A" apple station":
        toxin A (enterotoxin) of Clostridium difficile
      - Chocolate stream:
        Clostridium difficile can cause watery diarrhea (often with abdominal pain, fever, and leukocytosis)
      - Chocolate stream:
        Clostridium difficile can cause watery diarrhea (often with abdominal pain, fever, and leukocytosis)
      - "B" black licorice station:
        toxin B (cytotoxin) of Clostridium difficile
      - Eating black licorice:
        toxin B (cytotoxin) of Clostridium difficile disrupts the cytoskeleton via actin depolymerization → necrosis of colonic mucosal surfaces → pseudomembrane formation
      - Plastic wrap:
        toxin B (cytotoxin) of Clostridium difficile causes pseudomembrane formation (toxin B disrupts the cytoskeleton via actin depolymerization → necrosis of colonic mucosal surfaces → pseudomembrane formation)
      - Shoe in chocolate:
        diagnosis of Clostridium difficile infection can be made by detection of its toxins (A and B) in the stool
      - Shoe in chocolate:
        diagnosis of Clostridium difficile infection can be made by detection of its toxins (A and B) in the stool
      - Metro:
        metronidazole is effective against Clostridium difficile
      - Van/tongue ramp:
        oral vancomycin is effective against Clostridium difficile
      - Gasmask:
        Clostridium difficile bacteria are obligate anaerobes
    - - Soil:
        the metabolically inactive spores of Clostridium perfringens are ubiquitous in soil
      - Gasmask:
        Clostridium perfringens bacteria are obligate anaerobes
      - Walnuts:
        Clostridium perfringens bacteria have the ability to form metabolically inactive spores, which are resistant to decontaminants such as heat, chemicals, and radiation
      - Smoke:
        Clostridium perfringens can cause necrotizing skin and soft tissue infection, which can progress to myonecrosis and gas gangrene
      - Soldier:
        Clostridium perfringens infection is associated with military combat wounds
      - Alpha flag/clothespins:
        the alpha toxin of Clostridium perfringens is a lecithinase that cleaves lecithin (a phospholipid) molecules of phospholipid complexes → damage to cell membranes → myonecrosis and hemolysis
      - Purple hues:
        Clostridium perfringens bacteria are gram-positive
      - Alpha flag/clothespins:
        the alpha toxin of Clostridium perfringens is a lecithinase that cleaves lecithin (a phospholipid) molecules of phospholipid complexes → damage to cell membranes → myonecrosis and hemolysis
      - Private Ringen:
        Clostridium perfringens (a gram-positive, spore-forming bacillus)
      - Lysed tomatoes:
        the alpha toxin of Clostridium perfringens is a lecithinase that cleaves lecithin (a phospholipid) molecules of phospholipid complexes → damage to cell membranes → hemolysis
      - "DOUBLE fine zone":
        Clostridium perfringens produces a double zone of beta-hemolysis when plated on blood agar (both the alpha and theta toxin of Clostridium perfringens have hemolytic activity)
      - Purple pencil:
        the first-line treatment for Clostridium perfringens tissue infection is surgical debridement and administration of antimicrobials, particularly penicillin
      - "Slow" sign in muddy water:
        ingestion of a large quantity of Clostridium perfringens spores can cause late-onset food poisoning, characterized by watery diarrhea
    - - Robots:
        Clostridium botulinum (a gram-positive, spore-forming bacillus)
      - Purple hues:
        Clostridium botulinum bacteria are gram-positive
      - Can robot body:
        the anaerobic environment of improperly canned food allows spore germination and growth of Clostridium botulinum
      - Nuts:
        Clostridium botulinum bacteria have the ability to form metabolically inactive spores, which are resistant to environmental decontaminants such as heat, chemicals, and radiation
      - Gas mask:
        Clostridium botulinum bacteria are obligate anaerobes
      - Limp neck:
        Clostridium botulinum can cause a descending flaccid paralysis (due to production of botulinum toxin) starting from the cranial nerves
      - Droopy eyelids:
        Clostridium botulinum can cause a descending flaccid paralysis (due to production of botulinum toxin) that may first affect the eyes, causing ptosis and diplopia
      - Cutting ACh current:
        botulinum toxin of Clostridium botulinum is a protease that cleaves SNARE → inhibition of presynaptic release of acetylcholine (an excitatory neurotransmitter) at the neuromuscular junction → flaccid paralysis
      - Floppy baby robot:
        infant botulism results from ingestion of spores, which are able to colonize the GI tract of infants due to a not yet fully developed GI flora (in contrast to adults, who contract botulism from eating preformed toxin)
      - Honey:
        honey is frequently contaminated with Clostridium botulinum spores and it is advised that infants are not allowed to consume honey until they are at least 12 months of age
    - - Bull:
        Corynebacterium diphtheriae (a gram-positive bacillus)
      - Maraca design:
        Corynebacterium diphtheriae form V- or Y-shaped chains
      - Purple hues:
        Corynebacterium diphtheriae bacteria are gram-positive
      - Maraca colors:
        the cytoplasm of Corynebacterium diphtheriae contains metachromatic granules that stain with aniline dyes (the metachromatic granules stain red while the remainder of the bacillus stains blue)
      - Bowtie/accordion:
        diphtheria toxin of Corynebacterium diphtheriae inhibits elongation factor-2 by ADP ribosylation (a mechanism similar to that of exotoxin A of Pseudomonas aeruginosa)
      - Grey cotton candy in plastic wrap:
        the diphtheria toxin of Corynebacterium diphtheriae causes cell necrosis → dense, grey tonsillar/pharyngeal pseudomembrane formation
      - Bull's neck:
        laryngeal diphtheria can lead to severe lymphadenopathy → characteristic swelling of the neck known as “bull neck”
      - Water droplets:
        Corynebacterium diphtheriae is transmitted via respiratory droplets
      - Eating sausages:
        the diphtheria toxin of Corynebacterium diphtheriae can cause nerve damage (demyelination) → paralysis that typically begins in the posterior pharyngeal wall and soft palate
      - Heart cape:
        presence of the diphtheria toxin of Corynebacterium diphtheriae in the bloodstream can result in cardiac toxicity → myocarditis, arrhythmia, and heart failure
      - "TELE":
        Corynebacterium diphtheriae will grow as dark black colonies on cystine-tellurite agar
      - Laughing:
        Corynebacterium diphtheriae can be cultured in Loeffler's medium (where it develops metachromatic granules seen in the cytoplasm after staining with an aniline dye)
      - Bull's tongue:
        the ELEK test is used to differentiate toxigenic from nontoxigenic Corynebacterium diphtheriae
    - - Monkey testing lab:
        Clostridium tetani (a gram-positive, spore-forming bacillus)
      - Purple hues:
        Clostridium tetani bacteria are gram-positive
      - Walnuts:
        Clostridium tetani bacteria have the ability to form metabolically inactive spores, which are resistant to environmental decontaminants such as heat, chemicals, and radiation
      - Gas mask:
        Clostridium tetani bacteria are obligate anaerobes
      - Barbed wire:
        Clostridium tetani infection is classically associated with puncture wounds from barbed wire
      - Rusty nails:
        Clostridium tetani infection is classically associated with puncture wounds from rusty nails
      - Soil:
        the metabolically inactive spores of Clostridium tetani are ubiquitous in soil
      - Retrograde pulley:
        the tetanus toxin of Clostridium tetani travels via retrograde axonal transport to the spinal cord
      - Evil grin:
        the classic findings in tetanus include trismus (a spastic paralysis of the jaw muscles (lockjaw)), and risus sardonicus (continuous contraction of the facial muscles resulting in an “evil smile” appearance)
      - Cutting SNARE trap with scissors:
        the tetanus toxin (tetanospasmin) of Clostridium tetani is a protease that cleave** SNARE proteins**
      - Arched back:
        the spasmodic contraction seen in tetanus can extend to the neck and back → opisthotonos (backward arching of the head, neck, and spine)
      - Trapped “G&G” researcher:
        the tetanus toxin (tetanospasmin) of Clostridium tetani cleaves SNARE proteins → inhibition of GABA and glycine release (inhibitory neurotransmitters) from Renshaw cells in the spinal cord→ muscle spasms, spastic paralysis, and hyperreflexia
      - Wrench and saw:
        the tetanus toxin (tetanospasmin) of Clostridium tetani acts on Renshaw cells (inhibitory interneurons in grey matter of the spinal cord) → inhibition of GABA and glycine release → muscle spasms, spastic paralysis, and hyperreflexia
      - Orange syringe:
        prevention of tetanus includes administration of tetanus vaccine, which consists of deactivated tetanus toxin (often given with the diphtheria toxoid and acellular pertussis vaccine (DTaP))
    - - Beta light bulb:
        Listeria monocytogenes colonies are weakly beta-hemolytic (surrounded by a small zone of complete hemolysis when plated on blood agar)
      - Tumbling ornaments:
        Listeria monocytogenes bacteria exhibit tumbling motility in broth
      - Purple ornaments:
        Listeria monocytogenes bacteria are gram-positive
      - Rocket:
        Listeria monocytogenes bacteria form “rocket tails” via actin polymerization that allow movement within and between host cells
      - Santa's LIST:
        Listeria monocytogenes (a gram-positive bacillus)
      - Icicles:
        Listeria monocytogenes bacteria are able to grow in temperatures as low as 0°C and exhibit motility at temperatures between 22-27°C
      - Rocket in bag:
        Listeria monocytogenes bacteria are facultative intracellular pathogens
      - Milk:
        listeriosis outbreaks are associated with dairy products like milk, soft cheese, and ice cream
      - Cat:
        Listeria monocytogenes bacteria are catalase-positive
      - Cheese:
        listeriosis outbreaks are associated with dairy products like soft cheese, milk, and ice cream
      - Pregnant woman:
        the incidence of listeriosis is significantly higher in pregnant women
      - Baby in helmet:
        Listeria monocytogenes is the third most common cause of neonatal meningitis (following Streptococcus agalactiae (group B strep) and E. coli) :star:
      - Santa Claus:
        Listeria monocytogenes is a common cause of meningitis in adults over 60 and immunocompromised patients
      - Amp:
        ampicillin is effective against Listeria monocytogenes
    - - King Anthra's axe:
        Bacillus anthracis (a gram-positive, spore-forming bacillus)
      - Leather armor/"D" buckles:
        the capsule of Bacillus anthracis is composed of poly-γ-D-glutamic acid (a polypeptide)
      - Line of ships:
        Bacillus anthracis and cereus bacteria are gram-positive bacilli that occur in chains
      - Bellows:
        Bacillus anthracis needs oxygen to sporulate (but can make ATP with and without oxygen; ie, aerobic or facultatively anaerobic)
      - Ring of fire:
        cutaneous anthrax (the most common manifestation of Bacillus anthracis infection) presents with an area of central necrosis with surrounding erythema, edema, and eschar formation
      - Walnuts:
        Bacillus anthracis and cereus bacteria have the ability to form metabolically inactive spores, which are resistant to decontaminants such as heat, chemicals, and radiation
      - Purple hues:
        Bacillus anthracis and cereus bacteria are gram-positive
      - "EF" shield:
        the edema factor exotoxin of Bacillus anthracis mimics adenylate cyclase → increase in cAMP → edema and dysfunction of phagocytes
      - Camps:
        the edema factor exotoxin of Bacillus anthracis mimics adenylate cyclase → increase in cAMP → edema and dysfunction of phagocytes
      - "LF" shield:
        the lethal factor exotoxin of Bacillus anthracis is a protease that cleaves mitogen-activated protein kinase (MAPK) → apoptosis, tissue necrosis multisystem physiologic disruption, and death
      - "LF" viking burning map:
        the lethal factor exotoxin of Bacillus anthracis is a protease that cleaves mitogen-activated protein kinase (MAPK) and is responsible for the tissue necrosis seen in cutaneous anthrax
      - Sheep wool:
        wool sorters are historically associated with pulmonary anthrax/inhalation anthrax (woolsorters’ disease) due to inhalation of Bacillus anthracis spores carried in animal wool (though this form of anthrax is rare in developed countries)
      - Bloody axe:
        pulmonary anthrax/inhalation anthrax primarily manifests as hemorrhagic mediastinitis with bloody pleural effusions
      - Wide mast:
        chest X-ray of patients with hemorrhagic mediastinitis from pulmonary anthrax/inhalation anthrax may show a widened mediastinum or pleural effusions
      - Flower shield:
        fluoroquinolones are effective against Bacillus anthracis
      - Bicycle tire shield:
        doxycycline is effective against Bacillus anthracis
      - Vomiting:
        ingestion of Bacillus cereus preformed toxin (classically associated with reheated rice) can cause early onset food poisoning → watery diarrhea
      - Rice bowl:
        Bacillus cereus (a gram-positive, spore-forming bacillus)
      - Reheating rice:
        Bacillus cereus infection is classically associated with reheated rice (warm temperatures → spore germination → enterotoxin production (preformed toxin)→ early onset food poisoning)
  - - - Gasmask:
        Actinomyces israelii bacteria are obligate anaerobes
      - Jaw wrap: :star:
        Actinomyces israelii bacteria are a part of the normal oral flora and can cause cervicofacial disease following oral/jaw trauma (including dental procedures)
        
        Storm drain:
        actinomycosis can cause cervicofacial disease (commonly following jaw trauma) characterized by firm abscesses in the face or neck that eventually form cutaneous sinus tracts
        
        Yellow rocks:
        hard yellow granules (“sulfur granules”) drain from the sinus tracts in cervicofacial actinomycosis
      - Branching tree:
        Actinomyces israelii bacteria are gram-positive, filamentous branching bacilli
      - Purple pencil:
        penicillin G is effective against Actinomyces israelii
      - Purple hues:
        Actinomyces israelii bacteria are gram-positive
      - Israeli soldier:
        Actinomyces israelii (a gram-positive filamentous bacillus)
    - - NO limit CARD game:
        Nocardia asteroides (a gram-positive filamentous bacillus)
      - Purple hues:
        Nocardia asteroides bacteria are gram-positive filamentous bacilli
      - Branching tree:
        Nocardia asteroides bacteria are gram-positive, filamentous branching bacilli
      - Bellows:
        Nocardia asteroides bacteria are obligate aerobes
      - Soil:
        Nocardia asteroides bacteria are ubiquitous in soil
      - Tassels:
        Nocardia asteroides bacteria stain partially acid-fast due to mycolic acids in the cell membrane
      - Pink gun and holster:
        Carbol fuchsin is a dye used to detect acid-fast bacteria, such as Nocardia asteroides
      - Cat:
        Nocardia asteroides bacteria are catalase-positive
      - Ammonia spray bottle:
        Nocardia asteroides bacteria are urease-positive
      - Immunocompromised cane:
        Nocardiosis predominantly affects immunocompromised patients
      - Dented badge:
        pulmonary nocardiosis commonly causes infiltrates, multifocal nodules, and cavitary lesions in the lungs
      - Coughing:
        pulmonary nocardiosis can present with pneumonia-like symptoms
      - Tuberculosis cactus:
        cavitary lesions of pulmonary nocardiosis are often misdiagnosed as tuberculosis
      - Hole in hat:
        brain abscesses and ring-enhancing lesions on CT are features of CNS nocardiosis
      - Red cow spots:
        cutaneous nocardiosis occurs due to direct inoculation of bacteria or from disseminated pulmonary infection
      - Eggs:
        sulfonamides (particularly trimethoprim-sulfamethoxazole) are effective against Nocardia asteroides
  - - - Purple =Gram +
      - The Golden Staph of Moses
      - Thich Cell Wall appear violet under microscope
      - Strep vs Staph
        
        Catalase Test*
        
        Converts hydrogen peroxide to water
        
        Only Staph is Cat +
        
        Coagulase Test
        
        Converts Fibrinogen into Fibrin
        
        coagulase-positive (coagulase converts fibrinogen to fibrin, forming a clot in samples)
      - Staphylococcus aureus bacteria are beta-hemolytic (able to completely breakdown hemoglobin
      - ferment mannitol, turning mannitol salt agar yellow during culture (in contrast to most non-pathogenic staphylococci, which do not ferment mannitol
      - protein A (a virulence factor of Staphylococcus aureus) binds IgG in the Fc region, inhibiting complement activation and phagocytosis
      - Staphylococcus aureus is part of the normal flora of the nares and skin
      - Staphylococcus aureus can cause bacterial pneumonia, which appears as patchy infiltrates on chest X-ray (compared to lobar infiltrates in Streptococcus pneumoniae)
      - Staphylococcus aureus pneumonia most commonly follows an upper respiratory infection (especially influenza) due to weakening of the host immune system by the initial infection (known as superinfection)
      - Red camel humps:
        Staphylococcus aureus is capable of causing a variety of soft tissue infections including impetigo (pustules that rupture to form “honey crusted” lesions, especially on the face); furuncles (boils); carbuncles (communicating furuncles); cellulitis; and erysipelas
        
        Furuncle & Carbuncle
        
        Impetigo
        
        Erysipelas
        
        Cellulitis
      - Kneeling/knee bandages:
        Staphylococcus aureus is a common cause of septic arthritis, which presents with a warm, swollen, tender joint and purulent aspirate
      - Hearts on running camel:
        Staphylococcus aureus can cause acute infective endocarditis (which presents with rapid-onset of fever, chills, tachycardia, and sepsis), even in previously normal heart valves
        
        Acute Infective Endocarditis
      - Three pyramids/mortar and pestle:
        Staphylococcus aureus is the most common cause of infective endocarditis (typically of the tricuspid valve), and is often seen with IV drug use, prosthetic valves, and previous valve damage
      - Fish bones:
        Staphylococcus aureus is the most common cause of osteomyelitis :star:
      - Skin burn:
        some strains of Staphylococcus aureus produce exfoliative toxin (a tissue protease) that causes a diffuse desquamative rash (scalded skin syndrome)
      - Lightning bolt cape:
        some strains of Staphylococcus aureus produce a superantigen exotoxin (which binds MHC II to cause massive inflammation), resulting in fever, a desquamative rash, and sepsis (toxic shock syndrome)
      - Meats and mayo:
        staphylococcal enteritis commonly occurs due to consumption of food (classically mayonnaise and meats) contaminated with Staphylococcus aureus preformed enterotoxin
      - Mercy:
        some strains of Staphylococcus aureus bacteria are resistant to beta-lactams, including methicillin (MRSA)
      - Altered builders:
        methicillin-resistant Staphylococcus aureus have altered penicillin binding proteins, making it difficult or impossible for beta-lactams to adhere to their cell walls
      - Purple caravan:
        vancomycin is effective against methicillin-resistant Staphylococcus aureus
      - Pencil staff:
        nafcillin (a beta-lactam) is effective against non-MRSA Staphylococcus aureus
    - - Plumber:
        Staphylococcus epidermidis (a gram-positive coccus)
      - Purple hues:
        Staphylococcus epidermidis and saprophyticus bacteria are gram-positive
      - Plumbing:
        Staphylococcus epidermidis infection is associated with prosthetic joints
      - Tubing:
        Staphylococcus epidermidis infection is associated with indwelling catheters
      - Heart valve:
        Staphylococcus epidermidis can cause prosthetic valve endocarditis
      - Van:
        vancomycin is effective against Staphylococcus epidermidis (most strains are resistant to nafcillin and methicillin due to the production of biofilms)
      - Dirty hands:
        Staphylococcus epidermidis is a part of the normal skin flora
      - Drip pan:
        Staphylococcus epidermidis is a common blood culture contaminant
      - Exposed navel:
        Staphylococcus epidermidis is susceptible to the antibiotic novobiocin (differentiating it from Staphylococcus saprophyticus, which is novobiocin-resistant)
      - Covered navel:
        Staphylococcus saprophyticus is resistant to the antibiotic novobiocin (differentiating it from Staphylococcus epidermidis, which is novobiocin-sensitive)
      - Bladder cup:
        Staphylococcus saprophyticus is the second most common cause of urinary tract infections (especially common in young, sexually active females)
      - Cat:
        Staphylococcus epidermidis and saprophyticus bacteria are catalase-positive (differentiating them from Streptococcus species, which are catalase-negative). Only Staph is Catalase +. Converts hydrogen peroxide in water.
      - Ammonia spray bottle:
        Staphylococcus epidermidis and saprophyticus bacteria are urease-positive
      - Red jell-o:
        Staphylococcus epidermidis and saprophyticus bacteria are coagulase-negative Staphylococcus species (CoNS) (differentiating them from Staphylococcus aureus, which is coagulase-positive)
    - - Pie bakers:
        Streptococcus pyogenes (group A strep) (a gram-positive coccus)
      - Purple stripes:
        Streptococcus pyogenes (group A strep) bacteria are gram-positive
      - "Hot Apple" pie:
        Streptococcus pyogenes (group A strep) bacteria produce a hyaluronic acid capsule
      - Beta light bulb:
        Streptococcus pyogenes (group A strep) bacteria are beta-hemolytic (able to completely breakdown hemoglobin)
      - Flaky pie crust:
        Streptococcus pyogenes (group A strep) can cause impetigo (a superficial skin infection often presenting with “honey-crusted” lesions usually around the nose and mouth)
      - Red puffy gloves:
        Streptococcus pyogenes (group A strep) is the most common cause of skin infections, including cellulitis (infection of the subcutaneous tissue and skin with indistinct borders) and erysipelas (infection of the superficial dermis with sharp, indurated, raised borders)
      - Red neckerchief on pie chef:
        Streptococcus pyogenes (group A strep) can cause streptococcal pharyngitis, more commonly known as “strep throat”
      - Licking strawberry:
        one of the characteristic findings in scarlet fever (caused by the pyrogenic exotoxin of Streptococcus pyogenes (group A strep)) is strawberry tongue
      - Red neckerchief on cookie chef:
        pharyngitis is a characteristic finding in scarlet fever (caused by the pyrogenic exotoxin of Streptococcus pyogenes (group A strep))
      - Red frosting on gingerbread man's body:
        one of the characteristic findings in scarlet fever (caused by the pyrogenic exotoxin of Streptococcus pyogenes (group A strep)) is a diffuse desquamative “sandpaper” rash that typically spares the perioral area, palms, and soles
      - Lightning bolt cape:
        the pyrogenic exotoxin of Streptococcus pyogenes (group A strep) is a superantigen that causes widespread T-cell activation and inflammation, resulting in streptococcal toxic shock syndrome (STSS)
      - Burnt gingerbread man:
        certain strains of Streptococcus pyogenes (group A strep) produce pyrogenic exotoxin SpeB (a soft tissue protease) that leads to necrotizing fasciitis (a rapidly spreading infection of skin, subcutaneous tissue, and fascial planes)
      - "M" on hat:
        in rheumatic fever, the M protein of Streptococcus pyogenes (group A strep) inactivates complement, prevents phagocytosis, and causes the formation of cross-reactive antibodies (molecular mimicry), leading to pancarditis and mitral stenosis
      - Hitting hand away from cupcake:
        the M protein of Streptococcus pyogenes (group A strep) prevents phagocytosis by interfering with opsonization
      - Mitre hat:
        cross-reactive antibodies formed against the M protein of Streptococcus pyogenes can cause rheumatic heart disease → mitral regurgitation that can progress to mitral stenosis
      - Red neckerchief on master chef:
        rheumatic fever is caused by untreated Streptococcus pyogenes (group A strep) pharyngitis (not caused by GAS soft tissue infection)
      - "JONES" cupcakes:
        the JONES criteria is used for diagnosing acute rheumatic fever ("J" - joints (migratory polyarthritis), "♡" - myocarditis, "N" - nodules (subcutaneous), "E" - erythema marginatum, "S" - Sydenham chorea)
        
        "N" with nodular candies:
        acute rheumatic fever can present with subcutaneous nodules (which form mostly on extensor surfaces of the forearm and may show central fibrinoid necrosis)
        
        “♡”:
        acute rheumatic fever can cause pancarditis affecting the pericardium, myocardium, and endocardium (valves)
        
        "J" with frosting on elbow:
        acute rheumatic fever commonly presents with migratory polyarthritis (usually large joints such as the elbow, knees, and ankles)
        
        "E" with ring pattern:
        acute rheumatic fever can present with a rash that consists of hive-like C-shaped areas of erythema (not to be confused with cellulitis)
        
        Last “S” cupcake falling:
        acute rheumatic fever can cause Sydenham chorea, which presents with rapid involuntary movement affecting all muscles throughout the body (and may show up 1-8 months after infection)
      - Glomerular knot:
        post-streptococcal glomerulonephritis is caused by subepithelial immune complex deposition in glomeruli → renal damage and nephritic syndrome
      - Cola:
        “cola-colored” urine from hemolysis is a common finding in post-streptococcal glomerulonephritis (PSGN)
      - Later in the month:
        post-streptococcal glomerulonephritis (PSGN) leads to a nephritic syndrome several weeks after acute infection
      - Pie crumbs on face/red neckerchief on phone chef:
        post-streptococcal glomerulonephritis can follow Streptococcus pyogenes (group A strep) pharyngitis OR soft tissue infection
      - "P" cupcakes:
        streptokinase of Streptococcus pyogenes (a virulence factor) is a proteolytic enzyme that activates plasminogen → plasmin (which in turn degrades fibrin, preventing development of a fibrin barrier at the site of infection)
      - Basset hound licking pastries:
        Streptococcus pyogenes (group A strep) is bacitracin-sensitive (in contrast to Streptococcus agalactiae, which is bacitracin-resistant)
    - - Galactic baby:
        Streptococcus agalactiae (group B strep) (a gram-positive coccus)
      - Hippo:
        Streptococcus agalactiae (group B strep) is hippurate hydrolysis positive
      - Purple hues:
        Streptococcus agalactiae (group B strep) bacteria are gram-positive
      - CAMP tent:
        Streptococcus agalactiae (group B strep) produces CAMP factor, which enlarges the area of hemolysis formed by Staphylococcus aureus when plated together on blood agar
      - Glass helmet:
        Streptococcus agalactiae (group B strep) bacteria are encapsulated
      - Beta light bulb:
        Streptococcus agalactiae (group B strep) is beta-hemolytic (able to completely breakdown hemoglobin)
      - Helmet:
        Streptococcus agalactiae (group B strep) is the number one cause of neonatal meningitis)
      - Purple pencil in mothership:
        pregnant women who test positive for Streptococcus agalactiae (group B strep) on screening at 35-37 weeks of gestation are given intrapartum penicillin intravenously
      - Red onesie:
        Streptococcus agalactiae (group B strep) is the most common cause of neonatal sepsis
      - Galactic baby:
        Streptococcus agalactiae (group B strep) (a gram-positive coccus)
      - Coughing baby:
        Streptococcus agalactiae can cause pneumonia (primarily in infants)
      - Red arrow:
        a positive CAMP test appears as an “arrowhead” zone of hemolysis that forms at the point of intersection between Streptococcus agalactiae and Staphylococcus aureus
      - "35 wk":
        pregnant women are screened for Streptococcus agalactiae (group B strep) at 35-37 weeks of gestation, as GBS is the most common cause of neonatal meningitis
    - - “α knight tournament”:
        Streptococcus pneumoniae and viridans group streptococci are alpha-hemolytic (able to partially breakdown hemoglobin)
      - Sir Pneumo:
        Streptococcus pneumoniae (a gram-positive coccus)
      - Sir Pneumo's armor:
        Streptococcus pneumoniae is encapsulated (in contrast to viridans group streptococci, which are non-encapsulated)
      - Purple hues:
        Streptococcus pneumoniae and viridans group streptococci are gram-positive cocci
      - Stuck in mud:
        Streptococcus pneumoniae is bile-soluble (no hydrolyzation of esculin → no growth in the presence of bile salts)
      - Exposed chin:
        Streptococcus pneumoniae is susceptible to optochin (a chemical used in identification of alpha-hemolytic streptococci), differentiating it from viridans group streptococci, which are optochin-resistant
      - "1":
        Streptococcus pneumoniae is the most common cause of meningitis, otitis media, pneumonia, and sinusitis (MOPS)
      - Double lances:
        Streptococcus pneumoniae bacteria are lancet-shaped diplococci
      - Mopping:
        Streptococcus pneumoniae is the most common cause of meningitis, otitis media, pneumonia, and sinusitis (MOPS)
      - Rusty chest armor:
        Streptococcus pneumoniae can cause lobar pneumonia (usually with unilobar consolidation) with production of “rust-colored” sputum
      - IgA shield:
        the IgA protease of Streptococcus pneumoniae cleaves IgA at the hinge region → decreased effectiveness of IgA → bacterial adherence to mucosa
      - Sickle:
        sickle cell patients are more susceptible to infections from encapsulated bacteria, such as Streptococcus pneumoniae
      - Crow:
        macrolides are effective against Streptococcus pneumoniae
      - 3 axes flag:
        ceftriaxone is effective against Streptococcus pneumoniae
      - Adult Mezzanine/Children Ground:
        the pure polysaccharide vaccine against Streptococcus pneumoniae produces a predominantly IgM (B-cell) response and can be administered to adults; children <2 years of age must be given the protein conjugated vaccine (polysaccharide conjugated with a carrier protein) to elicit an IgG (T-cell) response
      - Green jester:
        viridans group streptococci (gram-positive cocci)
      - Viridans
        
        No armor:
        viridans group streptococci are non-encapsulated (in contrast to Streptococcus pneumoniae, which has a polysaccharide capsule)
        
        Jester's chin mask:
        viridans group streptococci are resistant to optochin (a chemical used in identification of alpha-hemolytic streptococci), differentiating them from Streptococcus pneumoniae, which is optochin-sensitive
        
        Green bile boots:
        viridans group streptococci are able to grow in the presence of bile salts (via hydrolyzation of esculin)
        
        Yellow teeth:
        Streptococcus mutans and sanguinis (viridans group streptococci) are part of the normal flora of the mouth and play a role in tooth decay and the development of dental caries
        
        Damaged mitre hat:
        viridans group streptococci can adhere to previously damaged heart valves (most commonly the mitral valve) and establish infection, leading to subacute bacterial endocarditis
        
        Plate shield:
        viridans group streptococci can adhere to tooth enamel and fibrin-platelet aggregates on damaged heart valves due to their ability to produce dextrans (insoluble extracellular polysaccharides) from sucrose substrate
        
        Deck of cards:
        viridans group streptococci can produce dextrans (insoluble extracellular polysaccharides) from sucrose substrate, which allows them to adhere to tooth enamel and fibrin-platelet aggregates on damages heart valves
    - - "Resist the 6.5% N.Ca":
        Enterococcus faecium and faecalis bacteria are able to grow in 6.5% hypertonic saline
      - Green bile boots:
        Enterococcus faecium and faecalis bacteria are able to grow in the presence of bile salts (via hydrolyzation of esculin)
      - "CALIfornia caucus":
        Enterococcus faecalis (a gram-positive coccus responsible for the majority (80-90%) of enterococcal infections)
      - Do U ♥ trees?":
        Enterococcus faecium and faecalis can cause a variety of infections, including UTIs (cystitis, pyelonephritis), endocarditis, and biliary tree infection
      - "Stop the FEES":
        Enterococcus faecium (a gram-positive coccus responsible for the minority (10-15%) of enterococcal infections)
      - Resisting getting in van:
        some strains of Enterococcus faecium and faecalis have developed resistance to multiple antibiotics, including vancomycin (vancomycin-resistant enterococci)
      - Purple hues:
        Enterococcus faecium and faecalis bacteria are gram-positive
      - Police line:
        linezolid can be used to treat vancomycin-resistant enterococcal (VRE) infection
      - "Caucus":
        Enterococcus spp. (gram-positive cocci)
      - Tiger stripes:
        tigecycline can be used to treat vancomycin-resistant enterococcal (VRE) infection
- - - - "Noir series":
        Neisseria spp. (gram-negative diplococci)
      - Red hues:
        Neisseria meningitidis and gonorrhoeae bacteria are gram-negative
      - Red handcuffs:
        Neisseria meningitidis and gonorrhoeae bacteria are gram-negative diplococci
      - Blue ring:
        Neisseria meningitidis and gonorrhoeae bacteria are oxidase-positive
      - Chocolate bar:
        chocolate agar (heated blood agar) is required for growth of Neisseria meningitidis and gonorrhoeae
      - "Vice City Private Nvestigator":
        the antimicrobials vancomycin, polymyxin (colistin), and nystatin (VPN) are included in Thayer-Martin agar, which encourages the growth of Neisseria meningitidis and gonorrhoeae while inhibiting the growth of other microorganisms
      - "Starring Thayer-Martin":
        Thayer-Martin agar is comprised of the antimicrobials vancomycin, polymyxin (colistin), and nystatin (VPN), which encourage the growth of Neisseria meningitidis and gonorrhoeae while inhibiting the growth of other microorganisms
      - “Mac private eye”/“5-9 PM”:
        deficiency in the terminal complement components C5-C9 (which form the membrane attack complex (MAC)) results in increased susceptibility to Neisseria meningitidis and gonorrhoeae infection
      - Multicolored chains:
        the pili of Neisseria meningitidis and gonorrhoeae bacteria display antigenic variation (due to frequent genetic rearrangement)
      - Ace:
        the IgA protease of Neisseria meningitidis and gonorrhoeae bacteria cleaves secretory IgA (found on mucosal surfaces) at the hinge region
    - - College dorm:
        Neisseria meningitidis (a gram-negative diplococcus)
      - Red hues:
        Neisseria meningitidis bacteria are gram-negative diplococci
      - College poster:
        Neisseria meningitidis is easily spread in close quarters, such as college dorms
      - Mac the detective:
        important characteristics of Neisseria meningitidis bacteria include
        
        Oxidase +
        
        Gram - Diplococci
        
        Growth on Chocolate Agar + VPN
        
        higher infection rates in patients with C5-C9 complement deficiency (absence of MAC),
        
        Production of IgA protease
        
        fimbriae/pili that demonstrate antigenic variation
      - Malt liquor:
        Neisseria meningitidis bacteria are able to ferment both glucose and maltose (in contrast to Neisseria gonorrhoeae, which can only ferment glucose) :star:
      - Nasopharyngeal swab:
        Neisseria meningitidis is transmitted via respiratory droplets (typically from nasopharyngeal colonization of asymptomatic carriers)
      - Glass capsule:
        Neisseria meningitidis bacteria are encapsulated
      - Syringes:
        meningococcal vaccines include antigens contained in the polysaccharide capsule of Neisseria meningitidis (the polysaccharide quadrivalent or conjugate vaccine)
      - No "B" syringe:
        Neisseria meningitidis subtype B causes ⅓ of meningococcal disease in the US because vaccines against subtype B have only recently become available
      - Sickle:
        sickle cell patients are more susceptible to infections from encapsulated bacteria, such as Neisseria meningitidis
      - Burning envelopes:
        the outer membrane lipooligosaccharide (LOS) of Neisseria meningitidis causes sepsis by generating a severe inflammatory response
      - Sprinklers:
        the inflammatory response caused by the Neisseria meningitidis endotoxins (LOS glycolipids) → increased capillary permeability
      - Wet spots on carpet:
        hemorrhagic skin lesions (e.g. petechiae, purpura) often present in fulminant meningococcemia
      - Outlet shock:
        the inflammatory response caused by the Neisseria meningitidis endotoxins (LOS glycolipids) → increased capillary permeability → hypovolemia → septic shock
      - Spotted boxers:
        hemorrhagic skin lesions (e.g. petechiae, purpura) often present in fulminant meningococcemia
      - Water tower:
        Waterhouse-Friderichsen syndrome (also known as fulminant meningococcemia) is a serious complication of meningococcemia characterized by bilateral adrenal hemorrhage → adrenal insufficiency
      - 3 axes:
        ceftriaxone is effective against Neisseria meningitidis
      - Cop with rifle stopping close contacts:
        rifampin should be administered prophylactically to close contacts of patients with meningococcal infection
    - - Red hues:
        Neisseria gonorrhoeae bacteria are gram-negative diplococci
      - Mac the detective:
        important characteristics of Neisseria gonorrhoeae bacteria include: gram-negative diplococci morphology, oxidase-positive, growth on chocolate agar and Thayer-Martin (VPN) agar, higher infection rates in patients with C5-C9 complement deficiency (absence of MAC), production of an IgA protease, and fimbriae/pili that demonstrate antigenic variation
      - Gonzo's bar:
        Neisseria gonorrhoeae (a gram-negative diplococcus)
      - Flirting:
        gonorrhea is a sexually transmitted disease
      - Clam-shaped napkins:
        the standard treatment for suspected gonococcal infection presumes a Neisseria gonorrhoeae and Chlamydia trachomatis co-infection; azithromycin or doxycycline should be administered in addition to ceftriaxone (effective against Chlamydia trachomatis and Neisseria gonorrhoeae, respectively)
      - 2 red pillows in chair:
        Neisseria gonorrhoeae bacteria are gram-negative diplococci that are facultatively intracellular within polymorphonuclear leukocytes (often neutrophils)
      - 3 axes:
        ceftriaxone (given as a single intramuscular injection) is effective against gonorrhea
      - Broken glass:
        Neisseria gonorrhoeae bacteria are non-encapsulated (in contrast to Neisseria meningitidis, which has a polysaccharide capsule)
      - Covering baby's eyes:
        passage of newborns through a birth canal colonized with Neisseria gonorrhoeae can cause an infection of the conjunctivae (gonococcal ophthalmia neonatorum), which results in blindness if left untreated
      - Cracked knees:
        disseminated gonococcal infection can cause septic arthritis or polyarthralgias (typically asymmetrical and of the knee)
      - Violin:
        “Violin string” adhesions can develop between the peritoneum and/or diaphragm and the capsule of the liver in Fitz-Hugh Curtis syndrome (commonly caused by gonococcal PID)
      - Chandelier:
        Neisseria gonorrhoeae infections can progress to pelvic inflammatory disease in women
      - Candle wax:
        a characteristic white, mucopurulent urethral discharge (in both men and women) or vaginal discharge can present in Neisseria gonorrhoeae infection
      - Fitz-Hugh Curtis band:
        Fitz-Hugh Curtis syndrome is a rare complication of pelvic inflammatory disease (commonly caused by Neisseria gonorrhoeae) characterized by inflammation of the peritoneum and/or diaphragm and the capsule of the liver, leading to the development of adhesions between these structures known as “violin string” adhesions
  - - - 5.5 - Yersinia enterocolitica & pestis
        
        English terrier:
        Yersinia enterocolitica (a gram-negative bacillus)
        
        "Yersin's pets":
        Yersinia pestis (a gram-negative bacillus)
        
        Red hues:
        Yersinia pestis and enterocolitica bacteria are gram-negative
        
        Puppy poop:
        Yersinia enterocolitica is primarily transmitted via pet feces
        
        Toddler:
        outbreaks of Yersinia enterocolitica are associated with daycare centers
        
        Icicles:
        25°C is the optimal temperature for growth of Yersinia enterocolitica bacteria (in contrast to Yersinia pestis, which is cultured most rapidly at 30°C)
        
        Safety pin:
        Yersinia pestis and enterocolitica bacteria often exhibit bipolar (“safety pin”) staining on microscopy
        
        Glass capsule:
        Yersinia pestis and enterocolitica bacteria are encapsulated
        
        Red stool:
        Yersinia enterocolitica infection can cause bloody diarrhea
        
        Licking abdomen:
        Yersinia enterocolitica infection can mimic appendicitis (pseudoappendicitis)
        
        Rodent:
        rodents, such as rats and prairie dogs, are the main reservoir for Yersinia pestis
        
        Flea:
        fleas are the vector of Yersinia pestis bacteria
        
        Armpit lumps:
        intensely painful and swollen lymph nodes with overlying erythema (buboes) are characteristic of Yersinia pestis infection
        
        Red shirt:
        disseminated Yersinia pestis infection can lead to tissue necrosis and cutaneous hemorrhage, DIC, septic shock, and multiple organ dysfunction syndrome
        
        Turkey baster:
        Yersinia spp. bacteria possess a type III secretion system that delivers effector proteins directly into host cells, such as Yersinia outer proteins (Yops)
        
        Sai:
        aminoglycosides (particularly streptomycin) are effective against Yersinia spp.
        
        Bicycle tire:
        tetracyclines are effective against Yersinia spp.
        
        “Vaccinate your pets before they're KILLED”:
        an inactivated (killed) vaccine against Yersinia pestis is available, though not routinely administered in the US
      - 5.6 - Campylobacter jejuni
        
        Red hues:
        Campylobacter jejuni bacteria are gram-negative
        
        Fire:
        Campylobacter jejuni is a thermophilic bacteria and grows at 42°C
        
        Bears:
        Campylobacter jejuni (a gram-negative, curved bacillus)
        
        Chicken:
        animals such as poultry, cattle, sheep, and dogs are common reservoirs for Campylobacter jejuni
        
        Red stool:
        Campylobacter jejuniinfection can cause bloody diarrhea
        
        Mustache:
        Campylobacter jejuni bacteria are curved bacilli (C. jejuni has a characteristic “seagull wing” shape on microscopy)
        
        Blue ring:
        Campylobacter jejuni bacteria are oxidase-positive
        
        Bear invading cooler:
        Campylobacter jejuni is an invasive pathogen and is able to penetrate the intestinal epithelium, frequently leading to bloody diarrhea
        
        Slapping knee:
        Campylobacter jejuni infection is associated with reactive arthritis
      - 5.4 - Escherichia coli (ETEC, EHEC)
        
        "E cola":
        E. coli (a gram-negative bacillus)
        
        Red hues:
        E. coli bacteria are gram-negative
        
        Pink milk carton:
        E. coli are lactose-fermenting bacteria, which form pink colonies on MacConkey agar
        
        Glass capsule:
        E. coli bacteria are encapsulated
        
        K cake under glass capsule:
        the K antigen of E. coli is a polysaccharide capsular antigen
        
        Cat:
        E. coli bacteria are catalase-positive
        
        Ribbon:
        the fimbriae of E. coli permit adhesion to host cells
        
        "1" bladder cup: :star:
        E. coli is the most common cause of urinary tract infections
        
        Strawberry milkshake: :star:
        E. coli is the most common cause of gram-negative sepsis
        
        Baby in helmet/K cake:
        only E. coli strains that possess the K1 capsular antigen cause neonatal meningitis
        
        Hamburger:
        enterohemorrhagic E. coli (EHEC) is transmitted via contaminated undercooked meat
        
        Red stool:
        enterohemorrhagic E. coli (EHEC) can cause bloody diarrhea
        
        Sorbitol free soda:
        Escherichia coli O157:H7 can be differentiated from other strains of E. coli by its inability to ferment sorbitol
        
        She-gorilla:
        enterohemorrhagic E. coli (EHEC) produces a Shiga-like toxin (virtually identical to the Shiga toxin of Shigella dysenteriae) which inactivates the 60S ribosomal subunit in host cells
        
        Glomerular straw popping red balloon:
        Shiga-like toxin (produced by some strains of E. coli) can cause hemolytic uremic syndrome (HUS) due to cytotoxic effects on endothelial cells of the capillaries in the glomerulus → platelet adherence and aggregation → thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury
        
        Plates:
        platelet adherence and aggregation in hemolytic uremic syndrome (HUS) (caused by Shiga-like toxin producing bacteria, such as some strains of E. coli) occurs due to cytotoxic effects on endothelial cells of the capillaries in the glomerulus → thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury
        
        "$1.57":
        Escherichia coli O157:H7 is an enterohemorrhagic E. coli serotype that produces Shiga-like toxin, which can cause bloody diarrhea and hemolytic uremic syndrome (HUS)
        
        Water truck:
        enterotoxigenic E. coli (ETEC) is a common cause of “traveler’s diarrhea,” which often presents with watery diarrhea, abdominal cramping, nausea, and vomiting
        
        eL Agua:
        some strains of enterotoxigenic E. coli (ETEC) produce heat-labile toxin (LT), which overactivates adenylyl cyclase → increased cAMP → water and chloride efflux with decreased sodium reabsorption, resulting in watery diarrhea (secretory diarrhea)
        
        San Gabriel:
        some strains of enterotoxigenic E. coli (ETEC) produce heat-stable toxin (ST), which overactivates guanylate cyclase → increased cGMP → decreased reabsorption of sodium and chloride, resulting in watery diarrhea (secretory diarrhea)
        
        Spilling water:
        enterotoxigenic E. coli (ETEC) is a common cause of “traveler’s diarrhea,” which often presents with watery diarrhea, abdominal cramping, nausea, and vomiting
      - 5.7 - Vibrio spp.
      - 5.3 - Shigella spp. SHE GORILLA
        
        She-gorilla:
        Shigella spp. (gram-negative bacilli)
        
        Red hues:
        Shigella spp. bacteria are gram-negative
        
        Green tutu:
        Shigella spp. bacteria form green colonies on Hektoen enteric agar (HE) (differentiating them from Salmonella spp., which form black colonies on HE) :star:
        
        Chained she-gorilla:
        Shigella spp. bacteria are immotile
        
        Gorilla protected from acid:
        Shigella spp. bacteria are acid-resistant (a low inoculum is required to cause infection)
        
        "M" pad:
        Shigella spp. invade M cells in Peyer’s patches of the gastrointestinal mucosa (where they induce host cell apoptosis and manipulate actin filaments of the eukaryotic cytoskeleton to achieve intracellular motility)
        
        Shooting into "M" pad:
        Shigella spp. can manipulate the eukaryotic cytoskeleton (primarily actin filaments) to achieve intracellular motility after invading M cells in Peyer’s patches of the gastrointestinal mucosa
        
        Red stool:
        bloody diarrhea is a common symptom of shigellosis
        
        Flames:
        shigellosis can lead to gastroenteritis and diarrhea, characterized by the presence of leukocytes (predominantly neutrophils) in the stool
        
        Glomerular knot:
        Shiga toxin produced by Shigella dysenteriae can cause hemolytic uremic syndrome (HUS) due to cytotoxic effects on endothelial cells of the capillaries in glomeruli (leading to platelet adherence and aggregation → thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury)
        
        Popped red balloon:
        microangiopathic hemolytic anemia (MAHA) often presents with schistocytes in peripheral blood smear and is a component of hemolytic uremic syndrome (HUS) (caused by Shiga toxin producing strains of bacteria, such as Shigella dysenteriae)
        
        Plates:
        platelet adherence and aggregation in hemolytic uremic syndrome (HUS) (caused by Shiga toxin producing strains of bacteria, such as Shigella dysenteriae) occurs due to cytotoxic effects on endothelial cells of the capillaries in the glomerulus → thrombocytopenia, microangiopathic hemolytic anemia, and renal insufficienc
        
        Young ringmaster:
        young children are more commonly affected by hemolytic uremic syndrome (HUS), which is caused by Shiga toxin producing strains of bacteria, such as Shigella dysenteriae
        
        60S sand timer:
        Shigella dysenteriae produces Shiga toxin (virtually identical to the Shiga-like toxin of enterohemorrhagic E. coli) which inactivates the 60S ribosomal subunit
        
        Turkey baster:
        Shigella spp. bacteria possess a type III secretion system that delivers effector proteins directly into host cells
        
        Popped red balloon:
        microangiopathic hemolytic anemia (MAHA) often presents with schistocytes in peripheral blood smear and is a component of hemolytic uremic syndrome (HUS) (caused by Shiga toxin producing strains of bacteria, such as Shigella dysenteriae)
      - 5.8 - Helicobacter pylori
      - 5.2 - Salmonella enteritidis & typhi
        
        Salmon:
        Salmonella spp. (gram-negative bacilli)
        
        Red hues:
        Salmonella enteritidis and typhi bacteria are gram-negative
        
        Flopping salmon:
        Salmonella enteritidis and typhi bacteria are motile
        
        Black placemat:
        Salmonella enteritidis and typhi bacteria form black colonies on Hektoen enteric agar (HE) due to production of H2S (differentiating them from Shigella spp., which form green colonies on HE)
        
        Glass capsule:
        Salmonella enteritidis and typhi bacteria are encapsulated
        
        Lemon:
        Salmonella enteritidis and typhi bacteria are acid-labile
        
        Chicken:
        chickens are the reservoir for Salmonella enteritidis
        
        Seagull:
        Salmonella typhi colonizes the gallbladder of chronic carriers
        
        Red-spotted apron:
        typhoid fever (caused by Salmonella typhi bacteria) can present with a characteristic rash known as “rose spots”
        
        Fish bones/sickle:
        Salmonella spp. can cause osteomyelitis in sickle cell patients
        
        Sickle/fish bones:
        Salmonella spp. can cause osteomyelitis in sickle cell patients
        
        Green droppings:
        the khaki-green stools seen in typhoid fever are sometimes referred to as “pea soup” stools
        
        Flower:
        fluoroquinolones are effective against Salmonella typhi (infections caused by Salmonella enteritidis typically do not require antibiotic therapy)
        
        Syringe in seagull:
        a vaccination is available for Salmonella typhi only (the oral vaccine contains live attenuated Salmonella typhi, and the intramuscular vaccine includes a Salmonella typhi capsular antigen)
        
        Flame:
        Salmonella enteritidis (and other nontyphoidal serotypes) most commonly cause a self-limited gastroenteritis
        
        Turkey baster:
        Salmonella enteritidis and typhi bacteria possess a type III secretion system that delivers effector proteins directly into host cells
        
        Open cages:
        Salmonella enteritidis and typhi bacteria are facultative intracellular within macrophages
      - 5.9 - Pseudomonas aeruginosa
      - 5.1 - Klebsiella pneumoniae, Enterobacter spp., Serratia marcescens
        
        Red hues:
        Enterobacter spp., Serratia marcescens, and Klebsiella pneumoniae bacteria are gram-negative
        
        Oxygen mask:
        Enterobacter spp., Serratia marcescens, and Klebsiella pneumoniae can cause pneumonia
        
        Urine drainage bag:
        Enterobacter spp., Serratia marcescens, and Klebsiella pneumoniae are common causes of urinary tract infections
        
        Hospital:
        Enterobacter spp., Serratia marcescens, and Klebsiella pneumoniae are common nosocomial pathogens
        
        Pterodactyl:
        Enterobacter spp. (a gram-negative bacillus)
        
        Pterodactyl flying:
        Enterobacter spp. bacteria are motile
        
        Pills:
        Enterobacter spp., Serratia marcescens, and Klebsiella pneumoniae commonly exhibit multidrug resistance
        
        Pink milk carton:
        Enterobacter spp., Serratia marcescens, and Klebsiella pneumoniae are lactose-fermenting bacteria, which form pink colonies on MacConkey agar
        
        Red triceratops residue:
        Serratia marcescens bacteria produce a distinct red pigment
        
        Triceratops:
        Serratia marcescens (a gram-negative bacillus)
        
        Triceratops charging:
        Serratia marcescens bacteria are motile
        
        Ankylosaurus with "kleb" tail:
        Klebsiella pneumoniae (a gram-negative bacillus)
        
        3 "A" club tail:
        Klebsiella pneumoniae is common in alcoholics, leads to abscesses, and often causes aspiration pneumonia
        
        Spike coverings:
        Klebsiella pneumoniae bacterial cells are surrounded by a prominent polysaccharide capsule
        
        Currant jelly:
        the sputum produced by patients with Klebsiella pneumoniae is classically described as “currant jelly sputum”
        
        Jelly on feet:
        Klebsiella pneumoniae bacteria are immotile
        
        Chest X-ray:
        cavitary lesions resembling those in tuberculosis may develop in Klebsiella pneumoniae pulmonary infections
        
        Ammonia bottle pointed at ankylosaurus:
        Klebsiella pneumoniae bacteria are urease-positive
      - 5.10 - Proteus mirabilis
    - - 6.2 - Haemophilus influenzae
      - 6.3 - Legionella pneumophila
      - 6.1 - Bordetella pertussis
    - - 7.1 - Bartonella henselae
      - 7.2 - Brucella spp.
      - 7.3 - Francisella tularensis
      - 7.4 - Pasteurella multocida