DIP Episode 78 - Gram Negative Rapid Review (+ Zoonotics)

Okay, welcome. My name is Divine. It is a past midnight here. And this will be the second podcast that is supposed to be a rapid review of a micro. In this podcast, I'm going to be talking about the gram negatives. And just like I did for the first podcast, you know, I kind of take a look at this first page, like the gram negative algorithm. I'm just trying to see like the high-yield things relating to each bug. So you're talking about gram negatives, right? Obviously, the first thing you want to start with is, you know, the coxai, right? I mean, this first deep pitch says, oh, you have diplococci, you have Kokobacilli, you have curved rods, and then you have bacilli. Right? And we'll talk about all these groups. But I think probably, you know, my starting point is to talk about the diplococci, right? And they're all eros, right? And obviously here we're dealing with the my cereal and more acylla species. So the thing is, if we sort of start with a nice, zero species, right? So nice, zero species, the gram negative, right? And they're diplococci. So in exams, you want to be careful, right? Because many people want to see this diplococci, the first thing that jumps to mind is strep pneumo. If you want to be careful there, right? If it's a gram positive diplococci, fine, strep pneumo. If it's gram negative diplococci, you probably want to think more about my cereal species, right? And again, my cereal species, they are all oxidized positive.

And obviously the two big ones you want to know, you want to know my cereal made in jid it is versus my cereal gonorrhea. And the thing is, with these bugs, it's actually kind of high you to know some key identification differences, right? So for example, I established, I believe in the last podcast that my cereal made in jid it is has a capsule, but my cereal gonorrhea actually does not have a capsule. And in fact, I sort of think of it as nice cereal made in jid it is has everything has it all when I sure gonorrhea is really lacking, it lacks a lot of stuff, right? So nice cereal made in jid it is has a capsule has a vaccine, nice cereal gonorrhea does not have a capsule. And there's no vaccine against nice cereal gonorrhea. Now, the thing is, if you sort of think of the two orifices of your body, right? So like your respiratory tract, like the top most versus your bottoms, right? That's like your genitals. Those are sort of the ways that these two nice cereal species getting right? So nice cereal made in jid it is, it's a very high yield respiratory pathogen. It ultimately gains access to the nervous system through the respiratory pathway, right? And then nice cereal gonorrhea comes in through the genitals, right? And both of these organisms ferment glucose, but nice cereal made in jid it is ferments maltose. Remember the emin made in jid it is for emin maltose, okay? So again, those are just kind of like high yield things to know, right?

So nice cereal made in jid it is already said, it's gram negative, right? Diplococcus has a capsule, right? And remember that it loves to grow in chocolate egar, okay? Loves to grow in chocolate egar. Remember the emin made in jid it is for the emin maltose, right? It has the ability to ferment maltose. And again, you get it through respiratory droplets. And actually it's kind of important to know this, right? Because it is kind of like a respiratory pathogen, right? Remember I told you that IG is the guardian of the mucosa. So if you want to be any kind of notable bug that survives in the respiratory mucosa, right? You need something that can deal with that IG problem, right? I mean, it's good for us, but for the bacteria, right? So the way you deal with that IG problem is by having IG produce. Remember I say that strep pneumo also has that IG produce, right? And because nice cereal made in jid it is, it's a gram negative organism, right? I told you that gram negatives have lipopolisaccharide, right? They essentially have, it's endotoxin, right? In fact, in nice, very many jid it is, people tend to call it lipolygosaccharide, right? Again, that can trigger like, circulatory collapse septic shock, right? And obviously nice, very many jid it is, you worry about it with meningitis. And I will tell you this, classically, nice, very many jid it is, shows up like in a crowded area, right? So like a college dorm, a military barak or something like that, right?

So like, place with a lot of people, tons of military recruits. That's why at least I believe in the US before you start college or something ridiculous, you do need to get the nice German and jid it is a vaccine. So basically, it represents is a cure onset headache, fevers, right? No core rigidity, right? And usually, I will say almost 100% of the time on the USML is those people who have skin findings, right? So they will have PTI, PTI classically, basically like red spots that you find on a present skin. If you see those things, you really want to think about nice, seramine and jid it is. And if you just to sort of bring in some integration with immunology, right? Remember, if you have a deficiency in a complement component, like your terminal complement cascade components, like C5 to C9, you have an increase risk of recurring my cereal infections. Now, remember, for a person has my, I guess, and that weird way they would ask that same thing. So there is this disease that is again, discussed in the context of hematology and oncology, PNH, proxysamone, nocturnal hemoglobinuria, where you have like a GPI anchor deficiency because you have a PGA, right? So PGA, if you sort of scrambled those were the GPI anchor, you have like a GPI anchor issue. Ultimately, the treatment is a curusumap. A curusumap is a monocloryl antibody against C5. If you're taking a monoclonal against a terminal complement component, you do have an increase risk of my cereal infections.

In fact, the classic USML question is to ask, when a patient is studying a curusumap, what's the next best step in management? You want to go ahead and vaccinate them against a my cereal meningitis, right? So they don't get life threatening infections in that regard. And if a person has an isermin ingitis, right? On any exam, your good to drug is safe triaxone, right? Safe triaxone. And then if you want to sort of prephylax close contacts, right? You can give one of three drugs. You can give rifampin, that's an RNA polymerase inhibitor, it's also used to treat TB. You can give safe triaxone or you can give seaprofloxacin, but the preferred agent, the first line agent, is rifampin. So those are how you think about my cereal meningitis. And remember, my cereal meningitis, right? You can have like, you can have like the my cereal meningitis infection, sort of going to your adrenal glands, right? And then, classically, it will present as a case where the person has like, you know, like, DIC, like shock, they have like seculatory collapse. And they'll have all these electrolyte anomalies that are consistent with adrenaline and sufficiency, right? So they'll have like a hyponychromia because our dose range is not around anymore to help your rehabs, obsidian. They will have hyperchylemia because again, remember our dose during helps you with potassium in the nephra, right? So hyponychromia, hyperchylemia, DIC shock kind of picture with like seculatory collapse.

Think about water house Friedrichs syndrome with my serum meningitis, right? And again, gram negative, diplococcus. And really, that's how you treat that. And that's how those are the high you things about my serum meningitis. And then if we're talking about my serum, right? This one, sexually active, um, can it can present in many different ways, right? So it can present with arthritis. So if you see like sexually active person with arthritis, right? And they have like a high white count. They have fevers. And again, they have skin findings, right? Again, ptiki. Just look up pictures of this. It's usually a pretty, uh, pretty striking. Think about my serum, it can be like a migratory arthritis, right? So migratory means starting one joint, most of another joint, right? Um, usually for those joints, you tap those joints and you'll find like, uh, you'll find a lot of white cells, you'll find a lot of neutrophils and all that stuff, okay? Um, another way, um, my serum going to reckon present is as PID, right? So pelvic inflammatory disease, right? So, classically in a female, you know, be a lady that has like, you know, low abdominal tenderness, um, cervical motion tenderness, right? Um, um, that's how my serum going to real also present. It can present like pure link discharge from the vagina, just very nasty gupisto for coming from the vagina, right? Um, and again, my serum, going to my serum going to rare you obviously treat that with septraxone as well.

And just a kind of high you'll think to know for the USML Es, if you're treating my serum infection, my serum going to reinfection, you also need to empirically treat chlamydia because many times, if people have my serum, they also have chlamydia at the same time, right? So, you give septraxone and then you give you zythromycin, zythromycin is a macrolid, it can cover the chlamydia, um, another alternative, I guess is doxycycline, doxycycline also covers the chlamydia, uh, pretty well. So you treat both at the same time, right? And again, my serum going to rare, the big tabo, my serum going to raise, it has PILI, right? So it makes it very easy for it to attach to, you know, kind of attach to myocosola surfaces. And my serum going to rare, again, just like my serum in GD, it is, it actually has IG proteins as well, that's why it's very sturdy, that surviving myocosol surfaces. And the thing is, I guess, and the thing is sort of think about, right? So if, let's say, a mom has gonorrhea, right? And then she delivers a kid, right? When she delivers that kid, as that kid is passing through the birth canal, that kid can acquire the gonorrhea infection, especially in the region of the eye, right? You can cause something called as, I believe it's known as of thalmya and your natar, okay? It's just one of those, it's like a nice, her gonorrhea infection of the eye. If you don't treat it, you can actually cause blindness.

Usually for that, you go ahead and, you go ahead and use, uh, what is it called? Like a topical, uh, erythromycin, right? You apply there, it's a nice into the eye to sort of deal with it. Uh, back in the days, do you silver nitrate, but normally does that anymore because it sort of burns the, the kid's eye, and it sounds as kind of vicious, right? Don't do that to a little kid. Um, and then I guess another thing, once I'm about my seri gonorrhea, right? So if you want to culture it, you can actually culture it on something known as, uh, the thirmartina egar, right? It's just one of those weird things you want to keep, keep at the back of your mind. And again, if a patient has a nice seria, usually you also want to just go ahead and test them empirically as a clinical pro, just go ahead and test them empirically for a chlamydia as well or you can just empirically treat, give them safe tracks, want to cover the nice seria, and then give them like easy thromycin, which is a microlitre, right? That's a 50s inhibitor, or you can give, um, doxycyclic, that's another fifth, uh, that's actually a 30s, but your static 30s inhibitor, that can also do, do the trick. Now, um, the next bug I guess I'll talk about more acetylic, caterylus, it's like a gram-negative diplococcus on exams, I want you to think about more acetylic in the context of otitis media, right?

It's a relatively common, it's actually one of the most common causes of otitis media is that big, big, big thing you want to remember about that. I mean, yeah, they ask about treatment, you can give them oxysyline, or you can give like a oxysyline plus clavolanit, um, because, um, there's a lot of resistance, like more acetyl, many more acetyl, um, sort of strains make a ton of bitter lactamesis, so you can give like a oxysyline plus clavolanit. Remember clavolanit is a, is a bitter lactamesis inhibitor, so that can help you, the, um, it's like clavolanit, augment the activity of a oxysyline, right? I mean, so happens the drug mean is a augmented. So, I guess that's it for me with a gram-negative acoxy, right? So I think just, um, let me do some kind of triage here, because I, again, I always start these podcast with good intentions, right? Like, I'm gonna keep this to like 30 minutes, um, but then I end up like all these things keep jumping, jumping into my mind that are all high-yield, and then I keep seeing them, and then the podcast gets long. So let me sort of do a triage here. Let me talk about the high-yield box first. So, um, I try to, I forgot to say one thing about my ceregonalia, right? So, uh, classic thing, right? So they can give you a question about a patient.

Let's say she has PID, so pelvic inflammatory disease, so she has like the low abdominal tenderness, cervical motion tenderness, and then they see that after a while she starts completing over right upocodian pain, um, that's sort of like the liver spot, right? Um, the thing I want you to think about on the those circumstances is like, sort of like spread of that my cereal infection to the liver capsule, right? So you can actually have an isyrel infection, my ceregonalia infection of the liver capsule. I believe it's known as the FITSU Curtis syndrome, just one of those weird things you want to keep at the back of your mind. And then if we go to the gram negative bacilli, right? So like the gram negative rods, um, obviously the big, big one you want to think about, I mean there's, there are many big, big rods, but let's talk about them one by one. Let's kind of start with pseudomonas, right? Um, pseudomonas, they're just some, there are many key things you need to know about pseudomonas, right? So obviously it's gram negative, it's a gram negative rod, um, it's oxidized positive, right? It's just one of those weird things you're like, why is this clinically relevant? It loves to survive in environments that have oxygen, right? But it's just one of those weird things, keep at the back of your mind for a test, but it's a lactose non fermenter. And I mean the big pseudomonal species you want to know about is as pseudomonas, cereginoza, right?

And the thing is pseudomonas, right? It produces a lot of pigment, right? So like the classic one that shows up on exams is like pioscienin, it's like a blugring pigment. Um, and then it has like this fruity order, right? So that's why it loves like wet environments like brown patients, cystic fibrosis patients, like their airways. I remember from the prior podcast I said that, um, after the age of 18, the most common cause of pneumonia in a cystic fibrosis patient is pseudomonas, but prior to the age of 18, it's more along the lines of uh, of uh, staphores, right? And then also to kind of make an integration, I sort of raised that the last podcast, right? So a patient with chronic granulomatos disease, right? Remember, those people have any DPH oxidized efficiency. So they tend to be susceptible to infections with organisms that are catalysts positive. So the monos is actually catalysts positive. So guess what? Patients with CGD can have life threatening so the monol infections. And then another thing you also want to think about, remember, pseudomonas is actually an encapsulated organism, right? Remember whenever you have a capsule, it just makes it very, it just makes you a very hard bug to faggosite tubs. So here's one of those rare things you want to keep, uh, you want to keep at the back of your mind. Um, and so the monos again, wet environments, right?

So like socks, uh, canvas, like, like, uh, like, uh, like, gyms, colic canvas, but it's like shoes you wear to like run or whatever, goes with gym or whatever, um, those things tend to contain a ton of pseudomonas, right? And I guess to sort of help you out here. The thing is, if you remember, I talked about one of the virulence factors of corainy bacterium deuterium, right? I said the the fear, the the fear toxin, um, it's toxin was one of its higher virulence factors was exotoxin A, which was essentially like an ADP ribosyl liter. That's like a post translational modification of a longition factor too. Like the eukaryotic elongation factor too. And that basically kills protein synthesis, right? Because you're killing the, uh, elongation aspect of, of our translation, right? It so happens that that exotoxin A, that the fear toxin has is also a toxin that's held by pseudomonas, right? So pseudomonas, again, remember, it has endotoxin like the LPS that every gram negative has, but it actually makes exotoxin as well. Remember I said that, oh yeah, most gram negatives have endotoxin, but some gram negatives can actually produce exotoxin. Just one of those things you is one of those, don't say, oh, gram positive exotoxin, gram negative endotoxin, that is not always true. Gram negatives in general all have exendotoxin for the most part, or many of them also have exotoxin as well. Okay? Like exotoxin A, which is the monos, right?

And that exotoxin A, C mechanism of action ADP ribosyl solution, eukaryotic elongation factor too, right? So that, um, stops the protein synthesis. Now, what are some other high yield things you want to know about pseudomonas, right? So pseudomonas, remember, it loves with environment, right? So, um, if you're swimmer, right? So let's see your Californian person, you swim all the time, you can get something known as hot top folliculitis, right? With pseudomonas, because it loves to, it loves to hang out in water, right? So, swimmer's ear, um, sorry, seem to different things. Hot top folliculitis, which is like a skin infection, usually on the exams, the infection will sort of outline like a swimsuit. Think about pseudomonas with that. And then the ear, right? Swimmers ear, tidies, external, the most common cause on NVME exams, on the USME Ls, very high yield to know this, most common cause of a tidies, external is a pseudomonas aeroginosa, okay? Classically, that will show up with like, pain in the, with the pinna, right? Pain in the pinna. Just one of those things again, you want to keep, uh, you want to keep at the back of your mind. Now, um, remember, again, pneumonia in like cystic fibrocystheus patients, um, pneumonia in patients with chronic reloomitus disease, because remember, pseudomonas is a, it's a catalys positive organism.

And just as a clinical pearl, um, especially for the 30-year of med school, if a patient is on the wards and the aceptic, the two bugs, you always want to cover his muscles to the mornas, right? So usually on the wards, you give them, combating to cover MRSA and then you use those in, right? So people are actually in plus diesel back to cover, to cover pseudomonas. And one thing is, uh, many people once they hear the balls were black S-car in microbiology, the only bug that comes to mind is bacillus and threesis. Yeah, bacillus and threesis can cause a black S-car, but please do not forget that pseudomonas can also cause a black S-car, right? The boss phrase, there is a hemagangrainosa, that is the black S-car, that's so the companies are pseudomonas. And, um, it's floridly high to know the drugs that covers pseudomonas, right? Believe I repeated this in the previous podcast, but it's one of those things that is worth repeating, right? So if you want to cover pseudomonas, right? You can use vitamin Z, right? Zosin, pseudomona, I mean, sorry, papyracillin plus a thizobactem, right? There is a third generation, that's like the anti-seudomonal penicillin, um, there's a third generation cephalosporing that also covers pseudomonas, it's known as septazidine. And then there's a fourth generation cephalosporing that covers pseudomonas, that's a cephepi, right? High old ones to know. And then don't forget you amino glycosides, right?

Your 30s bacterosidal agents, those are also, those can cover pseudomonas, right? So like gentamysin, neomysin, amicasein, to bramycin, and the streptomysin. Also as trionem, right? Remember, like your monobactams, as trionem, those have the ability to cover pseudomonas. Let's see, come on, divine thing. Your carbapenemps, right? Your carbapenemps, like a meropenem, utopenem, duropenem, e-mi-penem, those have the ability to cover pseudomonas. I'm not exactly remember right now. I know there is one member of that category I just mentioned that does not expressly cover pseudomonas, but just in general your carbapenemps have the ability to cover to cover pseudomonas. And then one of the drug class that covers pseudomonas are your fluoroquino loans, right? So fluoroquino loans, like your c-pro-floxacine, gadi-floxacine, livo-floxacine, moxifloxacine, malibdixic acid, those all have the ability to cover pseudomonas. And then I guess while I'm on that topic, the drug that covers merse, right? Again, those are high-yield drugs to know for tests. Let me just sort of put everything together for you here. And so obviously vancomycin covers merse. Merse is covered by vancomycin. Also, remember vancomycin is nephronototoxic, right? Dapto-mycin also covers merse. The fifth generation cephalosporing, cephtaroline also has the ability to cover merse. There is this drug. It's a 50-s inhibitor, bacterostatic, it inhibits initiation, a lenezolid.

Lenezolid is an oral drug, although you can also get the IV formulation. Covers merse also covers VRE, right? So vancomycin resistant interococcus. There's one more drug that is forgetting right now. Covers vancomycin. I mean, covers merse. I've talked about vancomycin, I've talked about dapto, I've talked about lenezolid, I've talked about cephtaroline. Yep, the tigacyclin. It's like a glycicycline drug class. They're like advanced tetracyclins basically. Yeah, you advanced tetracyclins, like tigacyclin, does cover merse. Actually, if you want to dig into the width here, doxycycline, it covers merse as well, believe it or not. One more thing came to mind, clean the mycin. Clean the mycin covers merse. I mean, that's a 50-s inhibitor. The classically causes pseudomemaryansolitis from CD-phovergrowth. Yes, clean the mycin, also covers merse. Covers merse are real well. It's usually used to treat merse skin infections, or like anaerobic and pneumonia. Okay, good. So let's see, the only thing I want to say about pseudomonas. To be honest, I almost always thought you're high ill bug. Just trying to see, the only thing I'm forgetting. Yeah, I think I'm going to say about pseudomonas. Let's go ahead and jump to a bug that I guess is not exactly, it's like weakly gram negative if you may, right? Legionella. So Legionella, right? It's a gram negative organism. It's very high to know that, if you want to grow Legionella, you need iron and cysteine. Okay?

C-y-s-t-e-i-n-e, you need iron and cysteine for Legionella to grow. And the big thing one of the above Legionella, it loves air conditioning and waterfalls, right? So I was almost like 90 to 95% of the time on exams. The way Legionella shows up is business conference, waterfall or air conditioning system, like central air conditioning. They almost always for some bizarre is just mentioned business conference in Legionella questions. You see that? You really, really want to think about a Legionella. And also the classic patient is like a smoker, right? If a person is like a smoker, or they kind of have like a disease that places them at high risk of their immunosuppression, those are classic, classic presentations of Legionella. And the thing is on like strep pneumo that causes like a luba, like a big consolidation, like defined consolidation on chest X-ray. Legionella and other bugs like chlamydia and micro plasma, those tend to cause more atypical or walking pneumonia, right? Atypical or walking pneumonia, they're kind of like smothering pneumonia, with the person, yeah, that's a dog, man, I feel crappy for like a whole week or like two weeks before they present to the hospital, right? And usually you see like intestinal infiltrates on imaging versus like strep pneumo, right? Where it's like it's a typical pneumonia, like it's a legit pneumonia like dog. I was feeling great on Sunday, dog. It's Tuesday.

I feel like crap, like high fever, like tooth, almost like a tooth chattering fever. They just feel really bad. That's more what you see with like a bacterial pneumonia, like strep pneumo versus the typical pneumonia as well. You see intestinal infiltrates on imaging, right? So again, Legionella think about a smoker, immunosuppress person, waterfall, business conference, air condition, those are the big, big, big associations. And the thing is, it's actually kind of high yield to notice that Legionella actually stands positive with silver. In fact, I was saying general, it's very high yield to know the organisms that are silver, steam positive. Legionella is one high yield one you want to know for example, another high yield one you want to know for example is H by Lori, H by Lori, steams positive with silver. And then another one if you're thinking more in the realm of HIV AIDS is a neomocystis gerovetsi. Previously, I think it was known as neomocystis carinia, but neomocystis gerovetsi, I'm also steams positive with silver. Those three things are floridly high yield to know for example. So again, smoker, it's like an intracellular organism, it's like a fac-offative intracellular organism if you may. And again, the way think of Legionella, right? So it causes Legionnaires disease. I think of it as pneumonia plus, right? So like the plus means that they're not like, yeah, kind of weird things you find with with a Legionella, right? So you have like the pneumonia obviously.

And usually you can see like a pneumonia like relatively significant hypoxia. And then another thing you want to think about is it's usually an elderly person, right? Young people usually do not get Legionella on USML, right? It's usually like old guy, again, business conference, right? I mean, think about he who's like the business person at a business conference, then sort of mentally you head pink to picture of like old elderly smoker, right? Those, that's like the classic demographic on exams. So what I mean by pneumonia plus, the thing is these people may have like diarrhea, right? Like they'll have pneumonia and have diarrhea. And they tend to have like weird electrolyte abnormalities like hypo-neutrimea. That's like a classic presentation of a of a Legionnaires disease, okay? Just one of those with one of those withings you want to keep in your mind. And you basically check for the Legionella urine antigen, that's how you kind of make the diagnosis. And then you can treat it with a macrolid, right? So you can give like a retromycin or a zythromycin or anything of that sort. I mean, fluoroquinolone can also help, but usually on exams go to macrolid like a zythromycin or where a retromycin. And then this first aid page sort of lists like some weird things, the amor like zoonotic bacteria, but it's like two or three things you need to know about each one. So just sort of real those are fairly quickly, right?

So like if you look at this first aid page, it talks about like france cellar to learn sex under the cocoa bassella. So france cellar, right? The big things you want to know, like a gram negative, like again, it's like a sort of like a tiny rod. It's an intracellular pathogen. And this can actually be used as like a like you if you're reading the news or doing your digging. You see that this can actually be weaponized as like a bioterrorism agent if you may. But classically, the associational exam is rabbits. That's the big, big, big thing you want to remember rabbits. And it's carried by a tick. I believe it's known as the derma center thick tick. That's again one way thing you want to know. Right? So if for example, you're a person that like your farmer or something that you do with like rabbits, for example, think about think about france cellar, right? And the thing is they'll usually have like like really high fevers. They'll have like a lot of like lymphatoma apathy. And then usually they'll have like like almost like skin ulcers. In fact, I know there's something they call like all seroglandula, something, something, something with with france cellar. But classically again, rabbits, high fever, derma center, tick. It's like a zoonotic organism. And again, it's like an intracellular book. And usually it's like in like like Missouri or like Arkansas stuff like that. That's kind of like the classic, classic description.

I really would not worry about treatment, but those are the big things you want to know about france cellar tolerances. And then with a telepertosis, this is a super, super high-yield book. They love to test this on exams. And this fact just came to mind. So just see it out loud because I may forget down the line. But basically, many times when you have a bacterial infection, right, if you do a CBC, right, if you do a complete blood count, the white count that is really elevated in neutrophils, right, bacterial infection neutrophils. But border telepertosis is different. It's one of those weight infections where it's a bacterial infection, but you actually have lymphocytes that are elevated in the blood. And the lymphocytes, I mean, it is like ridiculous, right? He can be like 70,000 like crazy high white count. And you see like a crap tomorrholymphocytes, bacterial infection, think about border telepertosis. And again, please don't be an anti-vaxer. Don't kill your kids for any for like bizarre reasons, right? So border tele it's for its vaccine preventable, right? So like the T-dap or the D-tap vaccines, they cover border telepertosis pretty well. So I'm again, a classic little example, be like an immigrant that has like an unknown on certain vaccine history, or it can be like an anti-vaxer or a person that has like some weird objection to taking a vaccine, right? And classically again, it, the, the, but it's a pertosis causes like whooping cough, right?

So whooping cough, like you have this prolonged cough, and then you have like an inspiratory whoop, right? So usually it's like, does the classic way you will present on on an exam? And the reason I'm dramatizing it is remember your friends at the NBM, right? For step one, step two, step three, they have video questions where they put a patient and you play a video on the exam, right? That is basically what I practice now is basically the way whooping cough presents. So again, whooping cough, it's, I mean border telepertosis, because it's whooping cough, but basically right, it's a gram negative, uh, uh, uh, uh, cocoa bacilli, um, it's vaccine preventable, right? It's vaccine preventable. Um, and the thing you want to think about, right? Because it's like, you know, it's kind of like a respiratory pathogen, right? It should kind of make sense that the big antibody you want to generate to protect you against border telepertosis is IGA, right? Um, and remember, right, that IGA, uh, you're basically into half class switching, right? For that to happen from like IGM to IGA, right? And for that class switching to happen, um, you need, um, at least you want to make IGA, um, let's see, put on my immunology hat. Uh, if you want to class switch to IGA, that, that happens under the action of, uh, interlooking five. Yep, IL5 is what helps you class switch to IGA, um, versus IGE that's like interlooking four. Um, and I think IGG is also interlooking four as well.

I remember like general electric IL4 and then IL5 is, um, uh, class switch into IGA. Okay, just a nice immunology time there. But again, pertosis, you can present, prevent it with a vaccine, um, you can give like the D-tap or the T-dap of a vaccine. It's actually like, floridly high, you'll to know for example that it's an A cellular vaccine, right? So you're giving basically the cellular components on border tele, uh, that's what constitutes, uh, that's what constitutes the vaccine. And the thing is, um, uh, border tele, right? It grows on like, uh, kind of like some weird media, right? Um, there's like this one, I believe it's a French word, like the Bordagian Jew media, that's one. But I know that one that like, it tends to shop on USML is like the Regan Loh, like Regan Loh, like Loh, like L-O-W-E, right? So the Regan Loh media, uh, that's another thing that, uh, Bordagian Telepertosis, uh, loves to grow. And the thing is, Bordagian Telepertosis, you'll want to know that, uh, uh, uh, uh, it basically, how do I put this? It does the ADP ribosylation that we've come to associate with like exotoxin A of pseudomonas aeroginosa, and exotoxin A of, um, corainibacterium dephyry. But here's where you need to be careful. It does not do ADP ribosylation of like elongation factor two. And sort of mess with protein synthesis. What it does is that it performs ADP ribosylation of an inhibitory G protein. So this is a very nice, really, can tie in cell biology on the USML, right?

So it causes that ADP ribosylation. Again, that post-transitional modification of, uh, uh, inhibitory G proteins. And basically, that inhibitory G protein that it basically kills is the thing that sort of like, uh, shuts down, um, adenylid cyclists. So if inhibits the inhibitor of adenylid cyclists, adenylid cyclists are on wild, and then you get into a ton of trouble, right? That is basically how the pertossis toxin works. So it's, again, one of those weird, high-yle things you want to keep at the back of your mind, for example. And one of the thing they love to test on exams in relation to whooping cough, right? Sort of like the stages, right? So it's like, sort of like the incubation phase, you know, like the first, like, weak, tendi-ish, where you don't have any problems, uh, you get the infection, the bacteria is beginning to like jump for joint your blood and sort of like increase, increase, increase. And then you sort of get to the caterl phase, right? So caterl, right? So like a caterl. At least in the called caterl, it's when you have like, runny nose, right? So caterl phase, it's like another two weeks where you know, you have like, runny nose, you just like sneezing a ton, you feel like crap, you don't want to eat anything. And then the phase that really sucks is the paroxysmal phase, right? This is like a month. People can have the cough for a long, long, long, long time. In fact, sometimes people call this the 100-day cough, okay?

So basically you have like the cough with the respiratory whoops. And let me tell you this awesome USMLE secret. This is the way weoping cough will present. If a person has a cough that is so bad, that they vomit after the cough, you don't even need to read the rest of the question. That's what the teleportosis on an exam. Another classic way it presents is if a patient coughs so bad that they pass out after the cough, don't bother reading the rest of the question. That's what the teleportosis is. The third way they love to test this is a person, the coughs so bad that they get like a subconjunctival hemorrhage from the cough. That's it. That's what the teleportosis is. And then after the proxysmal stage, you then have the convalescent stage, you know, last for like a month, where the coffee no sort of goes down and you sort of get better. The bacteria no sort of goes down now with that. And really the way you treat pertosis, right, is you'll basically give a microlette, right? You give like every thromising, a classicly on exams. And if you're actually a close contact of a person with pertosis, you do actually need to, what do I want to say? You also need antibiotic profile access, right? So you also need antibiotic profile access to the microlettes as well, like every thromising. So I can say this kind of like a common concept, right? It's actually kind of high you to know certain infections where close contacts need to receive profile access.

I already said the first one, I see her meningitis, right? If you have nice, if you're close to the repersonal meningitis, you need to be pleased on rifampin or ciprofloxocin or septriaxal. rifampin is the preferred agent. If you're a close contact with a person with pertosis, like body teleportosis, you know, basically you have to take a microlette like a retromycin to sort of protect you there. Remember that the vaccines, you know, kind of wings after a while. So you know, every thing is like five to 10 years or something like that. You try to get like a booster, like a booster de-tap vaccine. And I think that's all I'm going to say about where the teleportosis, right? So the next bug I'll talk about, let's see, what else does that I'll lovely first did have here? So brucella. Again, this is another zoonotic thing, there's really no more you need to know about here. But the big thing you want to know about this is, it has an association like the, you know, like Texas, California, Arizona, those are classic areas. And the big thing you want to remember is that it's associated with like dairy products, right? So like, let's say like, umpastras, like like milk, umpastras, like cow products, um, think about brucellosis with that. Or you can talk about like a person that works in, I think, you know, JD, call it an abattoir. Like basically, we're placed with a kill like cows and stuff, right? Or goats.

Um, sort of think of like, if you work like in a slaughterhouse, I guess that's the more appropriate US term. But if you see that, you know, think about, uh, think about brucellosis. And the classic disease causes is something called an unduland fever, right? The person who have like undulant, right? So undulant means he waxes and wins, waxes and wins. This is about tend to have like, you know, fever is like at a particular time of day. Usually it's like literally like in the evenings, they have like high fevers. They sort of feel like crap. They'll have like back pain. They'll have like joint pain. And many times their liver is get pretty big. And then they'll have like a lot of sweating. And if you sort of say like that, we're closer, like a ton of sweating, um, right up a quadrant pain, like big liver, joint pain, back pain. And then fevers that sort of show up at a specific time during the day, um, so like in the evenings, um, like high fevers, 100, 102, think about brucellosis. Um, and, um, really the way you, um, the way you treat is probably not high yield to know for exams, but I'll just say this and I just give you like a trick. If you're dealing with all these zoonotic infections and you don't know what to choose on an exam, just choose doxia cycling, but it's almost always a safe answer. Well, really the other trick means for brucellosis, I don't know very high. I'm not going to talk about it. And then I guess, let's see. So what does first aid have for us here?

Um, let's see, it was an ex-high yield mortgage talk about you talk about some of these curved rods. Um, let me talk about Campylobacter jijunai, right? So first aid, you want mentions here that it grows in 42, like at 42 degrees, right? That's kind of a high yield thing to know. So remember like Campylobacter, come fire, that's a high yield thing you want to know. Um, it's an oxidized positive bug, right? Um, and again, it's gram negative, it's kind of like a curved rod. And the thing is, Campylobacter actually shares some nice properties with a shigella, right? So shigella, right? You need like 10 and you get like a mass in a sin infection. Campylobacter, I mean, it's not 10, it's like in the hundreds, but you don't need many Campylobacter box, so that dancing in your, in your body to get into trouble. Um, you don't need many organisms, you can get infection that way. And the thing is, the classic exposure here is poultry, poultry, poultry, poultry, poultry, cattle, chickens, turkey, think about that with, um, with a Campylobacter, right? And the thing you want to know is that it can cause bloody diarrhea, okay? In fact, it's probably, it's the, if I'm not mistaken, this is the most common cause, very high yield. It's the most common, in most common infectious cause of bloody diarrhea in the US. And again, so bloody bloody diarrhea, think about Campylobacter. And then please don't forget the association of Guillem-Barré syndrome, right?

So, classically, that'll present as a symmetric ascending paralysis on exams. Um, um, people think that it's like a kind of like a mimicry sort of thing where, um, they're kind of like some, some antigens you're finding like Campylobacter, Gigionet, that kind of look like antigens you'll find around like a myelin. So when your body makes like antibodies and whatnot against those Campylobacter antigens, um, those antibodies kind of like cross-react with, um, with like some myelin proteins. And then you can basically have like a peripheral demylineating disease like, uh, like a Guillem-Barré syndrome. And again, symmetric ascending paralysis. Contrast that with botulism where you have like asymmetric descending flasad paralysis. And, um, again, really your treatment is like a fluoroquinolone, right? So like a retromycin. Uh, sorry, a macroidic like a retromycin, you can also give a fluoroquinolone that's fine. Just remember like EF, like two consecutive letters in the alphabet, every thromycin, uh, uh, uh, a fluoroquinolone, right? Every thromycin, again, macrolid, or fluoroquinolone. That should, uh, that should help with that. And to be honest, I think that's what I'm going to say about Campylobacter. And then, uh, this first deep page talks about H. Pylori. H. Pylori is super high yield, right? Uh, in fact, I think I mentioned this last time that it produces ures, right?

So by having that ures, um, it can basically, um, counter the acidic environment of the stomach, um, and remember that, um, H. Pylori steins positive with silver. Again, that's a very high yield thing to know. And it's one of those bugs that has the ability to cause cancer, right? So it can cause like stomach cancer. Um, I think they call it like a motoma. That's something you learn about in mythology, but it can cause like a more, more trauma. Basically, if you, if you treat the H. Pylori, the cancer can actually go away. Another classic bug I'll say that, um, you know, I guess it's in the domain of micro. That causes a lot of cancers is, um, EBV, right? So like Epstein bar virus, like, then the causes mono, it can cause like Nizofar and Jokarcinoma. Um, it can cause, um, what's the similar to logic malignancy? Um, come on, I think, brackets lymphoma, right? The 814 translocation, where you have like the starry sky appearance on, uh, on, on histology. Um, and EBV can also cause, um, you can cause many cancers, right? It can cause certain like leukemia and lymphomas. And then also don't forget, um, she's to sum a hematobia. Um, that can cause a cancer of the bladder, right? Uh, it can also cause a hemorrhagicistitis. Just one of those rare things you want to keep, uh, keep at the back of your mind. So back to Hpylori. So Hpylori, right, silver stain, produces, urease, right? And the transmission is fecal oral, right?

So, uh, you know, either wrong stuff and then you're getting to trouble, right? And the big thing you want to make causes, causes ulcers, right? It can cause like ulcers in the stomach, it can cause ulcers in the, the, right? It can cause peptic ulcer disease. And, um, really the way you treat, um, is with, um, uh, there's something called triple therapy. So it's like a combination of a microlete, um, oxysylene and, um, a PPI. So do I remember it? It's just remember the word cap, like C-A-P, right? So clarit thromizing is the microlete, the A-stance from oxysylene, and then the P-stance for PPI like homepursol. Does the zone work? You can try quadruple therapy, right? Quadruple therapy is like where you sort of throw in metronides all, you throw in a bismothosophilicelicelate. That's like, uh, that's like an ulceric protein agent. Um, uh, uh, uh, um, no bismothisid an ulceric protein agent. Well, bismoth helps with diarrhea. Let's just leave it at that. I see more about it in the GI from ecology, a podcast. You can go listen to that. And then the tetracycline and then a PPI like homepursol. That's a quadruple therapy. Usually try that if triple therapy, triple therapy doesn't work. And there are many ways you can actually diagnose H-bylory, right? So you can do like a urea-breath test. Um, you can check like serologies. Um, you can actually do like a biopsy of the GI tract like the Bodinum. You do like a silversteen, and you see those organisms.

Um, and really, I think that's all I should probably say about, uh, H-bylory. And again, remember it's urea-spositive, it's oxidative and again, it's the most common cause of peptic ulcer disease. Uh, most common infectious cause of peptic ulcer disease. And again, remember it can cause stomach cancers. So now, uh, let's see. So for states says, uh, another curved rod. So the Vibrio species, let's talk about those, right? The Vibrio species, there's really not much to learn about them. Uh, just remember that they love to grow in like alkaline media. Um, for step one, especially, just remember like the TCBS media, um, TCBS events like thio-sulfate and then like citrate and then like some bile throning and then like some salt sugar solution or something like that throning. Um, so Vibrio colorey loves to grow in a alkaline environment. I mean, there are, it tends to cause like the rice water diaria, right? So it usually will shop like as a USMLE question developing country, a ton of diaria. Um, you hear some stories of people losing up to like 18 liters of fluid in the day. That's a pretty bad. It's actually like life threatening. And really the way you treat, right, is with like oral rehydration therapy, right? Where you basically give, um, like a salt sugar solution. And your friends at the MBM, right? They love to integrate that with bio cameras. It's like, oh, it's a salt sugar solution work.

The thing is, remember us, uh, the way one mechanism by which glucose is reabsorbed in the GI tract, right? Is with the SGLT1 transporter, right? So like the sodium glucose links transporter. Um, so remember sodium is primarily an extracellular ion, right? So sodium flows down is gradient into the entire site. Um, glucose can go with it, right? So by giving a salt sugar solution, you basically encourage the activity of that transporter. Um, that transporter is actually not touched by the cholera toxin. Um, the cholera toxin tends to torch pretty much every other glucose or trans, every other like, um, like transport, like many transporters in the GI tract, but usually for the most part leaves those as sodium glucose, uh, linked transporters. And, um, the cholera toxin, right? I mean, you get cholera like fecalero spread like you consume like contaminated water. That's the classic presentation on tests. And the thing is the cholera toxin again. I hope by now you sort of realize that ADP ribosolation is just bad. It's not good for you in any way shape of form, right? I already talked about how the deuteria toxin um, ADP ribosolates elongation factor two that kills protein synthesis. I talked about, and that's exotoxin A. I talked about how so the monocerigenosa, ADP ribosolation, elongation factor two, um, kills protein synthesis. I talked about how the deuteria protosis ADP ribosolation of the inhibitory G protein, right? So like G so by, right?

And then by inhibiting that inhibitor, and then lecyclyrams while they're getting to trouble. Also the cholera toxin also works by ADP ribosolation, okay? And actually ADP ribosolates, uh, stimulatory G protein, okay? So again, you can see how your friends at the USMLE, right? Would love to integrate some very nice cell physiology or cell biology with micro. These are very nice dinky ways they can make those integrations and tests. So I'll encourage you to keep those things at the back of your mind. So um, so vibranol, again, ADP ribosolates like a stimulatory G protein. But the thing is when you remember a different one, like, uh, the same modification, we do different things to different proteins. It so happens that when you ADP ribosolates this uh, stimulatory G protein, you actually activate a deli-cyclyce and you increase cyclic AMP, right? And then by doing that, you have like a secretory diarrhea, right? So you dump a ton of chloride into your GI lumen and then water follows, right? So you have just bad, bad, bad, bad, bad diarrhea. And again, you need to give ORT, if not this patient will not survive. I mean, these people lose crap ton of uh, of uh, of fluid. So, um, what are the other high, and again, vibrio species, you can cover them with tetracycline. But the other vibrio species that you want to keep at the back of your mind, right?

So if a patient, for example, consumes oysters and they have like, like a watery diarrhea, you know, think about other vibrio species, especially like a vibrio-parachymolyticus. But vibrio-vonificus also presents the same way, right? So let's assume you expose like, like, like an aquarium or something like that, um, sort of think of those things. But vibrio-vonificus, the adetinocase, if a patient has liver disease like cirrhosis, we can get like a life-threatening vibrio, like basically if they have vibrio-vonificus, if you have vibrio-vonificus infection and you're serotic, you have like n-stitially red disease, you outcomes tend to be worse. That's kind of like the thing you want to keep at the back of your mind. But again, vibrio-parachymolyticus vibrio-vonificus don't forget your, your consuming oysters, shellfish, exposure to aquariums, bloody, bloody, bloody, blah, they tend to cause like a watery diarrhea. But again, vibrio species, you can cover them with uh, with tetracycline. So I think that's all I'm going to say about the vibrio species. So, um, while we're on that topic, let's see. Let me talk about, um, you know, some members of the I guess, entero-bacteriaeasea class. Those are kind of high up to no. So let's, yeah, let's talk about them. Let's sort of, because if you notice, I've sort of touched many of the upper parts of this first-aid diagram.

I've talked about my cirrhosis on Rhea, I've talked about my serum in Gididis, I've talked about more acylla-cataralis. I've not talked about each flu. I'll talk about that shortly. Um, but I've talked about Bordehtella, I've talked about Bracela, I've talked about Francisela, I haven't talked about Pastorella. I'll get to that in a bit. But I've talked about Cegin-Junai, I've talked about vibrio-colore, I've talked about each by Lord. So let me sort of like settle at this bottom part. I've got to talk about pseudomonas. Oh, of course a lot of bugs actually. I've talked about pseudomonas. So I guess sort of like the big bugs I still need to talk about. I need to talk about Himophilus influenza. I still need to talk about, so forgive me, I'm just trying to take stock of where I am right now. So I need to talk about each flu. And the Himophilus species, I need to talk about Shigella and Yersinia and Samonella and Prudius and Ecoli and Clipsiala. And Serecia, I mean Serecia, the big thing I want to know about is like red pigment. That's all I'm going to say about that. Okay, we still have a ways to go, but let's, you know, start one by one, right? So, interibacteria is here. There's probably like a big, big test you sort of want to begin to remember with the interibacteria. You want to be able to parse out those that are lactose fermenters and those that are lactose non fermenters. Okay, so lactose fermenters be basically grown something known as like a muconkey egar.

That's like the big thing you want to remember. So lactose fermenters, the big ones you probably want to remember, you want to remember like Ecoli and Clipsiala. Okay, and then your lactose non fermenters, the four big ones you want to remember, you want to remember your two SS, your one P and your one Y. So I think of it as like a spy, like having spies, right? So like two SS, one P and one Y, like your shegella, salmonella, and it so happens that those two things cause bloody diarrhea. So kind of nice to keep those to that's treating your mind and then proteos and then your senior. It's just to sort of confuse things a little, proteos and salmonella, they move so they are mortal and they produce a hydrogen sulfide. Contrast that with shegella and your senior, shegella and your senior, they don't move so they are non mortal and they actually do not produce a hydrogen sulfide. So it's just one of those way things you want to keep at the back of your, at the back of your mind. And the thing is your interior bacteria in general, they usually, many of these bugs cause uti's and one thing you want to keep at the back of your mind is that they have the ability to reduce like nitrate to nitrate, right? So it kind of makes sense, right? If you're preaching, you just spend uti in a patient, right? You sort of like check the urine, you do like a urinalysis, you check for something called like lucoside estuaries, you check to see if the urine is positive for nitrates.

That positivity for nitrates is because the members of the interior bacteria see it, class which again, cause a lot of uti's, the tend to reduce a nitrates to a nitrate, right? So it's one of those way things you want to keep at the back of your mind. And again, remember E coli has a capsule, right? So I want to remember that, remember that E coli is the second most common cause of meningitis in a in a neonate, right? Remember I gave you that genomonic in the last podcast. I said like group E strip can cause meningitis, the number one, full by E that's equivalent in number three is a list area. And then remember that E coli is the most common cause very high out is the most common cause of uti's in the US. I said that the second most common cause was what? I hope you are telling me staffs that prophetic, because remember it's a grand positive, coxide, it's a catalyst positive like other staff species, but it's coagulose negative and it's novel biosand resistant. Yep, it's novel biosand resistant. Okay, so again, I know micro is hard, but just, just make those repetitions. At some point, guess what? It will stick. You just need to make the repetitions and sort of know the classic scenarios that micro is presented. Micro is like a scenario heavy thing. Many people think that just, I mean, there's a lot to memorize and get mirrored. What if you can recognize the scenario? Usually you can, it basically tells you what the bulk is on an example.

That's why I keep saying, oh, this is the classic demographic. This is the classic we present on tests. So I guess let's sort of talk about some of these in terms of accuracy. I mean, obviously the highest yield one is equal, let's talk about them. So equal lie, again, the gram negative rods, right, the abacilite, gram negative bacilite, and the alactose fermenters. Right? Now equal lie, I would encourage you to never take a micro quiz or exam or the US ML Es. If you don't know as much as possible about equal lie, right, you're just asking for it if you do that. So why is equal lie important? Right? So what are some important things about equal lie? Right? So the thing is equal lie species tend to be like fac-o-tative anaerobic. Right? So they can use oxygen, they can live without oxygen, doesn't really matter. And again, the alactose fermenters, right? And it's mega, it's like floridly high, you know, that if you grow them on something called like EMB, I think it's EMB stands for like, I think like Eocene methylene blue for mom is taking. But on EMB agar, they tend to, they tend to have like this green, this sort of grass like a green as green colonies. Okay? If you see like, oh, question when you talk about green colonies, green on agar, think about a equal lie. And equal lie, right? There's many types of equal lie, right? There's like, there's like, enteropathogenic, enter hemorrhagic, enterinvasive, enterotoxigenic.

But I'm still like the big ones you want to know, eat egg and eat egg, right? Enterotoxigenic, equal lie, and enter hemorrhagic equal lie. And enter hemorrhagic, the work hemorrhagic is kind of scary already, right? Because there's lots and lots and lots of problems, especially bloody diarrhea that I'll get to that I'll get to in a second. So, um, equal lie, right? You tend to get them through, you know, like, you know, fecal or all transmission, um, many of them tend to ferment a sorbitol, doesn't that way? Again, there are just many weird things they love you to know and exempts about equal lie, right? And, um, I guess, let me just say some higher things about equal lie. And then maybe I'll begin to talk about some of the specific bugs, right? So, again, I already said it's the most common cause of UT Is in the US. In fact, like, cystitis, pylon arthritis, most common causes are equal lie. And the reason behind that is that, um, the half-pil lie that help them to attach to like, uh, uh, your othelium really well, right? So, your othelium, as like the traditional epithelium, that lines your, your G-U system, right? Um, and really, the way you treat those UT Is, you can give like a fluoroquine or like super-fluxusin, bloody, bloody, blah, um, you can give, uh, uh, back trim, right? So, trimethoprimsophomythoxysol, that works as well. But, let me just tell you this, for purposes of the USMLE, if a patient ever has pylon arthritis, right?

So, like a kidney infection, the drug you should always pick. 100% like, don't, don't think twice, don't pass, we don't collect 200 dollars. Go ahead and give that patient safe triaxle. That is the way you cover, you cover pylon arthritis. That is the only treatment, but in the real world and on USML Es. And then I already said that, um, uh, equal lie, right? Can cause, um, meningitis in a new unit. It's like the second most common cause of meningitis in units. Um, and then, uh, really like many GI infections, right? That caused by equal lie because remember, it's part of your normal GI flora. So, uh, another high yield thing to know about the equal lie species, right? I'd like the, you know, the GI infections. Because again, it's part of your native GI flora, right? So, uh, I guess let me sort of talk about some high yield things with like the gastroenteritis that can accompany equal lie, right? So, for example, uh, if you're thinking about it, right? Interotoxygenic equal lie, um, uh, that's the, um, that's the most common cause of like travelers diarrhea, right? So, classically, you, you return from a foreign country and then you have like a nasty watered area, I mean, some people call it a Montezuma's revenge, uh, think about it, right? And you definitely want to know the, the toxins, right? They'll go with it, right? So, there's like the heat libel toxin, the heat stable toxin. And you want to know how those toxins work, right?

So, um, there's a nice no warning that you've probably heard, like a libel as the air and stable as the ground, right? So, the heat libel toxin, right? libel as the air, air, air, right? It actually, it's a click AMP. I mean, I didn't eat cyclists and then stable as the ground, right? The heat stable toxin activates a one-year cyclist, okay? And again, by doing those, you basically have, um, uh, you have like a nasty, nasty, nasty, nasty, uh, nasty diarrhea. Um, and then there is interrohimorragic equal line, right? So, it causes watered area, ehec, right? So, that's like the one that's called like O1577, because it's a bloody diarrhea. Um, sometimes they call it like sugar toxin producing a equal line, right? Um, usually these people, they'll have just nasty bloody diarrhea, right? And they won't have any fevers, um, but they just have just nasty, nasty, nasty, nasty bloody diarrhea. And the thing is the toxin basically messes up with like the, because I mean, it's obviously too curious that it's affecting, remember, you carry it's have like an ADS ribosome that's made up of the, made up of the 60s and the 40s. I talk about those in the self-hesiology podcast, but, um, I mean, self-balancing podcast, uh, but the, uh, toxin from ehec, sort of messes with the 60s ribosome subunit in Eukaryotes, right? And remember that one classic thing that can arise with ehec is like a hemolic uremic syndrome, right?

So, um, it's like where people have like a hemolic anemia, uh, thrombocytopenia, like renophilia, right? Um, hemolic anemia, those are things that I'll probably discuss in a future um, hematology podcast. And really for ehec, um, they will try to trick you on exams by getting you to give those kids antibiotics, you actually don't, because when you give antibiotics, you kill off the bug, but as you kill off the bug, guess what spills into circulation? That's toxin. And that toxin is what mediates a lot of the damage, right? So, actually taking antibiotics may actually worsen infection. So, I'm talking about, you don't give antibiotics for ehec, it's just one of those again, where things you want to keep, uh, where things you want to keep at the, at the back of your mind. And then, um, so again, it's the other thing I want to say about Eukaryotes, I, you know, I can't leave it at that. That's all I'll say. So, let's talk about clipcella, right? So, clipcella, um, again, it's back from part of this inter-bacteria-seed business. Remember, clipcella has a capsule. I remember I mentioned in the last podcast. Things that have a capsule E coli, clipcella, strep pneumo, right? Grobistrip, so the monocerigenosa, remember, crypto-cocostinial formants, it's that, what is it called? It's that, it's that thing that causes meningitis, India, in stain, in HIV patients. Yeah, those are the big, big, big things. Grobistrip, strep, regalacty, nicermin, in jiditis also has a capsule.

Hemophlos influenza also has a capsule. And then, don't forget your spore-forming organisms, right? Again, I'm making all these repetitions. You just help you remember, right? Your spore-forming organisms, you want to think about things like, like coxila bonediye, um, the causes Q fever. You also want to think about, um, come on, divide what else? Um, you know, close-stream species and your bacilla species, right? Those are the big things you want to remember. So, back to the rule. Let's talk about clipcella, right? So, clipcella, um, big things you want to know about this is, uh, it causes pneumonia, right? And the pneumonia, right, is, uh, with a corangelly spure. That's like the classic bosoids. Basically, like cough mixed with, uh, blood, right? That's why it's called, like, corent, uh, jelly spure. Um, and classically, it's usually a patient that has, like, some condition that makes them uptundate, right? So, like an alcoholic. Um, in fact, let's put it this way. Um, if you see an alcoholic with the red corangelly spure, one example, think about, think about a clipcella, think about clipcella pneumonia with that. Remember, it has a capsule, right? Um, and because it's a lactose fermenter, right? It grows on, uh, it grows on maconkey, um, aconkey, um, egg, uh, and the thing is, um, one thing that messes, one thing that messes with people on the example is they may say, oh, divine.

But alcoholics, they can also aspirate, get like an aspiration pneumonia, that, um, so how do I differentiate between clipcella as the cause of pneumonia and alcoholic, and then an Arab as the cause of a pneumonia and an alcoholic? Here's the trick you should use. If you mentioned that the sputum is foul smelling, go to an anaerobic, okay? But if the sputum is not foul smelling, then think about, uh, think about a clipcella, okay? Basically, if a patient has like alcoholic, red corangelly sputum, think about a clipcella, think about clipcella with that. And really, the way three clipscella is you can give like safe tracks on, you know, give like a fed generation syphilosporing, that covers clipcella pretty well, uh, for the most part. And then shigella is no more than I'm going to see here, cause it's a nasty bloody diarrhea. But remember, it's non-motel, and it does not produce a hydrogen sulfide. It's one of those weird things you want to know. Excuse me. So non-motel does not produce hydrogen sulfide, causes a bloody diarrhea, okay? Um, again, it's a gram negative bacilli, um, it's spread through the fecalurera out. You don't need much, you know, like 10 organisms that you're screwed. Um, and it's not a lactose fermenter, right? On like E. coli and clipcella, it is not a lactose fermenter. So it does not grow on, uh, doesn't grow on maconkey, um, eager. And the thing is, shigella is actually kind of like sneaky, right?

So the thing is, it makes like, uh, uh, basically when it invades like your cells, um, in fact, it tends to invade like, uh, some immune-like cells, like you find in the genitriarch, when it invades your cells, it actually doesn't get out of a cell. It's sort of like, uses like, almost like the actinroquettes that you find with a posterior, to go from cell to cell, sort of like in a lateral fashion, so that it just never comes out of yourself. So it means it's just never sees it, right? So it's just one of those weird things you want to keep at the back of your mind. And again, just like the E. coli O157, he's seven toxin, the toxin that's made by, um, by shigella, sort of messes of the eukaryotic 60s, or a basomala subunit. And the classic way it presents on tests is that the patient will have like, you know, like a fever, 100, 101, um, sometimes it could be pretty high actually like 102. And then they'll have like abdominal pain. And the thing is, here's the, as like the progression you want to keep in mind, they have watery diarrhea first, and then be progressed to bloody diarrhea. So watery diarrhea first, and then bloody diarrhea, if you see that, you know, think about shigella, right? And usually it's like from, um, shigella like dysentery. There are many of these like shigella, sonia, bloody, bloody blood. But think about like dysentery from like a shigella, right? That's like the more common, uh, more common pathogen at least on tests.

And this you can give antibiotics for. In general, you try not to give antibiotics, right? You just, you know, replace your fluids, give them any electrolytes that they may be missing, um, because of the diarrhea. But this you can actually give antibiotics for, but for ehek, you never on, it, never give antibiotics on NB Ms for ehek, okay? But you can certainly do that for, um, for shigella, even if it's not advisable. Now, um, I know the thing for state mentions here, the talk about your sinia and terocolerica. Um, I mean, your sinia species, you don't think I'll say about your sinia is, um, I guess I can talk about your sinia and terocolerica. Um, it can cause like, you know, it can cause like a bloody diarrhea. Um, but the, the thing is the abdominal pin you get with your sinia and terocolerica, they call it like, uh, it sort of looks like appendicitis, right? So they can have like abdominal pin in the right lower quadrant, kind of like where you have appendicitis. That's why it's called like a pseudo appendicitis. And really, the association is like pork, like consume pork or like on past rice milk. And then you have like what could potentially be a bloody diarrhea. Sometimes it's watery, but usually an endgame is it's bloody. And you have like a regular quadrant being think about your sinia and terocolerica. I mean, there's also like your sinia pestis, but that's like super loyal. So I'm probably not going to talk much about that.

I mean, it causes like super high fivers. Um, I think this is the bug that causes like the bobonic plague. Um, I usually like if you're, um, if you're exposed like squirrels or like like some red dogs, um, yeah, or you're abiding by like fleas or something like that. That's how you can get the your sinia uh pestis. Um, I mean, it's super contagious. And basically if a patient is infected and then you insert and heal it from the patient, then you can get into trouble. Uh, yeah, I think this is what actually does what made it sort of goes through like respiratory droplets. And it's like the cause of the bobonic plague. Um, but it's like super on NBM is I'm not going to see more than that about your sinia pestis. And then proteus, right? So I've already talked about proteus, but again, proteus, there's not much you need to know about proteus, right? Big things you want to know about proteus, it can cause utis, but basically if they give you a question about a patient that has a uti and the urine has a super high pH, think about proteus, right? Because proteus expresses ures, right? So, um, you know, it can sort of split split up urea into like ammonia, so you can have like urine at a high pH. And the thing is it can also cause a certain kind of kidney stone. In fact, they call them like, through white stones or like staghorn calcula, if you may, that's a classic association with a proteus, right? And then it grows with a swarming motility on Egard. That's like a buzz freeze.

You want to be able to remember with, uh, with, uh, with a proteus, uh, proteus amirabilus. Um, and let me just put it this way. This is something that you likely not see on like a med school exam. Well, who knows? Who knows? Uh, your med school question, right? Maybe like evil and put this kind of thing. Not evil. Let's just say there are people like some weird questions. Let me not call people evil. That's not very nice. But, um, there's one weird thing I want to talk about the emission step one, especially the thing is there's this proteus species known as a proteus vulgaris. I mean, it causes utis and all that stuff. The thing is they're certain actually antigens from some strings of proteus vulgaris that can cross react with like rickets here, rickets side. Um, so that actually forms the basis of a test known as, um, I believe it's known as the will Felix test. So it's actually a test that you can use to identify like rickets, yeah, some rickets, yeah, organisms. Um, I'll probably talk about that in this podcast or in a different podcast. Although I think I've actually mentioned this in one of the bacterial case podcasts I had from like back in the day, if you sort of scroll down through through my, uh, through the website. So let's jump to Samonella, right? So Samonella, there is actually a decent chunk of high-yield stuff you want to know about Samonella, right? So again, it's part of the interior bacteria. It's a lactose non fermenter. I'll just get out of the way.

Unlike shegella that is non-multile, Samonella is multile, right? Um, and unlike shegella that does not produce hydrogen sulfide, Samonella does in fact produce a hydrogen sulfide. And the classic way Samonella presents some examples, right? You'll present a patient that has like fever, right? And they'll have like abdominal pain. And then they'll have like salmon colored lesions on the abdomen. The boss phrase for that is rural spots on the abdomen, but your friends at the NBME, they will, I can almost find that they will not put rural spots on the abdomen, bloody, bloody, bloody, bloody. Right? So, uh, just salmon colored lesions on the abdomen, fever abdominal pain, you know, think about a Samonella infection. And again, remember, it's a lactose non fermenter. And let me sort of bring in this association here, because I believe I said this yesterday when I was talking about stuff worries. I said that stuff worries is the most common cause of, of osteomyelitis. But I said that if you have a sickle cell patient, the most common cause of osteomyelitis, very high yield, the most common cause of osteomyelitis and the sickle cell patient is Samonella. So here's why. The thing is your stomach acid is awesome for destroying Samonella. But here's the problem. If a patient has sickle cell disease, right? We have all these sickle cells. Those sickle cells can obstruct like blood vessels that feed like your stomach, right?

And if you obstructing those blood vessels, the cells in your stomach, right? Like your parietal cells, for example, they may not work as well. They may not produce enough acid, right? And if you're not producing enough acid, guess what you won't be able to deal with very well. You won't be able to deal with Samonella, right? Again, this is kind of like a weak explanation, but there's actually some evidence of this in the literature. But so because you're not producing enough acid, you don't deal with that Samonella. So patients with sickle cell disease, especially susceptible to life threatening Samonella infections, especially like osteomyelitis with Samonella. Now, what are some high yield, I guess, things you want to know about Samonella. So one thing you want to know is that it can cause a bloody diarrhea, right? So, classically, bloody diarrhea after consuming like poultry. I know that's kind of like similar to what you find with Campilo Bacteria Junai. Well, think more about like chickens and things like that, like chicken or egg products. And you have like bloody diarrhea. Think about Samonella with that. And usually it's like, oh, you've just consumed food at like a large garden or something. And then you have like bloody diarrhea a few days after you have abdominal pain and fevers. Think about Samonella infection. And the thing is many times the Samonella sort of like invades your GI tracks, goes into the bloodstream.

So many, actually, many patients that have a Samonella, a bloody diarrhea, you can actually detect Samonella in their bloodstream. They have like blood cultures that are like positive for Samonella. And the thing is Samonella loves to cause hepato splenumegaly, right? So again, if they describe bloody diarrhea with like big liver, big spleen, think about, think about Samonella. Think about Samonella. Let's see, one of the things we don't want to say about Samonella. Again, don't forget like Samonella, typhee, right? That can cause typhoid fever, right? Again, the salmon collod lesions on the abdomen, fever, developing country. Think about Samonella typhoon. Really, the way you cover Samonella, you can cover Samonella with like a fluke in a lung or with a microlet. Okay? Any fluke in a lung, any microlet should be able to cover, should be able to cover Samonella. And then one of the bizarre thing I guess you want to keep in mind with Samonella is there's just thing that I want to talk about. What is it? If you're a petster owner, right? Or you deal with like turtles for some bizarre reason, you can also get a Samonella infection that way. So Samonella has like a weird exam as a general turtles. Okay? So just one of those weird things you want to keep at the back of your mind. Again, it causes bloody diarrhea. And really the way you can prevent someone, you know, just cook your food properly, right? Because improper food cooking is usually what is implicated in Samonella.

In fact, I can say that after Campino Bacteria, June 9, being like the most common infectious cause of bloody diarrhea in the US, Samonella is a closed second. Samonella is if I'm not mistaken, the second most common cause of blood, most second most common infectious cause of bloody diarrhea in the US, right? Because there's many other things that cause bloody diarrhea, like osrylic colitis, bloody, bloody, bloody blood. Well, those are not necessarily from infectious causes. So I think that's all I'm going to say about Samonella. Again, I already said it's mortal, mixed hydrogen sulfide. Yeah, I think I've said all the high-eof things I'd like to mention. So I guess let's jump to Himophlos, right? So, you know, why not? Himophlos species, right? There's probably just two big ones you want to know here, like H. Flue. Remember, again, H. Flue just not cause the flu. If you pick an answer that, oh, like what causes the flu heat, you choose H. Flue. After that, the examination, go home and cry, right? Like, say this in many podcasts, you just need to never get it wrong, got a test, right? That's kind of like bad for. So, H. Flue, remember before, it was a relatively common cause of epiglotyitis. Remember the thump sign on chest x-ray? It was a relatively common cause of epiglotyitis. But now there's a vaccine, right? There's like a conjugate vaccine. So, we don't get H. Flue anymore. But don't forget that non-typical H.

Flue is one of the most common causes of otitis media in the US. And again, the Himophlos species, you know, they're gram-negative rods. They are more like the, they are put on the this like cocoa basil right? So, like they're like short rods, if you may. And, um, key things you want to know about the Himophlos species, right? So, I don't know for some bizarre reason, they love to test this on exams. But they love growing on something known as, if you want to grow sort of growing your Himophlos species, they grow on, um, like chocolate, a guy that contains like something known as Himin, H-E-M-I-N, and N-E-D. I think the Himin is known as like factor X, and then the N-E-D is known as like factor V. So, they need factors X and V to grow, right? Um, um, and again, there's a vaccine against the Himophlos influenza type B. Remember, it's an encapsulated organism. And again, it's a conjugate, it's a conjugate, it's a conjugate vaccine. Now, here's one thing I want you to think about with H-Flo. If you see a COPD patient that has pneumonia, right? Like a big-time smoker with pneumonia, I really want you to think about H-Flo as the potential inciting agent. That is a relatively common scenario on, on the USM Ls. Um, so it has a capsule, um, and again, right? Because it, it's like a respiratory pathogen, if you may. Um, again, you want to deal with that IG problem, right? So, it should make sense that it has an IG protein, right?

So, remember I already said that strep pneumonia has IG proteinase, um, and I share my anxieties, and I share my gonorrhea, both have IG proteinase. Um, Himophlos influenza is another bug that has, um, that has an IG, has IG protein. So, again, he, uh, Himophlos influenza type B is definitely, uh, definitely vaccine, uh, preventable. So, again, if you see a big lotitis and like, child with no immunization, like an anti-vaxer kid, or again, immigrant with a non-vaccination, history, a big lotitis. Think about him, or Flo, uh, Himophlos influenza. Now, um, how do you treat Himophlos infections? Third-genresion, sephalosporia, so like seph traaxone, shudah, shudah, do the trick. Um, and again, conjugate vaccine. Notice I've repeated this fact like three, four times. It's super high you to know. It classically shows upon exams. And, um, I guess the other, maybe the last and I'll say about the Himophlos species, probably talk about like, Himophlos ducry, um, that's the thing that causes some shankroid. And remember, Himophlos ducry makes you cry, right? So, it causes like a pinless ulcer, right? The pin, if you're looking at the STI's pinful, I mean, sorry, it causes a pinful ulcer. The pinful uti, right? Um, Himophlos, Himophlos ducry, right? Mix you cry, and then HSV. HSV also causes a pinful ulcer, right? So, if you see a pinful shanker, think about H2 C, right? If you see a pinless shanker, think about syphilis, right? Treponema pallidum.

Um, and, uh, yeah, again, third-genresion, sephalosporia, and you should be good to go with Himophlos ducry. And again, you get that with, uh, sexual contact, right? So, have sex and you get H2 C. Okay, um, let's see. So, I think, uh, let's see, what have I not talked about in this first heat chart? Program negatives. So, I've talked about my Syria, talked about my reseller, talked about heat flu, talked about Bordetella, Pastorella, just think about this with like dogs, with dogs and cats, and especially cats, cat bites, um, think about Pastorella. I've talked about reseller, I've talked about Francicella, I've talked about Siji Junai, I've talked about V-colore, I've talked about H2 C by Laurie, I've talked about Shigella, your senior San Monella and Prudios, I've talked about Sudo Monas, I've talked about E. coli, hmm, I've talked about Klebsiella, I've talked about Serisha, the red pigment, hmm, I've talked about all these bugs, but I feel like there's some other weird bugs that may occasionally pop your head, I don't know, why do I have misgivings in my heart that I've not talked about some bugs?

Hmm, I've talked about Pastorella and cats, like cat bites, and really the way you cover that is like a Moxicillin clavolanica, it's like Augmentin, um, all the bugs I've not talked about, I've talked about anaerobes yesterday, sorry again I'm thinking I'll route out loud with this podcast, um, I've talked about the anaerobes, anaerobes above the diaphragm, you treat those with clindamycin, so like anaerobic, like pneumonia, gif clindamycin, usually that will present a fast malinsputem, and then anaerobes beneath the diaphragm, you give metronitisal, so like a GI infection, um, um, syphilis, syphilis is a good one, so let me, let's talk about syphilis, it's kind of a high urtuno, again, syphilis, those are your trapponimos species, right, and they're spirochitis, right, so they're spiro shaped, and the big, big, big bogger you want to know is trapponema paladum, right, um, and syphilis can be spreading many ways, right, so sexual contact is like the big one, but um, mom can also spread it to her baby, right, through like, you know, through like the placenta, right, um, and actually it's not just going through the birth canal, like in utero, equally, I mean sorry, uh, trapponema paladum can literally travel through the placenta to the baby, and that is, uh, it's not great, that can have a pretty devastating, um, consequences, and remember I said, primary syphilis tends to present with like, you know, the pinless shanker versus like hemophlos ducry or, um, HSV, um, so like, hair piece implants virus that tends to cause more of a pin-fuller, pin-fuller infection, and um, so there's like primary syphilis, and then there's like secondary syphilis, right, remember secondary syphilis are such a little russian, the palms and souls, I talked about that with the Kawasaki cars and the monica in the gram positive podcast, right, we're like, uh, Kawasaki avarice with hand-foot-mod

e disease, uh, ricketsary ketsai, um, secondary syphilis, and then Kawasaki's disease, those are problems where you can get a russian palms and souls, right, so secondary syphilis russian palms and souls, um, you can also get a condoloma lada, right, um, those are like skin-like growth syphurumae, um, and please, please, please, here's one thing I want to say, please do not confuse condoloma lada that you find in secondary syphilis with condoloma lada that you find in, um, in hbv, right, so the humana papiloba virus, right, um, and then tertiary syphilis, right, can cause like many problems, right, you can get like, um, uh, if you go to like neurology, there's something called like the markus gun popel, um, uh, there's something that you may see, um, sorry, not markus gun, the argyle rubber tin popel, but something I describe in my neurology podcast, or that would be like a five-day-minute electron, I'm not gonna do that right now, um, you can also I think the posterior columns, right, so the spinal cord like your dorsal columns, um, so you can get like tibis or salads with that, um, people can have like gummers in the central nervous system, um, that syphilis can also sort of like, you know, nuke your cardiovascular system, uh, those are kind of like high-yle things you want to know with tertiary, tertiary syphilis, but that's not all, right, that's syphilis is a very high-yled box, so there I guess, uh, some other high-yle things I just sort of talk about, right, so again, let's talk about, I guess like how you can test for syphilis, right, so again, obviously, the spirochitis, um, and actually one other thing I guess I'll mention with tertiary syphilis is like the aortaitis, right, so it can actually cause an euricaneurysm, because it can sort of infect the vis-a-visorum that you find, uh, uh, around the urine, remember the urine is a large blood vessel, right, so,

uh, it can infect the vis-a-visorum caused like an endadiritis, and uh, you can get into trouble with that, because if you kill the vis-a-visorum, you're not having enough blood supply to like the media, right, of the, of the uh, the aorta, right, then they're getting into trouble with that, but you sort of weaken the wall and get an aneurysm with that, but, uh, so again, primary syphilis, right, again, the painless shanker, um, it just spontaneously resolves if you do nothing, and really if a patient is like primary syphilis, here's the key thing you want to keep in mind, the way you detect like primary syphilis is with dark field microscopy, that is like the best test you can do, like, see, oh, within like a week or two, you want to detect syphilis, um, go ahead and do dark field microscopy, I want to be careful, don't say, ah, painless shanker, I'm just touching with my finger, uh, guess what, you're giving yourself syphilis that way, gotta be careful, gotta be careful, gotta be careful, um, that shanker is teaming with spirochetes, so again, wear gloves, just as a clinical prop, if you're ever seen a patient, always wear gloves, it doesn't matter, always wear gloves, uh, you don't want to take something else with you, uh, so you're going home, so dark field microscopy, probably like the best thing you can do under those circumstances, and you can trip up and sill in then, um, and then secondary syphilis, right, uh, you feel like, you know, like one to three months after like the primary infection, um, and again, you can get like the condiloma ladder, um, you're still infectious, um, under these circumstances, and I mean, there you can sort of begin to do like some serological tests, I'll talk about those, uh, talk about those in a second, because those are very high, you know, an intense to confuse a, a lot of the med students, and then after secondary syphilis,

you cannot really have like latent syphilis, latent syphilis has like, there are really no clinical features, there's really nothing that happens with a, the offensive syphilis, or your serologies will be positive, right, your serologies will definitely be positive, be positive, um, and then after that, you can get like tertiary syphilis, right, and tertiary syphilis is something that happens like, it can happen like months to years after, right, so it sort of happens after like latent syphilis, um, that's where you get the gomas, you can get the erotitis, you can get the argyle, robertine, pupel, um, you can get the tibis or salis, you can get all that stuff, and again, serology will be positive, right, um, and you see divine, you keep saying serology, serology, you know, let's sort of talk about this, so let's make a gradition, if a patient has primary syphilis and you want to detect it on exams, go for a dark field microscopy, if a patient has secondary syphilis, go for serologies, right, and the thing is usually serologies are not great in secondary syphilis, um, like, your serologies may be like sensitive, but they are not like super specific, right, but once the patient gets into tertiary syphilis, those serological tests are awesome, right, they are very good on that those circumstances.

In fact, um, um, um, those serologies, right, so they are sort of divided into two, right, so they are tests that are known as the trapponimo tests, and then the test that it known as the non-tripponimo tests, now here's the deal, the trapponimo tests are sensitive, sorry, the non-tripponimo tests, they are sensitive, but they are not specific for syphilis, so what are those non-tripponimo tests, basically those non-tripponimo tests, right, again, the name sort of gives away what it is, right, so it's a non-tripponimo test, so it's a test that is not involved with trapponimo pallidum, so let me just give a, like, some nice background here, so say, for example, trapponimo pallidum infects a cell, it infects that cell, destroys that cell, right, the thing is, as you are destroying that cell that has been infected with a T pallidum, some of the contents of that destroyed cell sort of spills into the circulation, right, those contents you can detect them in the serum, right, so those contents, those are the things that sort of make up the basis of the non-tripponimo test, right, well think about it, those tests, see, they're good, right, both they are not specific, because there are many other things besides T pallidum that can destroy cells, right, and those non-tripponimo tests, they have like fine-seen names like RPR, there's one called a VDRL, I think the VDRL is like venereal disease research lab, I think that's like, kind of like a lab that did research on like syphilis, so RPR VDRL, those are like, you know, you know, you know, you're not in trapponimo tests, they're sensitive, but they're not specific, in fact some people say they are not sensitive, more specific, but the test that's specific for syphilis for T pallidum are your trapponimo tests, your trapponimo tests have fine-seen names, the two big ones you want to remember for exams are FTA, ABS, and MHA, TPP,

so you can repeat it again, FTA, ABS, and FHA, and MHATP, right, so those tests, they are trapponimo tests, because you're literally making antibodies to T pallidum components, okay, that's why they are specific for T pallidum infection, and usually if you're trying to diagnose a patient with syphilis, first you do like the non-trapponimo test, right, and then after you do the non-trapponimo test, you confirm with a trapponimo test, right, so remember, for every screening test, there's something that pathoma repeated in these videos series so many times, for every screening test, there has to be a confirmatory test, right, and the screening test is really pretty sensitive, and then the confirmatory test is really more specific, right, so the non-trapponimo test, like RPRVDR, good screening test, but if you want to confirm, you do the trapponimo test, like the MHA TPP of the FTA ABS, and then one other thing I guess I'll sort of mention is like congenital syphilis, right, so remember congenital syphilis, again like I said, it can sort of cross the bloodstream, it can cause a lot of problems, I mean cross the bloodstreams are cause a lot of problems for the baby, right, so the classic presentation is a newborn with a lot of snuffles, right, so like a lot of rhinorrhea, usually put, there's like a classic picture that shows up on exams, just sort of Google syphilis newborn snuffles, you'll see what I need, those snuffles you don't want to touch them, guess what, they are teaming with a lot of spirochet, so you want to be careful there, and then there's some other things that you find in congenital syphilis, right, so like the Hodgian since teeth, so they'll have like sort of like notched a sheep to the teeth, they can have something called seabird shins, so they have like a frontal bone of like I think it's like the TB or something like that, if you sort of see those th

ings think about a congenital syphilis, so how do you treat syphilis, right, so syphilis you treat with penicillin, right, penicillin is the drug of choice for the treatment of syphilis, I mean they are like longer regimens that you use if the vision has like neuro syphilis or something like that, but yeah syphilis in general think about a penicillin, now one classic scenario that shows up on USMN disease, you'll talk about a pregnant woman that has syphilis, right, and they're like hmm, and they say oh this pregnant woman has like hypersensitivity reaction to syphilis to penicillin, you know like hmm, what's the next step in management and the otrido suggest give like a macrolid, because some macrolids actually cover syphilis believe they're not, like oh give a macrolid, give toxic cycling, bloody bloody blood, the thing is in pregnancy, the only drug you should ever use to treat syphilis is guess what penicillin, so if mom has a penicillin allergy, do you know what happens, you'll bring into the hospital, desensitizer to that penicillin and still give her that penicillin, okay, penicillin is the, is not the only drug that used to treat syphilis in pregnancy, it is floridly high yield to know that for example, and then one last thing I guess I will say about syphilis, right, so let's assume you know you start tripping for syphilis, and then you know you start to pinching like yeah I'm going to cure this person, right, and then they give you an example question and say that this person gets penicillin and then they become febrals, so they have like fevers and they become like hypotensive and they have like joint pain and the sort of issues don't feel well, think about something like the gyresh hexheimer reaction, right, gyresh is J-A-R-I-S-C-H, and then herxheimer is H-E-R-X-H-E-I-M-E-R, the gyresh hexheimer reaction, basically something that arises whenever you give

an antibiotic for syphilis, and also I guess for any like spirochidol infection, you can get this gyresh hexheimer reaction with that, okay, so again syphilis is a super super high yield bug, I would definitely know all these things I just mentioned, and then let's see what should I talk about, um, what are the bugs, I feel like this podcast has gone on for a long, this is 95 minutes, but I still keep thinking that they're high yield things I've not talked about, let's see, oh, chlamydia, chlamydia is high yield, okay, so let me talk about chlamydia, so chlamydia, right, so, hmm, which way start?

chlamydia doesn't graham's stain, that's a good start, um, the way you see chlamydia is with something called the ginsus stain, in fact that ginsus stain can also help you identify like um, tripanosomes, right, that cause like malaria and stuff, um, no, wait, yeah, tripanos, like tripanosomes, um, that cause like sleeping sickness, um, um, ricette, wait, what are the things that I identify with ginsus stain, I know chlamydia is one of them, I believe ricette here is another, but really I think also can be identified with the ginsus stain if I'm not mistaken, uh, you guys listening to this, just look me up on that, but I'm almost starting that is correct, and tripanosomes as well, I believe I also identified with the ginsus stain, so, um, let's talk about chlamydia, right, so chlamydia kind of high yield to know about, right, unfortunately, um, so what are some higher things to know, right, so stains with the ginsus stain, can't see it on gram stain, and the thing is chlamydia species in general have like two components, there is something called like an elementary body, and there is something called like a articulate body, it's just one of those weird things you sort of want to keep at the back of your mind, and they are like obligating tracelola organisms, right, so classicly on exams, they describe a patient that has like an STI, and then they say that oh, they do a grams, or even a UTI, and they say they do a gram stain, I'm like man, I'm not seeing them gram stain, if you see that, basically stop reading the question, they try to get you to think about chlamydia, that's the classic way it presents on, it presents on exams, now there are many kinds of chlamydia you want to know about for tests, so the first one is like chlamydia tracometis, chlamydia tracometis, chlamydia tracometis, the big things you want to know here is again obligating tracelola bug, remember I

talked about like that elementary body and that reticulate body, the thing is you can have a form that basically does not replicate, bodies like the form that infects cells, that is the elementary body, the reticulate body, think of the R in reticulate for the R in replication, that is the chlamydia kind that sort of like replicates, that's kind of like a nice way to sort of remember that, and chlamydia tracometis, so there are like multiple cerevar types, so there's like the A through C cerevars, there's the D through C cerevars, and then there's the L1, L2, L3 cerevars, so let's talk about those cerevars one by one, so the A through C cerevars, the tend to cause tracoma, right, the cause tracoma, tracoma, right, classically think about this with you know like newborn conjunctivitis, right, and actually this conjunctivitis you want to treat because it can actually be like life threatening and cause blindness, I guess normally you can basically make the newborn blind, which is obviously not an ideal outcome, right, and for that you tend to give, so if you notice I said for my cereal, gonorrhea, conjunctivitis you give like topical microlystic, like topical erythromycin like ointment, or I drop for that, that will not work in chlamydia, for chlamydia actually you have to give systemic antibiotics, you give like oral macrolates, it's just that you probably want to avoid like giving like oral erythromycin, it's really to a newborn because it's an associated with an increased risk of something called pyloric stenosis, you learn that in like gastroenterology, so the A through C cerevars because basically like conjunctivitis, right, in fact this is probably like the leading cause of like preventable like blindness, it's really like developing in developing countries, chlamydia tracomandis, the A through C cerevars, and then if you're thinking about chlamydia and ST Is, thin

k about the D through C cerevars, in fact these are probably like the most common bacterial causes of ST Is in the US, notice I said bacterial causes, right, I didn't say like all cause, right, remember herpes, HPV, they're relatively common ST Is, but those are viral, right, versus chlamydia that's that's a bacteria, and again, basically anything you can get with an acere, you can get with chlamydia, right, so like you can get like your arthritis, you can get pelvic inflammatory disease, all those things can arise with chlamydia, and the thing is, here's when we don't try to trick you on exams, right, the thing is chlamydia can cause many neonatal problems, I said he can cause like neonatal like conjunctivitis, right, where those are the A through C cerevars, you may be careful, the D through C cerevars, if mom has like an STI, and baby crosses the vagina, the birth canal, and picks up those D through C cerevars, those babies can actually get like life threatening like newborn sepsis, and pneumonia, and classically that pneumonia is a sort of something called the staccato cough, I'll encourage you to look at videos of that, the staccato cough, that's classic with, in fact if you see the Bosworth staccato cough, don't bother reading the rest of the question, it's a chlamydia, pneumonia, end of story, so the D through C cerevars, and the things that cause that pneumonia, the A through C cerevars cause the conjunctivitis, and then the L1 through three cerevars cause something called lympho-granolumavenirium, so I feel like I should maybe take a small sidebar and talk about some STI's here, so you don't mix them up on your test, right, so lympho-granolumavenirium is caused by the L1 through L3 cerevars of chlamydia tracomytus, right, so it basically causes like, very, like, think of it as like, they call them like bubbles, like big lymph nodes on the genitals, so don't con

fuse chlamydia tracomytus, L1 through L3 cerevars causing lympho-granolumavenirium with this bug, it's actually a subtype of clapsialis, called clapsialagranolomatis, it causes something called granoloma inguinali, okay, and then also don't confuse that with shankroid, that is caused by hemoflose ducryte, remember that's like the painful shanker, hemoflose ducryte mix ucryte, so how do you make it that diagnosis of chlamydia, right, I mean you can do a gram stain but no one really does that, I mean you can do the gram stain, you don't see anything but no one really does that in the real world, the thing that's done these days are you can do like the game's stain but I'll say probably most common on exams is to do like a nucleic acid amplification test, right, so you just do PCR, you can identify that pretty quickly, and really the way you treat chlamydia is you give easy thromice and macrolid or doxycycline, right, just remember like Anthony Davis, the guy that I'm really praying that somehow gets attrided to the leakers without us giving up too much, so just remember A, D, Anthony Davis, now help you remember what covers a chlamydia, right, so the A for easy thromising and then the D for a D for doxycycline, and again remember, of thalmia, you're not room with niaceregonorrhea, you do a topical erythromycin but conjunctivitis from chlamydia, you need to give systemic antibiotics, and then one of the weird thing is, come on divine, thank you just came to mind, when I was talking about this thing when he came to mind, yes, so I already mentioned before that if a patient has like a niacerele infection, you go ahead and give like niaceregonorrhea, you give septraxone cover the niacere, and then you empirically cover chlamydia with like is ethromycinodoxycycline?

Now, if you detect chlamydiale infection, you do not empirically cover niacere, so if you detect chlamydia, all you need to do is is ethromycinodoxycycline, no, though, come on sensing to do is to detect a niacere, but you do not do, I mean, is to check for niacere as well, but the empiric treatment guideline that I see if you have like oh niaceregonorrhea, give septraxone and is ethromycinodoxycycline? You don't do that with chlamydia, if you detect chlamydia, you give only is ethromycinodoxycycline, pending testing for niacere, if you don't see niacere, you don't have to empirically cover niacere, that's basically what I'm saying, and I guess there are actually more chlamydia species, right? So, there's like, there's a chlamidofela pneumonia, right? So, remember chlamidofela pneumonia causes pneumonia, it causes like a walking pneumonia, it's like an itibic pneumonia, right? So, you see like, an intestinal infiltrates on chest x-ray, and really you can cover that with a macrolite, right? And there's kind of like a nice pneumonia cure that helps you remember that macrolite covers the itibic pneumonia, right? Because think about it, the most common cause of itibic pneumonia is microplasma. The second most common cause I believe is chlamidofela pneumonia, and then the third most common cause is ligenella, right?

So, MCL, and it so happens that if you spell out the word macrolite, and M is the first letter, a C is one of the other letters, and then an L is like the final letter in that MCL series. So, that helps you remember that macrolites, I used to cover like the typical pneumonia-cosina organisms, and then last one I'll mention you don't forget chlamidofela, sydiccy, right? So, it causes sydicosis, so basically if you have like a pet part, for example, and then or you're like a pet store owner and you have like pneumonia, you really want to think about chlamidofela sydiccy, okay? Sydicosis, and really you cover that with like a tetracycline, like doxycycline, for example, right? So, bird exposure pneumonia, think about chlamidofela sydiccy, they are other like weird things with birds, but that's not appropriate for a gram-negative podcast, those are more like for like endemic like fungi, like histoplasma and all that fun stuff, so that's a different podcast, not this one. So, parrots, think about chlamidofela sydiccy, remember the pain parrots for the pain sydiccy? So, I think that's all I'll say about chlamydia. I guess I can talk about Lyme disease, yeah, for those of you listening to this podcast, I'm so sorry, I apologize, not my intention to make this thing run long, but I promise you all these things I'm talking about, they are mega, mega, mega high-eal for exams. Lyme disease, I guess there's some things you need to know there, remember that Lyme disease, right?

It's caused by Boralia Baudofri, right? Remember that's another spirochet, kind of like, kind of like a trapeonema paleda, Boralia Baudofri is a spirochet, and remember that it's carried by the exodistic, right? And it's floridly high yield, for example, remember that the exodistic carries other things, right? So, it carries Boralia Baudofri, it carries an aplasma, right? So, the thing that causes an aplasmaosis is carried by that by the exodistic, I know there's one more thing, Babisiosis, Babisiosis, Babisiosis, also carries a Babisiumicrodi, remember that thing that causes like motis cross on a red blood cells on a blood smear, just leave it there, that's a parasite, okay? But Boralia Baudofri, Lyme disease, right? And Lyme disease, big things you want to know, right? There's like stage ones, stage two, stage three, right? And don't forget the geographical association, right? So, like New England, right? So, Connecticut, New York, New Hampshire, and all, Maryland, Massachusetts, whatever, like the New England area, right? That's where, that's like the classic, so if they give you like Texas, you probably shouldn't be picking Lyme disease on your exam, and then there are many stages, right?

Like, there's stage one, where like they have like the Bows Eyewash, that picture, look it up, classic thing that shows up on tests, and then stage two, basically the organisms sort of, you know, kind of spreads in the blood, those people tend to have, you know, like, you know, like, chills, fevers, kind of like flu-like illness, a lot of muscle and joint pain, those are like very prominent symptoms, like the throges and all that stuff, and then stage three, that's where they begin to have like exotic stuff happen, right? So, they can have like Lyme carditis, right? So, they can have like Lyme disease affecting the heart, they can have like Bels Paulsy, right? So, if they have like, like a criniol seven issue, right? Those things sort of are rising, the setting of like a stage three Lyme disease, and let me see this, because this is super high you to know for example, in general Lyme disease, you treat it with doxycycline, okay? You treat Lyme disease with doxycycline with two exceptions. If a patient has Lyme disease that involves their brain or involves their heart, you treat with septriaxone, that is a very classic, floridly high-old detail to know for exams. Every other form of Lyme disease, doxycycline, that's fine, no one cares, but I guess you should cure your physician, but if you have like Lyme disease of the heart, Lyme disease of the nervous system like Lyme meningitis, pull out your septriaxone.

Now, special word on doxycycline, the thing is doxycycline is a great drug, right? But if a kid is less than eight years old and we have Lyme disease on an exam like, they have the bulls eye rush and they are less than eight years you do not give them doxycycline, the drug you give is erythromycin, okay? Erythromycin, actually it's not erythromycin, sorry it's amoxicillin, you give amoxicillin. If a kid is less than eight years old, you do not give them a tetracycline like doxycycline because you can have like two discoloration and all that stuff, okay? If a woman is also pregnant and she has Lyme disease, again, you also do not want to give doxycycline, so again doxycycline is heterogeneous, so you go for amoxicillin under those circumstances. So, I think that's all I'm going to say about a Lyme disease. Let's see, I mean like leptosperosis, so like leptosparine terrogens, the boss-freezoes associated with this is like Hawaii, you know, Hawaii, assuming like bodies of water that has like like rodent infested urine, and because it's a spirochet, you can also detect it with like dark field microscopy, I think that's what I'm going to say about like to leptosparine terrogens, I mean, rickets here, ricketsai, I mean ricketsai is kind of high, so let's let's talk about it real quick. Right, so ricketsia is actually carried by the, by the dermacentritic, there's another bogey mentioned already that is carried by the dermacentritic. What is it?

I talked about it earlier, is it brussella? Dermacentritic, dermacentritic, huh, talked about this. What is it? Dermacentritic, dermacentritic, I'm almost certain is brussella, almost certain is brussella, again, apologize, it's just occasionally hard to keep, keep all these things straight in a person's head. Dermacentritic, dermacentritic, huh, oh it's not brussella, talked about the dermacentritic in the context of rabbits, so that has to be francella, yep, so apologize, scratch that. So dermacentritic, carries francella, tolerance, and carries ricketsia ricketsai. So I guess a nice way to remember that is just remember france, like the shutting form of france, like fr, the f of francella, and then the r for ricketsia ricketsai, or you can just remember like father, like the first and the last letter in the word father, f of francella, r for ricketsia ricketsai. If I can really go to try hard to keep this podcast to only two hours, so I guess I have a seven minutes wish to play with at this point.

But yes, ricketsia ricketsai causes a rocky mountain spotted fever, it's actually pretty bad, and actually one thing I forgot to mention, right, if a patient has nice sereninjitis, right, I already said it gives a fracture, so the thing is you don't sit on meningitis, just as a clinical pro, if a patient has meningitis, you need to treat them, if you don't treat them, they will likely be dead within 24 hours, okay, so you don't you don't scroll meningitis, even if you're not, just go ahead and treat, you can treat first ask questions later, okay, so ricketsia ricketsai, right, again, it's carried by the dermacentr, dermacentr, tick, and they are certain, I guess, like geographical areas, you should sort of keep at the back of your mind, basically like like Oklahoma, Tennessee, the Carolinas, right, so like North Carolina, South Carolina, sort of think of that with a rocky mountain spotted fever, and these people, right, rocky mountain spotted fever, right, they'll have like a super, super high fever, like fever is 102, 103, right, and then don't forget the rash is on the palms and sores, okay, the palms and sores, palms and sores, palms and sores, and the thing is the rash sort of spreads from, like spreads from the outward end, right, so you know, it sort of starts on the wrists, and then sort of spreads to the trunk, okay, and then again, remember, rash on the palms and sores, right, remember secondary syphilis, and also koksaki, e-virus with that, right, and the thing is, it's like mega high you to know that people that have rickets here, rickets are usually on the exams, they have like a rash, and that rash is a particular rash, okay, so that particular rash, again, you sort of see like red dots on the present skin, if you see that, think about a rickets here, rickets like, and the thing is, oh, this was white the whole, like, oh, if a person has been in joy, he's

don't mess around, same deal with rocky mountains spotted fever, you don't mess around with rocky mountain spotted fever, if a patient has rocky mountains spotted fever and you don't treat it quickly, it's rapidly fetal, the mortality is almost like, it's like 100% if it's not treated, okay, so treat first ask questions later, okay, and the treatment of choices, doxycycline, and this is where you also have to be careful for the USML Es, remember I just said that tetracycline is not given to kids that are less than 8 years old, right, I did, here's the deal, in rocky mountain spotted fever, if a kid is less than 8 years old, you still give them doxycycline, doxycycline is the drug of choice for the treatment of rocky mountain spotted fever at any age, the only exception is an appregnant woman, an appregnant woman, you probably don't want to give doxycycline, the drug of choice for the treatment of rocky mountain spotted fever in an appregnant female is chloramphenicol, in fact, this is probably the only indication for chloramphenicol on any USMLE exam you will ever take, okay, so it's one of those high or bizarre things you want to know at the back of your mind, right, and again don't forget that willphilic's test, I talked about detecting like proteos vulgarissa antigens, we get here, we get size is a willphilic's positive, again no one uses in the real world, but it may not be common in the real world, but it's very common on USMLE exams, and I mean I guess I can see like a few words about early cure, chaffyenses, serliciosis, erlicia, ginsestane, that's how you can detect it, like many of these words are nodic organisms you can consider a doxycycline, and sort of think of it as like rocky mountain spotted fever light in a sense, right, so they generally won't have like a rash, but they'll have like the fever, but they tend to have hematologic abnormalities, right, s

o they'll have like low pleatleus, right, so they'll have like thrombusidopenia, they'll have like a low icon, they'll have like lucopenia, if you sort of see that cluster think about them early cuses, and again your coverage is with with with a doxycycline, and then don't forget like your microplasma and walking pneumonia is the most common cause of walking pneumonia, I remember, right, it doesn't really have a cell wall, right, it actually sort of you sort of nickelester of weight to grow, right, it's like the smallest possible organism, and it's associated with like corda glutinine disease, like IgM antibodies, that's something you learn in like rheumatology, and again it's the most common cause of walking pneumonia, and you can cover it with macrolid, um, and I think that's all I'm gonna say, um, I'm just trying to think, is there any other high-yield bulgur I have not talked about, I just want to be relatively thorough with this, so that if you listen to this, you literally feel like a gram-negative ninja, something like that, um, I mean bacterial vaginosis can be called by gallerino vaginalis, remember like the fishy order from the vagina, um, and the vaginal pH will be, um, it'll be greater than 4.5, if I treat that metronidous, um, yeah that's all I'm gonna say, so um, that'll be for gram-negatives, I'm writing talk about TB, but TB, I believe I've talked about it, and actually I've talked about it in a different podcast, but it's an order podcast, if you sort of scroll down through my website, but I think this is where I'm gonna stop, so I wish all the very best, um, will you find this to be helpful and high-yield?

Um, and again, as I said at the end of every podcast, I offer tutoring for many exams, right, so um, certain portions of the MCAT, step one, step two, step three, and step two, include step two, see a step two, ck, and then the medicine-infraining exam, and then the ABIM internal medicine board exams, I've offered tutoring for those, um, and then I have experience as an admissions committee member, so I do actually prepare AMACAS applications for people trying to get into med school, and Iroh's applications for people trying to get into um, residency, right, like personal statements, application preparation, mocking reviews and all that stuff, I prepare people for all those states, and then, um, especially if you're an international medical graduate, I certainly can render a lot of help, I have helped tons of international medical graduates, um, tutor, prepared applications, and all that stuff, so if anyone in those uh, situations, please tell them to reach out to me, so I wish all the best, have a wonderful rest of the day, and I hope the leakers win today, so God bless, I'll see you in the next podcast, thank you.

N. meningitidis is a high-yield respiratory pathogen causing meningitis; N. gonorrhoeae is primarily associated with genital tract infections.

Treponema pallidum.

Smoker, elderly patient, and exposure to air conditioning/waterfalls/business conferences.

Salmonella species (or Campylobacter jejuni, both are high yield).

High fever, rash starting on the wrists/ankles and spreading centrally, and exposure to tick bites in endemic areas.

Piperacillin-tazobactam, third-generation cephalosporins (e.g., Ceftriaxone), carbapenems, and aminoglycosides.

Greenish/metallic sheen colonies.

Shigella dysenteriae or Salmonella species (or other Shigella/Enterobacteriaceae).

Escherichia coli; it has a capsule.

Legionella pneumophila.

Rifampin (or Ciprofloxacin/Ceftriaxone).

Chlamydia trachomatis.

ETEC causes watery diarrhea via toxin activation of adenylate cyclase; STEC (O157) causes bloody diarrhea and can lead to HUS.

Greenish/metallic sheen colonies.

Shigella dysenteriae or Salmonella species (or other Shigella/Enterobacteriaceae).

Escherichia coli; it has a capsule.

Legionella pneumophila.

Rifampin (or Ciprofloxacin/Ceftriaxone).

Chlamydia trachomatis.

ETEC causes watery diarrhea via toxin activation of adenylate cyclase; STEC (O157) causes bloody diarrhea and can lead to HUS.