WEBVTT

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Hi, my name is Andrew Berg.

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I'm one of the creators of SketchyMicro

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and I'll be guiding you through
this chapter on Staph and Strep.

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In this video, we'll be bold

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and dive right into perhaps
one of the most important bacteria

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you'll learn from Microbiology,

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Staph aureus.

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She's a beast.

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If you make it through this video

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I promise it will only get easier.

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The name Staphylococcus aureus
tells a decent amount right up front.

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Staph and coccus come from the Greek
meaning grape and granule respectively.

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And this is because,
under the microscope,
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staphylococci looks like
a bundle of grapes.

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Now aureus is Latin.

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And it means golden.

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And this is because when it grows
on blood agar,

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its colonies have a yellow
or golden appearance to them.

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So it took this idea of it being
a golden staphylococcus

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or golden staph.

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We've called this scene
The Golden Staff of Moses.

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I hope you enjoyed it.

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Now I'll start by drawing this
desert background.

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You'll notice I've gotten
really fast at drawing.

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Yeah, you know.
I guess it's just practice.

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What can I say?
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Anyway.

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Here's Moses. He's carrying
a very impressive golden staff.

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The golden staff of staph aureus.

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Notice his robes are violet.

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We did this because staph aureus
is gram-positive.

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And gram-positives take up
crystal violet stain

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in their thick cell wall

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and hold on to it even after the rinse

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and the addition of red safranin

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so they appear violet
under the microscope.

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We'll tend to use a lot of violets
in the gram-positive videos.

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And likewise, we'll use red
in the gram-negative videos.

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Let's keep talking about
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how exactly we can identify
staph aureus in the lab.

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So far, we've gone over that
they're gram-positive cocci.

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But so are strep.

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So how are you going to tell them apart
besides their shape?

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The first test you'll use
is the catalase test.

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Catalase converts hydrogen peroxide
to water.

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And is present in all staphylococci
but not strep.

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Since staph is catalase-positive,

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we'll add this cat
standing for catalase.

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You'll notice you won't see
a cat in the strep videos

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or any catalase-negative videos.

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We've placed him right here,
front and center,

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and we've even made him look cool
and Egyptian looking

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so that you don't forget about him.

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So if it's gram-positive
and catalase-positive,

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we're pretty certain we're dealing
with the staph.

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Now how do we know it's staph aureus

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versus a different kind of staph?

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Well first, staph aureus has that
nice golden color when plating.

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But alternatively, you can run
a coagulase test.

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Coagulase is an enzyme that converts
fibrinogen to fibrin.

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And it's present in staph aureus.

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Notice, Moses is standing in front
of the Red Sea.

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Literally, a sea colored red.

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It's red because it's supposed
to remind you of blood.

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And his parting of the red sea
is him actually coagulating it.

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So again,

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this will remind you that staph aureus
is coagulase-positive.

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Another way to differentiate

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Staph aureus from other types of staph

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is that it's beta-hemolytic.

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We'll have Moses carrying this
bright red light bulb

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with a B inside of it.

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This is our symbol

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that we'll always use
for beta-hemolysis.

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We've designed it to look like
a red light bulb

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because when looking at a Petri dish
showing beta-hemolysis,

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it looks kind of like
a glowing halo of light

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on a red backdrop.

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We're trying to convey that here.

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The last where to know you're
dealing with a staph aureus

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is to plate it on Mannitol salt agar.

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The salt selects for only
staphylococcus species.

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And you can also differentiate
whether or not

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it can ferment Mannitol.

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If it can ferment Mannitol,

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as in the case of staph aureus,

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it will turn the agar yellow.

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If it can't, the agar will stay pink.

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So to represent its ability
to ferment Mannitol,

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we'll draw this tall man here
behind him.

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Tall man, or if you flip those,
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man tall, Mannitol.

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A little bit of a stretch, I know,

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but I think you've got it.

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And we'll have him wearing
bright yellow clothes.

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to remember that Mannitol fermenters
turn the agar bright yellow.

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Now let's turn our attention to this

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big letter A in Moses' staff.

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You may have smartly assumed
that this staff stands for aureus.

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But you'd be wrong.

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It actually stands for protein A.

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And it's a main virulence factor
for staph aureus.

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So you should definitely know it

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and even better, you should know
how it works.

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Protein A is a component of the
staph aureus cell wall.

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And it can bind Fc portion
of immunoglobulins.

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To visually represent this,
we'll show the A

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binding an antibody at the Fc region.

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By doing this, protein A
prevents compliment

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from binding the same region

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working to prevent opsonization
and phagocytosis.

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All of these better enables
to colonize its host

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which brings me to my next point.

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Staph aureus colonizes the nares.

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Or opening of the nose.

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And how we'll we show this?

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Notice the sphinx back here
is missing his nose.

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That's because we've moved it
right here.

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We're using it as our symbol
for colonizing the nose.

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Now we're going to dive
into the diseases

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caused by Staph aureus.

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The first grouping are
the inflammatory diseases.

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First, we'll have this guy
walking the camel.

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And he's falling to his knees
and coughing.

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As he does that, he's pulling
the camel down to his knees too.

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First, let's talk about their coughing.

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Staph aureus causes pneumonia.

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An X-ray is said to look like
there's patchy infiltrate.

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So we'll draw this patchwork quilt
on the camel and on the coughing man

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to remind of you of these
patchy infiltrates.

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More importantly, you should remember
this icosahedron-shaped lamp

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hanging off of the camel.

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Actually, got suckered into buying
one of these in Morocco.

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But anyway, in our drawing,

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they're supposed to remind you

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of the icosahedron-shaped capsule
of a virus.

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And we have this here because
the pneumonia caused by staph aureus

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is most commonly a secondary
post-viral superinfection.

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Or a bacterial infection that occurs

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after our immune system is weakened
by a viral infection.

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Next, let's talk about why
we have the kneeling.

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Well it's because we wanted to
draw attention to the knees.

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So we'll even add bandages to
the camel's knees.

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And this should tell you that
they have join problems.

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And in this case, it's from
septic arthritis.

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Staph aureus is the most common cause
of septic arthritis in adults.

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Staph aureus causes a range
of skin infections

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like cellulitis, impetigo,

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furuncles which are boils

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or carbuncles which are slightly
larger boils and abscesses.

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But on test,

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they tend to stick more toward

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the really nasty abscesses.

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So we'll make these camel's humps
covered with red cloth.

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In this way, they look like some
really large erythematous abscesses.
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Over here, we have a camel
getting spooked

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and running in a full camel sprint

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towards the edge of a cliff.

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This poor passenger
is really freaking out.

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And rightly so.
She's clutching her chest in fear.

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So this camel getting
spooked out of nowhere

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is starting to sprint

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should make you think of
a really rapid onset.

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It just happened out of nowhere.

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And all of a sudden you're
at the edge of a cliff.

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We're using her clutching her chest

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and having the heart all over the camel

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to signal heart problems

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specifically endocarditis.

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So altogether, Staph aureus
causes rapid onset

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or acute bacterial endocarditis.

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In question stems,

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you should be thinking about
staph aureus endocarditis

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and someone that's an IV drug user.

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And in these cases, it's generally
a right-sided heart infection

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especially in the tricuspid valve.

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So first, to remember IV drug users,

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rather than drawing her and
the camel shooting up

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somewhere in the bathroom stall,

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we'll stick to something more
appropriate for this era

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and we'll draw a mortar and pestle

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with these weird medication vials.
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These drugs will remind you
of IV drug use.

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To remind you that tricuspid
is the commonly affected valve,

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we'll draw these three

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or tri-pyramids lined up
directly behind her.

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Staph aureus is also the most common
cause of osteomyelitis in adults.

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So we'll add some fishbones here.

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Fishbones left out in the sun like this

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would be really rancid and smelly

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which should clue you into some
sort of infection of the bone.

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It will be the symbol we always
use for osteomyelitis.

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But this time, we'll add two
because staph aureus

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is the most common cause
of osteomyelitis.

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Now, we'll talk about
the toxic media the diseases

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caused by the staph aureus.

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The first is called
Scalded Skin Syndrome.

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We'll draw this bald gentleman
with his turban off

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just roasting in the sun,
getting really sunburnt

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or you can say his skin
is getting scalded.

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And just like a sunburn,

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in Scalded Skin Syndrome,

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your skin will begin to peel off.

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This is all mediated by
exfoliative toxin, a protease.

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The next toxigenic disease is
Toxic Shock Syndrome.

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The classic situation for
toxic shock syndrome

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is someone leaving some sort of
foreign packing in for too long.
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Like a gauze after a rhinoplasty.

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Or a tampon.

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The toxin is called
Toxic Shock Syndrome Toxin (TSST)

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and it's a superantigen

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which causes non-specific binding of
MHC class II

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and t-cell receptors.

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This causes overactivation
and eventual cytokine storm

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which could be potentially fatal.

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To remind you of superantigen and shock,

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we'll draw on a cape,

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the super cape,
with a lightning bolt for shock.

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We'll use this in another video

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to represent Toxic Shock Syndrome.

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For the last toxin, we'll draw
another running camel

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but this time the women on it
is clutching her mouth

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and looking green as if she just
threw up in her mouth a little bit.

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She has food poisoning.

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And the running camel signifies
rapid onset.

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It's a rapid onset food poisoning

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because the toxin is preformed.

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So as soon as it's ingested,

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it can start causing symptoms
within 1 to 8 hours.

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Unlike most food poisonings
we learn about,

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staph aureus food poisoning
is more associated

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with vomiting than diarrhea.

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This is why we have her look like
she's going to vomit.

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The food poisoning comes from meats
and cream-based food

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like mayonnaise or custards
that are left out for too long.

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So we'll draw some meats

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and what looks like to be
a jar of mayonnaise

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which clearly or without
adequate refrigeration.

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So now this next part
may not be biblically accurate.

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But in our story, the pharaoh comes out

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raises his hands and shows
the Israelites mercy.

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This gesture of mercy
will stand for MRSA.

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Or Methicillin-resistant Staph aureus.

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MRSA becomes resistant methicillin

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by altering its
penicillin-binding protein

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or PBP.

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So PBP and staph aureus

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helps construct the cell walls.

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In the story, the Israelites slaves
used to be responsible

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for constructing the cell walls.

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But now that they've left,

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the pharaoh resorts to using these
altered pyramid building people.

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The Anubis, or jackal-headed god.

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Think of these altered humans
building the pyramids

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and you should remember that MRSA

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acquires its resistance to penicillin

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by altering its
penicillin-binding proteins.

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Now for the treatment of MRSA,
we use Vancomycin.

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Our symbol for Vancomycin
throughout the course will be a van.

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But to keep with this era,

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instead of using a van,
we'll use a caravan.

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But we'll still have it shaped
to look like a vancomycin van

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that you'll see in our future drawings.

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Finally, if the staph aureus infection

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is determined to be
methicillin-sensitive,

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then you should treat it with
an appropriate penicillin

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because this will actually work more
effectively in killing the bug

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than Vanco.

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A good choice for
methicillin-sensitive staph aureus

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is a penicillin called Nafcillin.

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We'll change this pharaoh staff
into a pencil.

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Pencils are our symbol for penicillin

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and a good pneumonic people use
is Naf for staph.

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Which we've illustrated by substituting

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a staff for a pencil.

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Okay, and that's all for me right now.

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I've got pretty bad writer's cramp

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so I'm gonna stop here.

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But, continue on to the next video

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where we discuss staph saprophyticus

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and staph epidermidis.

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I hope you enjoyed this one.