Phloston

Three main classifications to be aware of: diplococci,

rods (aka bacilli) and coccobacilli-pleomorphic rods

Gram(-) diplococci

Gram(-) diplococci
All cocci that are gram(-) are diplococci (i.e. they are

PAIRED).

Gram(-) diplococci
All cocci that are gram(-) are diplococci (i.e. they are

PAIRED).
The only two you need to know are Neisseria
meningitidis and Neisseria gonorrhea.

Gram(-) diplococci
All cocci that are gram(-) are diplococci (i.e. they are

PAIRED).
The only two you need to know are Neisseria
meningitidis and Neisseria gonorrhea.
Once again, they exist as PAIRS. Its HY to see an
image of a vaginal swab, por ejemplo, and then they
ask for the organism.

Gram(-) diplococci
All cocci that are gram(-) are diplococci (i.e. they are

PAIRED).
The only two you need to know are Neisseria
meningitidis and Neisseria gonorrhea.
Once again, they exist as PAIRS. Its HY to see an
image of a vaginal swab, por ejemplo, and then they
ask for the organism.
Ill give an introduction of the organisms with regard
to their classifications before discussing them in more
detail individually.

Gram(-) diplococci
N. gonorrhea and N. meningitidis youve gotta know

that both ferment glucose, BUT ONLY N.

MENINGITIDIS FERMENTS MALTOSE. Thats HY.

Gram(-) diplococci
N. gonorrhea and N. meningitidis youve gotta know

that both ferment glucose, BUT ONLY N.

MENINGITIDIS FERMENTS MALTOSE. Thats HY.
You culture Neisseria on THAYER-MARTIN medium,
which is VPN client contains Vancomycin (kills
other gram+s) + Polymyxin (colistin; kills other grams) + Nystatin (kills fungi).

Gram(-) diplococci
N. gonorrhea and N. meningitidis youve gotta know

that both ferment glucose, BUT ONLY N.

MENINGITIDIS FERMENTS MALTOSE. Thats HY.
You culture Neisseria on THAYER-MARTIN medium,
which is VPN client contains Vancomycin (kills
other gram+s) + Polymyxin (colistin; kills other grams) + Nystatin (kills fungi).
USMLE also wants you to know that the TM medium
is a chocolate agar. Mmm could use some Lindt 99...

Gram(-) diplococci
Theyll mention Neisseria and then ask you for the

antibiotics AND THE TYPE OF AGAR. Theyll literally

have:
Choice A) VPN on blood agar
Choice B) VPN on chocolate agar
Etc.
And youll have to remember chocolate. Most people
will recall the VPN, but dont forget Thayer-Martin is
chocolate agar. Done deal.

Gram(-) rods
There are four categories here with respect to the

USMLE (yay, time for memorization): 1) lactosefermenting; 2) NON-lactose-fermenting; 3) small,

curvy growth on Campy agar; 4) strictly anaerobic

Lactose-fermenting rods
Klebsiella and E. coli are fast lactose-fermenters. Ive

only ever seen questions asking about these two

fermenters. FA mentions Citrobacter and Serratia as
slow fermenters, but Ive never seen a question
regarding the latter two organisms with respect to
lactose-fermentation. Klebsiella and E. coli are the
ones to know.

Lactose-fermenting rods
E. coli and Klebsiella are differentiated in culture

based on E. coli being indole(+). Dont worry about

the specifics, just remember that detail. E. coli can
apparently cleave a certain substrate to an indole
product.

Lactose-fermenting rods
E. coli and Klebsiella are differentiated in culture

based on E. coli being indole(+). Dont worry about

the specifics, just remember that detail. E. coli can
apparently cleave a certain substrate to an indole
product.
Ive never seen a question asking the specifics of
Klebsiella culturing other than it being a lactosefermenter. For E. coli, know that its pink on
McConkey agar and green-metallic on eosinmethylene blue (EMB) agar. Both of those are
exceedingly HY.

Lactose NON-fermenting rods

This is the big group. Its subdivided into four

categories (yay): 1) oxidase(-); 2) oxidase(+); 3) motile

at 25 but not 37C; 4) bipolar staining

Lactose NON-fermenting rods oxidase (-)

Theres Salmonella, Shigella and Proteus spp.

Lactose NON-fermenting rods oxidase (-)

Theres Salmonella, Shigella and Proteus spp.
Remember that.

Lactose NON-fermenting rods oxidase (-)

Theres Salmonella, Shigella and Proteus spp.
Remember that.
Salmonella and Shigella are distinguished based on

Salmonella being MOTILE and a PRODUCER OF H2S

gas. Shigella is NON-motile and DOES NOT produce
H2S gas. That is exceedingly HY.

Lactose NON-fermenting rods oxidase (-)

Theres Salmonella, Shigella and Proteus spp.
Remember that.
Salmonella and Shigella are distinguished based on

Salmonella being MOTILE and a PRODUCER OF H2S

gas. Shigella is NON-motile and DOES NOT produce
H2S gas. That is exceedingly HY.
Proteus, in terms of questions, is simply oxidase(-) and
urease(+). They like you to know that it causes
staghorn calculi.

Lactose NON-fermenting rods oxidase (+)

Notice this slide is now oxidase(+).

Lactose NON-fermenting rods oxidase (+)

Notice this slide is now oxidase(+).
The only two you need to remember are Vibrio spp.

and Pseudomonas aeruginosa.

Lactose NON-fermenting rods oxidase (+)

Notice this slide is now oxidase(+).
The only two you need to remember are Vibrio spp.

and Pseudomonas aeruginosa.

Vibrio is distinguished from Pseudomonas in culture
bc it grows well in alkaline media, whereas
Pseudomonas does not.

Lactose NON-fermenting rods motile at 25 but not 37C

Yersinia enterocolitica. Boom. Thats it. Im merely

referring to how things are cultured. In terms of the

USMLE, thats what you need to know. Its nonlactose-fermenting. Its a gram(-) rod. And its motile
at 25 but not 37.

Lactose NON-fermenting rods bipolar staining

Yersinia pestis. Thats it. Remember that

categorization. Its a non-lactose fermenting gram(-)

rod that demonstrates bipolar staining.

Small, curvy growth on Campy agar

This refers to both H. pylori and Campylobacter jejuni.

Small, curvy growth on Campy agar

This refers to both H. pylori and Campylobacter jejuni.
In terms of the USMLE, they want you to know not

only that, but also that H. pylori is urease(+) but C.

jejuni is urease(-).

Small, curvy growth on Campy agar

This refers to both H. pylori and Campylobacter jejuni.
In terms of the USMLE, they want you to know not

only that, but also that H. pylori is urease(+) but C.

jejuni is urease(-).
C. jejuni and H. pyloi are also both oxidase(+), but
fermentation analyses are not used to help distinguish
them in culture, which is why theyre grouped here
instead of under oxidase(+) non-lactose fermenters.

Small, curvy growth on Campy agar

This refers to both H. pylori and Campylobacter jejuni.
In terms of the USMLE, they want you to know not

only that, but also that H. pylori is urease(+) but C.

jejuni is urease(-).
C. jejuni and H. pyloi are also both oxidase(+), but
fermentation analyses are not used to help distinguish
them in culture, which is why theyre grouped here
instead of under oxidase(+) non-lactose fermenters.
C. jejuni also grows well at 42C. Thats HY.

Small, curvy growth on Campy agar

This refers to both H. pylori and Campylobacter jejuni.
In terms of the USMLE, they want you to know not

only that, but also that H. pylori is urease(+) but C.

jejuni is urease(-).
C. jejuni and H. pyloi are also both oxidase(+), but
fermentation analyses are not used to help distinguish
them in culture, which is why theyre grouped here
instead of under oxidase(+) non-lactose fermenters.
C. jejuni also grows well at 42C. Thats HY.
Ive also seen in questions that C. jejuni is either S- or
comma-shaped. Same goes or Vibrio.

Strictly anaerobic
Bacteroides spp. Thats it. Hardcore anaerobic. Thats

all the USMLE cares about in terms of its culturing.

But its also really important to remember in general
because occasionally youll have to deduce a
pathologys particular pathogen, and if you know the
environment is anaerobic, Bacteroides rings huge.

Gram(-) coccobacilli-pleomorphic rods

H. influenzae requires factors V + X for growth.

Know that NAD+ and haematin are V + X, respectively.

Gram(-) coccobacilli-pleomorphic rods

H. influenzae requires factors V + X for growth.

Know that NAD+ and haematin are V + X, respectively.

Legionella grows on charcoal yeast agar with iron +
cysteine. You need to pretty much memorize that
word for word.

Gram(-) coccobacilli-pleomorphic rods

H. influenzae requires factors V + X for growth.

Know that NAD+ and haematin are V + X, respectively.

Legionella grows on charcoal yeast agar with iron +
cysteine. You need to pretty much memorize that
word for word.
Bordetella persussis grows on Bordet-Gengou
medium, aka potato medium. Thats HY. I had also
encountered a question that required you knew it can
also grow on Regan-Lowe medium, and that it is
swabbed using a calcium alginate swab.

Gram(-) coccobacilli-pleomorphic rods

Francisella tularensis requires cysteine for growth.

Once again, just memorize that word for word.

Gram(-) coccobacilli-pleomorphic rods

Francisella tularensis requires cysteine for growth.

Once again, just memorize that word for word.

Pasteurella multocida is both oxidase and
catalase(+). Just memorize that. Itll show up on
your real deal and youll actually be angry if you didnt
make the effort. I just remembered the OC.

 Now for more specific info about each organism..

N. meningitidis
Has a polysaccharidic capsule exceedingly HY

N. meningitidis
Has a polysaccharidic capsule exceedingly HY
Vaccine can be made against the capsule

N. meningitidis
Has a polysaccharidic capsule exceedingly HY
Vaccine can be made against the capsule
Causes Waterhouse-Friderichsen syndrome, which

is haemorrhagic necrosis of the adrenal glands

(theyll ask you if its haemorrhagic or atrophic, etc., so
remember that its haemorrhagic)

N. meningitidis
Has a polysaccharidic capsule exceedingly HY
Vaccine can be made against the capsule
Causes Waterhouse-Friderichsen syndrome, which

is haemorrhagic necrosis of the adrenal glands

(theyll ask you if its haemorrhagic or atrophic, etc., so
remember that its haemorrhagic)
Prophylaxis = rifampin; Tx = ceftriaxone

N. meningitidis
Has a polysaccharidic capsule exceedingly HY
Vaccine can be made against the capsule
Causes Waterhouse-Friderichsen syndrome, which

is haemorrhagic necrosis of the adrenal glands

(theyll ask you if its haemorrhagic or atrophic, etc., so
remember that its haemorrhagic)
Prophylaxis = rifampin; Tx = ceftriaxone
Has a lipoligosaccharide (LOS), NOT a
lipopolysaccharide (LPS); LOS causes meningococcal
rash and WF syndrome

N. gonorrhoea
NO capsule

N. gonorrhoea
NO capsule
NO vaccine bc it has a pilus that undergoes

antigenic variation.

N. gonorrhoea
NO capsule
NO vaccine bc it has a pilus that undergoes

antigenic variation.
Causes septic arthritis in sexually active adults,
neonatal conjunctivitis, PID and Fitz-Hugh-Curtis
syndrome (inflammation of the liver secondary to
PID)

N. gonorrhoea
NO capsule
NO vaccine bc it has a pilus that undergoes

antigenic variation.
Causes septic arthritis in sexually active adults,
neonatal conjunctivitis, PID and Fitz-Hugh-Curtis
syndrome (inflammation of the liver secondary to
PID)
Tx = ceftriaxone or ciprofloxacin

Neisseria (in general)

Complement C5-8 deficiency leads to Neisseria

susceptibility. Thats really HY.

Neisseria (in general)

Complement C5-8 deficiency leads to Neisseria

susceptibility. Thats really HY.

Whenever treating for Chlamydia (one-time
azithromycin or week-long tetracycline HY) or
gonorrhea (ceftriaxone or ciprofloxacin), YOU
ALWAYS TREAT FOR THE OTHER ONE TOO
That means if you get a vignette of someone with
gonorrhea or chlamydia, the answer is NEVER just
azithromycin (or ceftriaxone); its ALWAYS
azithromycin + ceftriaxone. Most people wont even
realize they get that question wrong.

Neisseria (in general)

Theyll tell you a girl was treated for PID, the problem

resolved, then years later shes infertile. Then theyll

ask for what most likely contributed to the infertility:
A) Hx of unprotected intercourse
B) Hx of improper antibiotic Tx
C) Etc.
The answer is B, NOT A. She was likely treated for
one but not the other, and the other caused the
infertility. This has shown up in practice questions
and also on the real deal (per my friend on SDN). In
contrast, A is always the answer for cervical cancer.

Klebsiella + bacteroides
Both cause aspiration pneumonia, particularly in

alcoholics

Klebsiella + bacteroides
Both cause aspiration pneumonia, particularly in

alcoholics
Klebsiella leads to thick, red, currant-jelly sputum.

Klebsiella + bacteroides
Both cause aspiration pneumonia, particularly in

alcoholics
Klebsiella leads to thick, red, currant-jelly sputum.
Bacteroides causes extremely foul-smelling sputum.

Klebsiella + bacteroides
Both cause aspiration pneumonia, particularly in

alcoholics
Klebsiella leads to thick, red, currant-jelly sputum.
Bacteroides causes extremely foul-smelling sputum.
If they tell you theres a lesion on CXR that reveals air
fluid levels, that means theres an abscess
anaerobic bacteroides

Klebsiella + bacteroides
Both cause aspiration pneumonia, particularly in

alcoholics
Klebsiella leads to thick, red, currant-jelly sputum.
Bacteroides causes extremely foul-smelling sputum.
If they tell you theres a lesion on CXR that reveals air
fluid levels, that means theres an abscess
anaerobic bacteroides
Klebsiella notably causes thick, mucoid colonies

Klebsiella + bacteroides
Both cause aspiration pneumonia, particularly in

alcoholics
Klebsiella leads to thick, red, currant-jelly sputum.
Bacteroides causes extremely foul-smelling sputum.
If they tell you theres a lesion on CXR that reveals air
fluid levels, that means theres an abscess
anaerobic bacteroides
Klebsiella notably causes thick, mucoid colonies
Klebsiella causes empyema + cavitations HY!!

Klebsiella
Klebsiella is a common cause of spontaneous

bacterial peritonitis. That is very HY. Youve gotta

remember that. Spontaneous bacterial peritonitis or
empyema/cavitations = Klebsiella. Most people will
not remember that, and that will get you a high
USMLE score.

Klebsiella
Klebsiella is a common cause of spontaneous

bacterial peritonitis. That is very HY. Youve gotta

remember that. Spontaneous bacterial peritonitis or
empyema/cavitations = Klebsiella. Most people will
not remember that, and that will get you a high
USMLE score.
How do you treat Klebsiella infection?

Klebsiella
Klebsiella is a common cause of spontaneous

bacterial peritonitis. That is very HY. Youve gotta

remember that. Spontaneous bacterial peritonitis or
empyema/cavitations = Klebsiella. Most people will
not remember that, and that will get you a high
USMLE score.
How do you treat Klebsiella infection?
..third generation cephalosporin (says Kaplan)

Klebsiella
Klebsiella is a common cause of spontaneous

bacterial peritonitis. That is very HY. Youve gotta

remember that. Spontaneous bacterial peritonitis or
empyema/cavitations = Klebsiella. Most people will
not remember that, and that will get you a high
USMLE score.
How do you treat Klebsiella infection?
..third generation cephalosporin (says Kaplan)
FA says diabetics under Klebsiella, as though theres
increased risk in those pts, but in questions, Ive only
ever seen Pseudomonas as associated with diabetics.

E. coli
Four types: ETEC, EPEC, EHEC, EIEC

E. coli
Four types: ETEC, EPEC, EHEC, EIEC
ETEC = enteroToxigenic E. coli
EPEC = enteroPathogenic E. coli

EHEC = enteroHaemorrhagic E. coli

EIEC = enteroInvasive E. coli

E. coli ETEC
ETEC liberates two different toxins: heat-labile (HL)

and heat-stable (HS).

E. coli ETEC
ETEC liberates two different toxins: heat-labile (HL)

and heat-stable (HS).

ETECs HL-toxin causes WATERY diarrhea and is
ANALOGOUS TO CHOLERA TOXIN.

E. coli ETEC
ETEC liberates two different toxins: heat-labile (HL)

and heat-stable (HS).

ETECs HL-toxin causes WATERY diarrhea and is
ANALOGOUS TO CHOLERA TOXIN.
ETECs HS-toxin causes WATERY diarrhea and is
ANALOGOUS TO YERSINIA ENTEROCOLITICA
TOXIN

E. coli ETEC
ETEC HL-toxin, like vibrio toxin, increases cAMP

activity in the enterocytes, leading to increased Clsecretion and H2O efflux.

E. coli ETEC
ETEC HL-toxin, like vibrio toxin, increases cAMP

activity in the enterocytes, leading to increased Clsecretion and H2O efflux.

That is important to remember because ETEC HStoxin, like Yersinia enterocolitica toxin, increases
cGMP activity, leading to decreased NaCl and H2O
reabsorption.

E. coli ETEC
ETEC HL-toxin, like vibrio toxin, increases cAMP

activity in the enterocytes, leading to increased Clsecretion and H2O efflux.

That is important to remember because ETEC HStoxin, like Yersinia enterocolitica toxin, increases
cGMP activity, leading to decreased NaCl and H2O
reabsorption.
The cAMP vs cGMP MOAs of those toxins are
exceedingly HY.

E. coli ETEC
Notice that the cAMP ETEC HL-toxin + cholera toxin

MOA is increased SECRETION, whereas the cGMP

ETEC HS-toxin + Y. enterocolitica toxin MOA is
decreased REABSORPTION.

E. coli ETEC
Notice that the cAMP ETEC HL-toxin + cholera toxin

MOA is increased SECRETION, whereas the cGMP

ETEC HS-toxin + Y. enterocolitica toxin MOA is
decreased REABSORPTION.
One other very important thing to remember: whereas
ETEC HL-toxin and cholera toxin both cause watery
diarrhea, for HS-toxin vs Y. enterocolitica toxin, the
former causes watery diarrhea whereas the latter
causes bloody diarrhea. Remember that.

E. coli ETEC
ETEC is the organism responsible for travelers

diarrhea. Theyll frame this as a guy who went on

vacation and then came down with a short-duration
watery diarrhea. If it doesnt seem overly severe, its
travelers diarrhea (ETEC). If its very severe and the pt
is defecating literally litres of diarrhea, its most
definitely cholera > ETEC. For ETEC, lettuce is also a
big clue, bc ETEC likes to grow on that.

E. coli EPEC
All youve gotta know for this one is that it flattens

intestinal villi. Thats it. Literally. It causes diarrhea

in children, but if they mention the flattened villi, its
EPEC.

E. coli EIEC
Invades intestinal mucosa and causes bloody

diarrhea. Thats it. Literally. Thats it.

E. coli EHEC
O157:H7 is the most common. Produces Shiga-like

toxin (aka verotoxin). Both Shiga-toxin and Shiga-like

toxin inactivate the 60S ribosomal subunit by
cleaving rRNA.

E. coli EHEC
O157:H7 is the most common. Produces Shiga-like

toxin (aka verotoxin). Both Shiga-toxin and Shiga-like

toxin inactivate the 60S ribosomal subunit by
cleaving rRNA.
The difference is that Shigella invades whereas EHEC
does not.

E. coli EHEC
O157:H7 is the most common. Produces Shiga-like

toxin (aka verotoxin). Both Shiga-toxin and Shiga-like

toxin inactivate the 60S ribosomal subunit by
cleaving rRNA.
The difference is that Shigella invades whereas EHEC
does not.
Shiga-like toxin is phage-encoded.

E. coli EHEC
The Shiga-like toxin causes swelling of the renal

vascular endothelium, leading to endothelial

damage. The damaged endothelium consumes
platelets, leading to thrombocytopenia, and
subsequent irregular vascular contour in conjunction
with the narrowed lumina, leads to mechanical
haemolysis, thereby producing fragmented RBCS
known as schistocytes. That is all really HY.

E. coli EHEC
The process of thrombocytopenia leading to

schistocytosis produces an anaemia. This anaemia is

called microangiopathic haemolytic anaemia
(MAHA).

E. coli EHEC
The process of thrombocytopenia leading to

schistocytosis produces an anaemia. This anaemia is

called microangiopathic haemolytic anaemia
(MAHA).
Therefore, an anaemia characterized by
schistocytosis secondary to mechanical
haemolysis in the presence of thrombocytopenia
= MAHA.

E. coli EHEC
The process of thrombocytopenia leading to

schistocytosis produces an anaemia. This anaemia is

called microangiopathic haemolytic anaemia
(MAHA).
Therefore, an anaemia characterized by
schistocytosis secondary to mechanical
haemolysis in the presence of thrombocytopenia
= MAHA.
MAHA + acute renal failure = haemolytic uraemia
syndrome (HUS). EHEC causes HUS in children.

E. coli EHEC
Whereas polymorphonuclear (PMN) leukocytes are

seen in PSGN, they are NOT seen in HUS (makes

sense).

E. coli EHEC
Whereas polymorphonuclear (PMN) leukocytes are

seen in PSGN, they are NOT seen in HUS (makes

sense).
Another very high-yield point: EHEC does NOT
FERMENT SORBITOL. Retarded, but they want you
to know that. The other E. coli can ferment sorbitol,
whereas EHEC cant, so it this test is used to
distinguish.

E. coli
There is also a low-yield fifth category of E. coli called

EAEC = enteroaggregative E. coli. It forms a stackedbrick pattern of assembly. I had seen this in
UWorlds explanations, but I have never actually seen a
question on it. It would probably be a potential 270+
type question if it ever showed up.

E. coli
P1-pilus is the type of pilus that mediates adherence to

the urinary tract / bladder in UTIs. Ive seen that in

two questions.

E. coli
P1-pilus is the type of pilus that mediates adherence to

the urinary tract / bladder in UTIs. Ive seen that in

two questions.
Rifaximin is a non-systemic drug (stays confined to
the GIT) that is good for treating E. coli.

Salmonella vs Shigella
Ive already mentioned this earlier in the presentation,

but Ill say it again just bc its so HY: Salmonella

produces H2S (g) and is motile; Shigella does not
produce H2S (g) and is non-motile. They are both
oxidase NEGATIVE.

Salmonella vs Shigella
Ive already mentioned this earlier in the presentation,

but Ill say it again just bc its so HY: Salmonella

produces H2S (g) and is motile; Shigella does not
produce H2S (g) and is non-motile. They are both
oxidase NEGATIVE.
Ok, here we go: Shigella notably requires very few
organisms to cause infection (ohemgee really HY).
The USMLE is seriously in love with that. FA
mentions that Shigella is more virulent than
Salmonella, but youve gotta remember that it takes
very few organisms to cause Shigellosis.

Salmonella
Youve gotta know Salmonella enteritidis +

typhimurium vs Salmonella typhi.

Salmonella
Youve gotta know Salmonella enteritidis +

typhimurium vs Salmonella typhi.

S. enteriditis + S. typhimurium both cause bloody
diarrhea. Theyre both causes of gastroenteritis.
Both. Dont screw those up. And dont confuse them
with S. typhi, which instead causes typhoid fever.

Salmonella
Youve gotta know Salmonella enteritidis +

typhimurium vs Salmonella typhi.

S. enteriditis + S. typhimurium both cause bloody
diarrhea. Theyre both causes of gastroenteritis.
Both. Dont screw those up. And dont confuse them
with S. typhi, which instead causes typhoid fever.
Salmonella is one of the known organisms that bears
antigenic variation bc it has two flagellar variants.
(N. gonorrhea + B. recurrentis are two others with
antigenic variation).

Salmonella
Salmonella is the most common cause of

osteomyelitis in SICKLE CELL DISEASE. That is

insanely HY. If they ever mention osteomyelitis +
anything related to sickle cells Salmonella, NOT S.
aureus (which is ordinarily most common).

Salmonella
Salmonella is the most common cause of

osteomyelitis in SICKLE CELL DISEASE. That is

insanely HY. If they ever mention osteomyelitis +
anything related to sickle cells Salmonella, NOT S.
aureus (which is ordinarily most common).
S. enteritidis + typhimurium are transmitted by
turtles. USMLE likes that.

Salmonella
Salmonella is the most common cause of

osteomyelitis in SICKLE CELL DISEASE. That is

insanely HY. If they ever mention osteomyelitis +
anything related to sickle cells Salmonella, NOT S.
aureus (which is ordinarily most common).
S. enteritidis + typhimurium are transmitted by
turtles. USMLE likes that.
S. typhi causes typhoid fever rose spots on the
abdomen, and REMAINS LATENT IN THE ***GALL
BLADDER*** following initial infection.

Salmonella
Mild diarrhea + spots on the abdomen S. typhi.

Dont **** that up. Salmonella, PERIOD, causes

diarrhea, but if those rose spots appear, its S. typhi,
not S. typhimurium/enteritidis.

Shigella
Once again, very few organisms causes infection.

Shigella
Once again, very few organisms causes infection.
This is BECAUSE they can bind to unique sites on

mucosal M-cells not occupied by normal flora. Holy

cow. MUCOSAL INVASION is the MOST
SIGNIFICANT factor in Shigella pathogenicity, NOT
the toxin itself. Got that? (Shigella that loses ability to
invade despite toxin-liberation is less virulent)

Shigella
Once again, very few organisms causes infection.
This is BECAUSE they can bind to unique sites on

mucosal M-cells not occupied by normal flora. Holy

cow. MUCOSAL INVASION is the MOST
SIGNIFICANT factor in Shigella pathogenicity, NOT
the toxin itself. Got that? (Shigella that loses ability to
invade despite toxin-liberation is less virulent)
Shigella spreads to adjacent cells (after its already
invaded) via actin polymerization. Ridiculous. But
its in FA and also in UWorld.

Shigella
Shigella sonnei is the most common (80%) cause of

Shigellosis.

Proteus
Urease(+) causes staghorn calculi with UTIs.

Proteus
Urease(+) causes staghorn calculi with UTIs.
Second most common cause of UTIs in women.

Pseudomonas
Common cause of infections in DIABETICS. USMLE

likes diabetics + Pseudomonas. Whether its

osteomyelitis, pulmonary infections anything if
they mention that the pt is diabetic (or imply it)
Pseudomonas should be the first organism that pops
into your head.

Pseudomonas
Common cause of infections in DIABETICS. USMLE

likes diabetics + Pseudomonas. Whether its

osteomyelitis, pulmonary infections anything if
they mention that the pt is diabetic (or imply it)
Pseudomonas should be the first organism that pops
into your head.
Causes malignant otitis externa, which is when
otitis externa spreads to adjacent areas (e.g. mastoid).

Pseudomonas
Common cause of infections in DIABETICS. USMLE

likes diabetics + Pseudomonas. Whether its

osteomyelitis, pulmonary infections anything if
they mention that the pt is diabetic (or imply it)
Pseudomonas should be the first organism that pops
into your head.
Causes malignant otitis externa, which is when
otitis externa spreads to adjacent areas (e.g. mastoid).
Causes hot tub folliculitis anything waterrelated, think Pseudomonas (e.g. recent ear/skin
infection in swimmer).

Pseudomonas
Pseudomonas is an aerobic gram(-) rod, which means

aminoglycosides are great to treat it.

Pseudomonas
Pseudomonas is an aerobic gram(-) rod, which means

aminoglycosides are great to treat it.

Ticarcillin/tazobactam or pipericillin/tazobactam
are effective Tx combinations. Know those.

Pseudomonas
Pseudomonas is an aerobic gram(-) rod, which means

aminoglycosides are great to treat it.

Ticarcillin/tazobactam or pipericillin/tazobactam
are effective Tx combinations. Know those.
Ceftazidime (3rd gen) or Cefepime (4th gen) can both
treat it and are exceedingly HY, particularly the former.

Pseudomonas
Pseudomonas is an aerobic gram(-) rod, which means

aminoglycosides are great to treat it.

Ticarcillin/tazobactam or pipericillin/tazobactam
are effective Tx combinations. Know those.
Ceftazidime (3rd gen) or Cefepime (4th gen) can both
treat it and are exceedingly HY, particularly the former.
Im not just throwing Txs at you. For some magical
reason, the USMLE decided that everything related to
Pseudomonas Tx is extremely important to know. The
above drugs are all HY for Pseudomonas.

Pseudomonas
Produces a blue-green pigment (pyocyanin)

Pseudomonas
Produces a blue-green pigment (pyocyanin)
Has a grape-like odor

Pseudomonas
Produces a blue-green pigment (pyocyanin)
Has a grape-like odor
Major virulence factor is alginate

exopolysaccharidic capsule

Pseudomonas
Produces a blue-green pigment (pyocyanin)
Has a grape-like odor
Major virulence factor is alginate

exopolysaccharidic capsule
The FUNCTION of pyocyanin is to degrade reactive
oxygen species

Pseudomonas
Produces a blue-green pigment (pyocyanin)
Has a grape-like odor
Major virulence factor is alginate

exopolysaccharidic capsule
The FUNCTION of pyocyanin is to degrade reactive
oxygen species
Pseudomonas causes both botryomyosis and
ecthyma gangrenosum. If you pick ecthyma
gangrenosum from a vignette/image, thats a 260+
question.

Pseudomonas
If they show you an image of black necrotic skin

lesions, P. aeruginosa, B. anthracis, F. tularensis and Y.

pestis should all explode to the surface as firecrackers.
They like showing images of ecthyma gangrenosum,
then asking you to pick the organism. They might not
mention the pt is even diabetic. Its not an easy
question, but just remember it the DDx, and youll
pick it.

Pseudomonas
If they show you an image of black necrotic skin

lesions, P. aeruginosa, B. anthracis, F. tularensis and Y.

pestis should all explode to the surface as firecrackers.
They like showing images of ecthyma gangrenosum,
then asking you to pick the organism. They might not
mention the pt is even diabetic. Its not an easy
question, but just remember it the DDx, and youll
pick it.
Like C. diptheriae, P. aeruginosa inhibits EF-2, which
leads to decreased protein synthesis

Vibrio spp.
Vibrio cholera causes a surfeit of watery diarrhea.

Vibrio spp.
Vibrio cholera causes a surfeit of watery diarrhea.
The Tx is ALWAYS oral fluid/electrolyte

replenishment. They might mention a pt with severe

cholera, and then ask for the Tx, and IV fluid
replacement may be an answer, but its wrong. Oral is
correct. If the pt is going into shock, IV is clinically
correct, but IN TERMS OF USMLE QUESTIONS, THE
ANSWER IS ALWAYS ORAL. Thats what you need to
know.

Vibrio spp.
Vibrio cholera causes a surfeit of watery diarrhea.
The Tx is ALWAYS oral fluid/electrolyte

replenishment. They might mention a pt with severe

cholera, and then ask for the Tx, and IV fluid
replacement may be an answer, but its wrong. Oral is
correct. If the pt is going into shock, IV is clinically
correct, but IN TERMS OF USMLE QUESTIONS, THE
ANSWER IS ALWAYS ORAL. Thats what you need to
know.
Already mentioned, but it grows on alkaline media.

Vibrio spp.
The watery diarrhea with cholera is rice-water. The

rice is mucous. Remember that the MOA is similar

to heat-LABILE toxin of ETEC, which is increased
cAMP activation.

 Vibrio parahaemolyticus + V. vulnificus are lower-

yield, but Ive seen them show up.

 Vibrio parahaemolyticus + V. vulnificus are lower-

yield, but Ive seen them show up.

All youve gotta know is that you get both from
shellfish. And the other thing is that whereas V.
parahaemolyticus causes a diarrheal illness, V.
vulnificus can cause shock in 50% of pts. The latter
is how you differentiate the two if they want to get
more specific. Picking V. parahaemolyticus + V.
vulnificus from a question is probably 240+ range, but
V. cholera is very very HY.

Yersinia enterocolitica
Causes mesenteric adenitis. Know that hardcore.

Thats what the USMLE likes. Itll rock up like

appendicitis-like pain. Okay? So you get diarrhea
then appendicitis-like pain, and Y. enterocolitica
should be mad-high on the DDx.

Yersinia enterocolitica
Causes mesenteric adenitis. Know that hardcore.

Thats what the USMLE likes. Itll rock up like

appendicitis-like pain. Okay? So you get diarrhea
then appendicitis-like pain, and Y. enterocolitica
should be mad-high on the DDx.
Daycare centres are common sites of outbreak.

Yersinia enterocolitica
Causes mesenteric adenitis. Know that hardcore.

Thats what the USMLE likes. Itll rock up like

appendicitis-like pain. Okay? So you get diarrhea
then appendicitis-like pain, and Y. enterocolitica
should be mad-high on the DDx.
Daycare centres are common sites of outbreak.
Adults get hit harder than kids. Kids get the diarrhea
then appendicitis-like pain, but adults will get diarrhea
then arthritis.

Yersinia enterocolitica
Causes mesenteric adenitis. Know that hardcore.

Thats what the USMLE likes. Itll rock up like

appendicitis-like pain. Okay? So you get diarrhea
then appendicitis-like pain, and Y. enterocolitica
should be mad-high on the DDx.
Daycare centres are common sites of outbreak.
Adults get hit harder than kids. Kids get the diarrhea
then appendicitis-like pain, but adults will get diarrhea
then arthritis.
Transmitted by contaminated milk or pork/puppies.

Yersinia enterocolitica
Remember that it has similar MOA (increased cGMP)

as heat-STABLE toxin of ETEC, but whereas ETEC HStoxin causes watery diarrhea, Y. enterocolitica causes
bloody diarrhea (so sometimes the Sx can be Crohnslike, but in questions, appendicitis-like >>> HY).

Yersinia enterocolitica
Remember that it has similar MOA (increased cGMP)

as heat-STABLE toxin of ETEC, but whereas ETEC HStoxin causes watery diarrhea, Y. enterocolitica causes
bloody diarrhea (so sometimes the Sx can be Crohnslike, but in questions, appendicitis-like >>> HY).
The Yop plasmid confers infectivity to Yersinia.

Yersinia pestis
Causes plague.

Yersinia pestis
Causes plague.
Transmitted by fleas and prairie dogs.

Yersinia pestis
Causes plague.
Transmitted by fleas and prairie dogs.
Black skin ulcers, but unlike B. anthracis, they are

PAINFULLLLLL. The pt also gets PAINFULLLL

lymph nodes called buboes. So just remember that
plague is painful.

Yersinia pestis
FA doesnt mention it, and Ive only seen one practice

question on it, but one of my friends on SDN had a

pneumonic plague question show up on her real
deal. Theyll tell you a farmer got a strange
PNEUMONIA caused by a gram(-) rod, and youll
have to pick that its Y. pestis. Either UWorld or
Kaplan had the question, but the way she described it
from her actual exam was practically identical to how I
had seen it in the Qbank.

H. pylori
Causes most gastric ulcers (responsible for almost all

of duodenal ones), gastric adenocarcinoma and MALT

lymphoma.

H. pylori
Causes most gastric ulcers (responsible for almost all

of duodenal ones), gastric adenocarcinoma and MALT

lymphoma.
Its oxidase, catalase and urease(+). I had a question
ask me to list + or for all three of those enzymes for
H. pylori; you need to know its + for all three, not just
urease.

H. pylori
Causes most gastric ulcers (responsible for almost all

of duodenal ones), gastric adenocarcinoma and MALT

lymphoma.
Its oxidase, catalase and urease(+). I had a question
ask me to list + or for all three of those enzymes for
H. pylori; you need to know its + for all three, not just
urease.
Tx = PCA = PPI + Clarithromycin + Amoxicillin (or
metronidazole/tetracycline).

C. jejuni
50% of infections are from poultry. Holy cow. Know

that.

C. jejuni
50% of infections are from poultry. Holy cow. Know

that.
S- or comma-shaped

C. jejuni
50% of infections are from poultry. Holy cow. Know

that.
S- or comma-shaped
Grows at 42C

C. jejuni
50% of infections are from poultry. Holy cow. Know

that.
S- or comma-shaped
Grows at 42C
Causes bloody diarrhea

C. jejuni
50% of infections are from poultry. Holy cow. Know

that.
S- or comma-shaped
Grows at 42C
Causes bloody diarrhea
Also oxidase(+)

 The remaining organisms will be covered next week +

others.