BACTERIA

GRAM-POSITIVE COCCI

Staphylococcus Aureus

1
Golden staff
1
Staphylococcus aureus (a gram-positive coccus)
2
Purple robe
2
Staphylococcus aureus is a gram-positive coccus
3
Catalase cat
3
Staphylococcus aureus produces catalase, an enzyme that converts hydrogen peroxide
into water and oxygen
4
Coagulated river
4
Staphylococcus aureus produces coagulase, an enzyme that converts fibrinogen to
fibrin → clot formation in test samples; the coagulase test helps distinguish Staph
aureus from other gram-positive, catalase-positive, coagulase-negative cocci
 5
Beta light bulb
5
Most strains of Staphylococcus aureus demonstrate beta-hemolysis, which refers to
the ability to completely lyse hemoglobin → clear, transparent zones around colonies on
blood agar
6
Tall man in yellow
6
Staphylococcus aureus can ferment mannitol, which causes mannitol salt agar to
turn yellow; mannitol salt agar helps distinguish Staph aureus from non-pathogenic
staphylococci, which typically do not ferment mannitol
7
"A" bound to IgG
7
A primary virulence factor of Staphylococcus aureus is protein A, which binds the Fc
region of IgG antibodies, subsequently inhibiting complement activation and
phagocytosis
8
Nose
8
Staphylococcus aureus is part of the normal flora of the nares and skin
9
Coughing + patchy cloth
9
Pneumonia caused by Staphylococcus aureus often manifests on a chest X-ray
as patchy infiltrates that may progress to lobar consolidation
10
Viral lanterns
10
An upper respiratory infection, particularly influenza, can predispose individuals
to Staphylococcus aureus pneumonia
11
Joint bandages
11
Staphylococcus aureus is the most common cause of septic arthritis, which presents
as a warm, swollen, and tender joint along with purulent fluid on aspiration
12
Inflamed camel humps
12
Staphylococcus aureus is known to cause a range of skin and soft tissue infections,
including impetigo, furuncles, carbuncles, and cellulitis
13
Hearts on running camel
13
Acute infective endocarditis, a condition that manifests as rapid onset fever, chills,
tachycardia, and sepsis, can be caused by Staphylococcus aureus, even in individuals
with previously undamaged heart valves
14
Three pyramids + mortar and pestle
14
Tricuspid valve infective endocarditis (TVIE) caused by Staphylococcus aureus is
highly associated with IV drug use
15
Fish bones
15
Staphylococcus aureus is the leading cause of osteomyelitis, an inflammation or
swelling of bone typically caused by infection
16
Exfoliative burn
16
Certain strains of Staphylococcus aureus produce an exfoliative toxin that can lead to
scalded skin syndrome, a condition characterized by widespread skin peeling
17
Superhero cape + bolt
17
Some strains of Staphylococcus aureus produce a superantigen exotoxin, resulting
in toxic shock syndrome (TSS); TSS is characterized by a high fever, a desquamative
rash, and shock (low blood pressure and/or very high heart rate)
18
Rapid camel running + nausea
18
Ingestion of preformed enterotoxin made by Staphylococcus aureus can cause a rapid-
onset form of food poisoning (Sx usually develop within 30 m - 8 h), characterized by
a sudden nausea, vomiting, and stomach cramps
19
Mayo and meats
19
Ingestion of food contaminated with Staphylococcus aureus enterotoxin, notably items
like mayonnaise and meats, can result in staphylococcal enteritis
20
Merciful pharaoh
20
Certain strains of Staphylococcus aureus have developed resistance to beta-lactam
antibiotics, notably including methicillin (methicillin-resistant Staphylococcus
aureus (MRSA))
 21
Altered builders
21
MRSA strains have modified penicillin-binding proteins, which hinder the binding of
beta-lactam antibiotics to bacterial cell walls
22
Purple caravan
22
Vancomycin remains an effective therapeutic option against MRSA infections
23
Pencil staff
23
For non-MRSA Staphylococcus aureus infections, nafcillin, a beta-lactam antibiotic,
offers therapeutic efficacy
Staphylococcus epidermidis & saprophyticus

1
Plumber
1
Staphylococcus epidermidis (a gram-positive coccus)
2
Sappy couple
2
Staphylococcus saprophyticus (a gram-positive coccus)
3
Purple hues
3
Staphylococcus epidermidis and saprophyticus are gram-positive cocci
4
Catalase cat
4
Staphylococcus epidermidis and saprophyticus produce catalase, an enzyme that
converts hydrogen peroxide into water and oxygen
5
Runny juice
5
Staphylococcus epidermidis and saprophyticus do not produce coagulase, an enzyme
that converts fibrinogen to fibrin → no clot formation; the coagulase test helps
distinguish these species from Staphylococcus aureus, which is coagulase-positive
6
Ammonia spray
6
Staphylococcus epidermidis and saprophyticus produce urease, an enzyme that
hydrolyzes urea into carbon dioxide and ammonia
7
Plumber's exposed navel
7
Staphylococcus epidermidis is susceptible to the antibiotic novobiocin,
distinguishing it from Staphylococcus saprophyticus, which is resistant to novobiocin
8
Dirty hands
8
Staphylococcus epidermidis is part of the normal flora, commonly found on skin and
mucous membranes
9
Petri dish pan
9
As a component of the normal skin flora, Staphylococcus epidermidis is a
common contaminant of blood cultures
10
Plumbing joints
10
Staphylococcus epidermidis is one of the most isolated pathogens in prosthetic joint
infections
11
Tubing
11
Staphylococcus epidermidis is one of the leading causes of catheter-associated
infections
12
Heart valve
12
Staphylococcus epidermidis is the most common causative agent of prosthetic valve
endocarditis
13
Gunk on pipes and tubes
13
Staphylococcus epidermidis produces biofilms (extracellular polysaccharide matrix),
allowing for adherence to prosthetic devices and IV catheters
 14
Van
14
Vancomycin is the drug of choice for Staphylococcus epidermidis infections as most
strains show resistance to nafcillin and methicillin due to their ability to produce biofilms
15
Honeymooner
15
Staphylococcus saprophyticus commonly causes uncomplicated urinary tract
infections in young, sexually active females (AKA honeymoon cystitis)
16
Bladder cup
16
Staphylococcus saprophyticus is an encountered pathogen for uncomplicated urinary
tract infections (E. coli and Klebsiella are the most frequent causative agents)
17
Inflamed prostate fruit
17
Staphylococcus saprophyticus is a cause of acute bacterial prostatitis
Streptococcus pyogenes (Group A Strep)

1
Pie bakers
1
Streptococcus pyogenes (group A strep) (a gram-positive coccus)
2
Purple stripes
2
Streptococcus pyogenes is a gram-positive coccus
3
"Hot Apple" pie + glass capsule
3
Streptococcus pyogenes produces a hyaluronic acid capsule, a critical virulence
factor that helps it evade host immune defenses
4
Beta light bulb
4
Streptococcus pyogenes demonstrates beta-hemolysis, which refers to the ability to
completely lyse hemoglobin → clear, transparent zones around colonies on blood agar
5
Flaky pie crust
5
Streptococcus pyogenes can manifest as impetigo, a superficial skin condition that
often presents with "honey-crusted" lesions around the nose and mouth
6
Red neckerchief on pie chef
6
Streptococcus pyogenes is a significant cause of pharyngitis, often referred to
as "strep throat"
7
Red puffy gloves
7
Streptococcus pyogenes is one of the most common causes of skin infections,
including impetigo, cellulitis, erysipelas, and necrotizing fasciitis
8
Licking strawberry
8
Scarlet fever caused by pyrogenic exotoxin-producing Streptococcus pyogenes is
characterized by symptoms such as strawberry tongue (a red and swollen tongue
caused by the outermost layer of the tongue's surface peeling off), pharyngitis, and a
desquamative "sandpaper" rash that typically typically spares the palms and soles
9
Red neckerchief on cookie chef
9
Scarlet fever caused by pyrogenic exotoxin-producing Streptococcus pyogenes is
characterized by symptoms such as strawberry tongue, pharyngitis, and a
desquamative "sandpaper" rash that typically typically spares the palms and soles
10
Red frosting + not on hands and feet
10
Scarlet fever caused by pyrogenic exotoxin-producing Streptococcus pyogenes is
characterized by symptoms such as strawberry tongue, pharyngitis, and
a desquamative "sandpaper" rash that typically typically spares the palms and
soles
11
Superhero cape + bolt
11
The pyrogenic exotoxins expressed by Streptococcus
pyogenes are superantigens that are associated with toxic shock syndrome (TSS)
12
"B" + necrotic cookie
12
Some strains of Streptococcus pyogenes produce SpeB, a cysteine protease that
contributes to the rapid tissue destruction seen in necrotizing fasciitis
13
"M" on hat
13
The M protein is an virulence factor expressed on the surface of Streptococcus
pyogenes and plays multiple roles in its pathogenesis
14
Inhibiting eating
14
The M protein of Streptococcus pyogenes confers resistance to phagocytosis
15
Mitre hat
15
The M protein on the surface of Streptococcus pyogenes bacteria shares structural
similarities with human proteins found in the heart and other tissues → rheumatic heart
disease (the mitral valve is most commonly affected)
16
Red neckerchief on master chef
16
Rheumatic fever is a possible complication of untreated Streptococcus
pyogenes pharyngitis
17
"JONES" cupcakes
17
The JONES criteria is used for diagnosing acute rheumatic fever; J = joints, ♡ =
myocarditis, N = nodules, E = erythema marginatum, S = Sydenham chorea
18
"J" + elbow frosting
18
Rheumatic fever often presents with migratory polyarthritis, impacting larger joints
such as the knees and elbows
19
"♡"
19
Acute rheumatic fever can result in pancarditis, affecting the pericardium, myocardium,
and endocardium, with the latter primarily impacting the heart valves, especially the
mitral valve
20
"N" + nodular candies
20
In acute rheumatic fever, subcutaneous nodules may form, typically on joint extensor
surfaces like the elbows and forearms
21
"E" + ring pattern
21
In acute rheumatic fever, erythema marginatum can manifest as a non-itchy, ring-
shaped rash, primarily appearing on the trunk and limbs
22
"S" cupcake falling
22
Acute rheumatic fever can lead to Sydenham chorea, a neurological manifestation
characterized by sudden, involuntary, and purposeless movements primarily
affecting the face, hands, and feet, often accompanied by emotional instability and
muscle weakness; this symptom can emerge weeks to months after the initial
streptococcal infection
23
Glomerular knot
23
Post-streptococcal glomerulonephritis (PSGN) arises from immune complex
deposition in the glomeruli, typically presenting with features of nephritic syndrome
(hematuria, oliguria, hypertension, edema) when symptomatic
24
Cola
24
Acute PSGN cases may present with gross hematuria, frequently characterized as tea-
like, cola-hued, or rust-colored urine
25
Later in the month
25
PSGN typically manifests as nephritic syndrome a few weeks following an acute
streptococcal infection
26
Crumbs on face + red neckerchief
26
Both pharyngitis and soft tissue infections caused by Streptococcus pyogenes can
precede PSGN
27
Purple pencil
27
Early antibiotic treatment, particularly penicillin, of Streptococcus pyogenes pharyngitis
significantly reduces the risk of rheumatic fever; PSGN can still occur after an episode
of either streptococcal pharyngitis or skin infection even if the initial infection was
appropriately treated
28
Lysed "O" doughnuts
28
Streptolysin O is a Streptococcus pyogenes virulence factor that functions as
a hemolytic toxin, enabling the bacteria to lyse and damage host red blood cells and
immune cells, thereby aiding in evasion of the host immune response
29
"P" cupcakes
29
Streptokinase, a Streptococcus pyogenes virulence factor, is a proteolytic enzyme that
facilitates fibrin degradation by converting plasminogen to plasmin → invasion of
deeper tissues
30
DNA twists
30
DNases of Streptococcus pyogenes facilitate the degradation of host DNA, assisting the
bacteria in evading host immune defenses
31
Basset licking pastries
31
Streptococcus pyogenes is susceptible to bacitracin and pyrrolidonyl arylamidase
(PYR) test-positive, distinguishing it from Streptococcus agalactiae, which is bacitracin-
resistant and PYR test-negative
32
"O" doughnuts + antibody tongs
32
Antistreptolysin O titers are useful in diagnosing conditions like acute rheumatic fever
or PSGN that arise after a streptococcal pharyngeal infection; for streptococcal skin
infections, where ASO titers might be less responsive, clinicians often measure anti-
DNAse titers to enhance diagnostic sensitivity
Streptococcus iae (Group B Strep)

1
Galactic baby
1
Streptococcus agalactiae (group B strep) (a gram-positive coccus)
2
Purple hues
2
Streptococcus agalactiae is a gram-positive coccus
3
Hippo
3
Streptococcus agalactiae is hippurate hydrolysis positive; the hippurate hydrolysis
test helps differentiate Streptococcus agalactiae from other streptococci,
particularly Streptococcus pyogenes, which is hippurate hydrolysis negative
4
Glass helmet
4
Streptococcus agalactiae bacteria are surrounded by a polysaccharide capsule
5
CAMP tent + golden staff
5
When Streptococcus agalactiae and Staphylococcus aureus are grown together on
blood agar, the CAMP factor produced by S. agalactiae enhances the hemolysis
caused by S. aureus, resulting in a unique "arrowhead" zone of hemolysis; the CAMP
test is used to differentiate S. agalactiae from other streptococci
 6
Beta light bulb
6
Streptococcus agalactiae demonstrates beta-hemolysis, which refers to the ability to
completely lyse hemoglobin → clear, transparent zones around colonies on blood agar
7
Inhibited basset hound
7
Streptococcus agalactiae is bacitracin-resistant and pyrrolidonyl arylamidase (PYR)
test-negative, distinguishing it from Streptococcus pyogenes, which is bacitracin-
sensitive and PYR test-positive
8
Meningitis helmet
8
Streptococcus agalactiae is one of the leading causes of neonatal bacterial
meningitis
9
Red onesie
9
Streptococcus agalactiae is one of the most common causes of neonatal sepsis
10
Coughing baby
10
Neonates infected with Streptococcus agalactiae can present with pneumonia
11
Red arrow
11
When Streptococcus agalactiae and Staphylococcus aureus are grown together on
blood agar, the CAMP factor produced by S. agalactiae enhances the hemolysis caused
by S. aureus, resulting in a unique "arrowhead" zone of hemolysis; the CAMP test is
used to differentiate S. agalactiae from other streptococci
12
"35 wk"
12
Routine screening for Streptococcus agalactiae is recommended for pregnant women
between 35-37 weeks of gestation because it can be spread to the neonate during
passage through the birth canal if the mother is colonized
13
Purple pencil in mothership
13
If the screening test is positive for Streptococcus agalactiae during this gestational
window, intravenous penicillin is administered intrapartum
Streptococcus pneumoniae & viridans

1
Sir Pneumo
1
Streptococcus pneumoniae (a gram-positive coccus)
2
Purple hues
2
Streptococcus pneumoniae and viridans group streptococci are gram-positive cocci
3
"α knight tournament"
3
Streptococcus pneumoniae and viridans group streptococci demonstrate alpha
hemolysis, which refers to the partial breakdown of hemoglobin → greenish
discoloration around colonies on blood agar
4
Sir Pneumo's armor
4
Streptococcus pneumoniae bacteria are surround by a polysaccharide capsule
5
Sensitive chin
5
Streptococcus pneumoniae is distinguished from viridans group streptococci by
its sensitivity to optochin, an antibiotic used for identification of alpha hemolytic
streptococci
6
Double lances
6
Streptococcus pneumoniae bacteria appear as lancet-shaped diplococci on
microscopy
7
No bile boots
7
Streptococcus pneumoniae is bile-soluble, demonstrated by the lysis and
disappearance of its colonies on agar upon the addition of bile acids
8
Rusty chest armor
8
A possible clinical manifestation of Streptococcus pneumoniae infection is lobar
pneumonia, which is often associated with the production of rust-colored sputum
9
MOPS
9
Streptococcus pneumoniae is a leading cause of meningitis, otitis media,
pneumonia, and sinusitis (remembered by the acronym MOPS)
10
#1 sign
10
Streptococcus pneumoniae is a leading cause of meningitis, otitis media, pneumonia,
and sinusitis (MOPS)
11
IgA shield
11
The virulence factor IgA protease produced by Streptococcus pneumoniae cleaves IgA
antibodies → bacterial adherence to mucosal surfaces
12
Sickle
12
Patients with sickle cell disease have an increased susceptibility to infections by
encapsulated bacteria, such as Streptococcus pneumoniae
13
Macrolide crow
13
While penicillin or amoxicillin are first-line therapies against Streptococcus pneumoniae,
macrolides such as azithromycin and clarithromycin can be used as alternative options
 14
3 axes flag
14
While penicillin or amoxicillin are first-line therapies against Streptococcus
pneumoniae, ceftriaxone may be used to treat pneumococci that have reduced
susceptibility to penicillins
15
Vaccine sign
15
The CDC recommends pneumococcal conjugate vaccines (PCV) for young children,
certain at-risk individuals, and seniors without prior PCV. Pneumococcal
polysaccharide vaccine (PPSV23) is suggested for at-risk children and adults who've
had a PCV. Those who received a specific PCV can complete their series with another
PCV or PPSV23
16
Green jester
16
Viridans group streptococci (gram-positive cocci)
17
No armor
17
Viridans group streptococci are non-encapsulated
18
Resistant chin
18
Viridans group streptococci are distinguished from Streptococcus pneumoniae by
their resistance to optochin, an antibiotic used for identification of alpha hemolytic
streptococci
19
Protective bile boots
19
Viridans group streptococci are bile-insoluble, indicated by the persistence of their
colonies on agar after the addition of bile acids
20
Yellow teeth
20
Streptococcus mutans (part of the viridans group streptococci) is part of the normal flora
of the mouth and plays a role in tooth decay and the development of dental caries
21
Damaged mitre hat
21
Viridans group streptococci are a common cause of infective endocarditis in patients
with mitral valve disease
 22
Plate shield
22
Viridans group streptococci utilize dextrans (insoluble extracellular polysaccharides)
to adhere to tooth enamel and fibrin-platelet aggregates on damaged heart valves,
potentially leading to dental plaque and infective endocarditis, respectively
23
Deck of cards
23
Viridans group streptococci utilize dextrans (insoluble extracellular polysaccharides) to
adhere to tooth enamel and fibrin-platelet aggregates on damaged heart valves,
potentially leading to dental plaque and infective endocarditis, respectively
Enterococcus faecium & faecalis

1
"Caucus"
1
Enterococcus spp. (gram-positive cocci)
2
Purple hues
2
Enterococcus faecium and Enterococcus faecalis bacteria are gram-positive
3
"Resist the 6.5% N.Ca"
3
Enterococcus faecium and Enterococcus faecalis can grow in 6.5% hypertonic saline,
distinguishing them from most other gram-positive cocci
4
Green bile boots
4
Enterococcus faecium and Enterococcus faecalis can hydrolyze esculin in the
presence of bile, distinguishing them from most other gram-positive cocci
5
"Stop the FEES" + less people
5
Enterococcus faecium typically accounts for the minority of enterococcal infections
 6
"CALIfornia caucus" + more people
6
Enterococcus faecalis is typically responsible for the majority of enterococcal
infections
7
"Do U ♥ trees?"
7
Infections attributed to Enterococcus faecium and Enterococcus faecalis encompass a
range of conditions, such as UTIs (cystitis, pyelonephritis), endocarditis, and biliary
tree infections
8
Resisting entering van
8
Some strains of Enterococcus faecium and Enterococcus faecalis have evolved
resistance to numerous antibiotics, with vancomycin-resistant enterococci (VRE)
being particularly significant
9
Police line
9
For vancomycin-resistant enterococcal (VRE) infections, linezolid serves as an
effective treatment option
10
Tiger stripes
10
Tigecycline possesses activity against some VRE strains and might be considered as a
treatment option in specific clinical scenarios
Streptococcus gallolyticus (Group D Strep)

1
Galloping cow
1
Streptococcus bovis/equinus complex (SBSEC) → reclassified to
Streptococcus gallolyticus
2
Big D ears
2
Strep Gallolyticus are Group D streptococci
3
Purple moon
3
Strep gallolyticus are gram positive cocci in chains or pairs
4
Chains & pairs of planets
4
Strep gallolyticus are gram positive cocci in chains or pairs
5
Glass helmet
5
Strep gallolyticus is encapsulated
 6
Gamma aurora
6
Strep gallolyticus is gamma hemolytic (no growth on blood agar)
7
Liver + bile asteroid
7
Strep gallolyticus can grow in bile salt media
8
Moon moss
8
Strep gallolyticus forms biofilms on collagen-rich surfaces
9
Colon milky way
9
Strep gallolyticus is part of the normal GI tract flora in some animals and humans
10
Heart lantern
10
Strep gallolyticus can cause bacteremia and endocarditis
11
Crab constellation
11
Strong association between strep gallolyticus infection and colorectal neoplasia
12
Squid
12
Strep gallolyticus is sensitive to treatment with 3rd generation cephalosporins,
vancomycin & PCN
13
Van
13
Strep gallolyticus is sensitive to treatment with 3rd generation
cephalosporins, vancomycin & PCN
14
Purple pencil rocket
14
Streptococcus gallolyticus is sensitive to treatment with 3rd generation cephalosporins,
vancomycin & PCN
GRAM-POSITIVE BACILLI

Bacillus anthracis & cereus

1
King Anthra's axe
1
Bacillus anthracis (a gram-positive bacillus)
2
Purple hues
2
Bacillus anthracis and Bacillus cereus bacteria are gram-positive bacilli
3
Ring of fire
3
Cutaneous anthrax, a manifestation of Bacillus anthracis infection, typically presents as
a vesicle that undergoes central necrosis, leaving a black eschar with surrounding
edema
4
Chain of ships
4
Bacillus anthracis and Bacillus cereus are gram-positive bacilli that frequently grow
in chains
 5
"D" buckles + leather armor
5
The capsule of Bacillus anthracis is composed of poly-γ-D-glutamic
acid (a polypeptide)
6
Aerobic bellows
6
Bacillus anthracis and Bacillus cereus are aerobic or facultative anaerobic bacteria
7
Spored walnuts
7
Bacillus anthracis and Bacillus cereus can form metabolically inactive spores, which
are resistant to various environmental stresses, including heat, radiation, and chemicals
8
"EF" shield
8
The edema factor (EF) exotoxin of Bacillus anthracis is a calmodulin-dependent
adenylate cyclase that converts ATP into cAMP, contributing to the establishment of
infections
9
Camps
9
The edema factor (EF) exotoxin of Bacillus anthracis is a calmodulin-dependent
adenylate cyclase that converts ATP into cAMP, contributing to the establishment of
infections
10
"LF" shield
10
The lethal factor (LF) exotoxin of Bacillus anthracis acts as a protease that targets
mitogen-activated protein kinase (MAPK), resulting in the disruption of cellular signaling
pathways and impairment of the host's immune response
11
"LF" viking burning map
11
The lethal factor (LF) exotoxin of Bacillus anthracis acts as a protease that targets
mitogen-activated protein kinase (MAPK), resulting in the disruption of cellular
signaling pathways and impairment of the host's immune response
12
Sheep wool
12
Historically, wool sorters were at risk of contracting pulmonary anthrax, also known
as "woolsorters’ disease", through inhalation of spores present in animal wool,
although this transmission mode is now rare in developed nations
13
Bloody axe
13
Inhalational anthrax can manifest as hemorrhagic mediastinitis, and radiological
examinations may show a widened mediastinum
14
Widened mast
14
Inhalational anthrax can manifest as hemorrhagic mediastinitis, and radiological
examinations may show a widened mediastinum
15
Flower shield
15
The standard treatment for anthrax is a fluoroquinolone (ciprofloxacin, levofloxacin) or
doxycycline
16
Bicycle tire shield
16
The standard treatment for anthrax is a fluoroquinolone (ciprofloxacin, levofloxacin)
or doxycycline
17
Rice bowl
17
Bacillus cereus (a gram-positive bacillus)
18
Vomiting
18
Consumption of food (especially reheated rice) contaminated with Bacillus cereus can
induce symptoms like nausea, vomiting, diarrhea and abdominal cramps within ~1-6
hours after ingestion
19
Reheating rice
19
Bacillus cereus infection is classically associated with reheated rice (warm
temperatures → spore germination → preformed enterotoxin production→ early onset
food poisoning)
Clostridium tetani

1
Monkey testing lab
1
Clostridium tetani (a gram-positive bacillus)
2
Purple hues
2
Clostridium tetani is a gram-positive bacillus
3
Anaerobic gas mask
3
Clostridium tetani is an obligately anaerobic bacterium
4
Spored walnuts
4
Clostridium tetani can form metabolically inactive spores, which are resistant to
various environmental stresses, including heat, radiation, and chemicals
5
Barbed wire
5
Clostridium tetani infection is classically associated with puncture wounds from rusty
nails and barbed wire
 6
Rusty nails
6
Clostridium tetani infection is classically associated with puncture wounds from rusty
nails and barbed wire
7
Soil
7
Clostridium tetani spores are are widely distributed in soil
8
Evil grin
8
The classic clinical manifestations of tetanus include trismus, a spastic paralysis of the
jaw muscles (lockjaw), and risus sardonicus, a sustained contraction of the facial
muscles that results in an “evil smile” appearance
9
Arched back
9
Spasmodic contractions in tetanus can involve the neck and back, leading
to opisthotonos, characterized by backward arching of the head, neck, and spine
10
Retrograde pulley
10
The tetanus toxin, tetanospasmin, is transported retrogradely along axons to the
spinal cord and the brainstem
11
Cutting SNARE trap
11
Tetanospasmin functions as a protease that targets SNARE proteins, which are
essential for the fusion of synaptic vesicles with the neuronal membrane and
subsequent neurotransmitter release
12
Trapped "G&G" researcher
12
Tetanospasmin cleaves SNARE proteins in Renshaw cells (inhibitory interneurons in
the spinal cord) → reduced release of GABA and glycine (inhibitory
neurotransmitters) → muscle spasms, spastic paralysis, and hyperreflexia
13
Wrench and saw
13
Tetanospasmin cleaves SNARE proteins in Renshaw cells (inhibitory interneurons in
the spinal cord) → reduced release of GABA and glycine (inhibitory neurotransmitters)
→ muscle spasms, spastic paralysis, and hyperreflexia
 14
Orange toxoid syringe
14
Tetanus prevention involves the administration of the tetanus vaccine, which is
composed of an inactivated form of the tetanus toxin; this vaccine is often co-
administered with diphtheria toxoid and acellular pertussis vaccine as DTaP for infants
and young children and Tdap for older children and adults
Clostridium botulinum

1
Robots
1
Clostridium botulinum (a gram-positive bacillus)
2
Purple hues
2
Clostridium botulinum is a gram-positive bacillus
3
Tin can
3
The anaerobic conditions in improperly canned food can promote the germination and
growth of Clostridium botulinum spores
4
Nuts
4
Clostridium botulinum can form metabolically inactive spores, which are resistant to
various environmental stresses, including heat, radiation, and chemicals
5
Anaerobic gas mask
5
Clostridium botulinum is an obligately anaerobic bacterium
6
Limp neck
6
Botulism typically starts with cranial nerve dysfunction, often referred to as "bulbar
symptoms," and progresses to symmetrical descending weakness affecting the trunk,
limbs, and smooth muscles, culminating in flaccid paralysis
7
Droopy eyelids
7
Botulism typically starts with cranial nerve dysfunction, manifesting as "bulbar
symptoms" like ptosis (drooping of the eyelids) and diplopia (double vision)
8
Cutting ACh current
8
Botulinum toxin is a protease that targets SNARE proteins → inhibition of
acetylcholine release from presynaptic motor neurons → flaccid paralysis
9
Floppy baby robot
9
Infant botulism, often referred to as "floppy baby syndrome," results from the
ingestion of spores that colonize the underdeveloped GI tract of infants, leading to toxin
production; in contrast, adults usually contract botulism from consuming preformed toxin
10
Nuts in honey
10
Honey can contain Clostridium botulinum spores, which is why it's recommended to
avoid giving honey to infants younger than 12 months of age
Clostridium

1
Private Ringen
1
Clostridium perfringens (a gram-positive bacillus)
2
Purple hues
2
Clostridium perfringens is a gram-positive bacillus
3
Wounded soldier
3
Clostridium perfringens infections can occur in various wound types, especially those
contaminated with soil or fecal matter; they have historically been associated
with wounds sustained in military combat settings
4
Spored walnuts
4
Clostridium perfringens can form metabolically inactive spores, which are resistant to
various environmental stresses, including heat, radiation, and chemicals
5
Soil
5
The spores of Clostridium perfringens are commonly found in soil
6
Anaerobic gas mask
6
Clostridium perfringens is an aerotolerant anaerobe (it does not utilize oxygen but can
survive in its presence)
7
Gas vapor
7
Infections by Clostridium perfringens can lead to necrotizing skin and soft tissue
conditions, potentially progressing to gas gangrene (myonecrosis)
8
Alpha flag + phospholipid clothespins
8
The alpha toxin of Clostridium perfringens is a lecithinase that targets and cleaves
lecithin phospholipids in cell membranes → RBC hemolysis → failure to supply
oxygen to tissues
9
Lysed tomatoes
9
The alpha toxin of Clostridium perfringens is a lecithinase that targets and cleaves
lecithin phospholipids in cell membranes → RBC hemolysis → failure to supply oxygen
to tissues
10
"DOUBLE fine zone"
10
Clostridium perfringens displays a distinctive double zone of hemolysis on blood agar
plates due to the hemolytic activity of both its alpha and theta toxins (complete
hemolysis of inner zone due to theta toxin and incomplete hemolysis of outer zone due
to alpha toxin)
11
Purple pencil
11
Effective management of tissue infections caused by Clostridium perfringens involves
surgical debridement coupled with antimicrobial therapy, with penicillin G being a
commonly preferred choice
12
Muddy water
12
Clostridium perfringens can cause food poisoning primarily associated with ingestion of
its preformed toxin in improperly cooked or stored foods, leading to symptoms
like watery diarrhea; symptoms usually present within 2-12 hours
Clostridioides difficile

1
Different cluster candies
1
Clostridioides difficile
2
Purple rod-shaped candy
2
C. difficile is a gram-positive bacillus
3
Gas mask
3
C. difficile is an obligate anaerobe
4
Walnuts
4
C. difficile forms spores; bacterial spores are metabolically dormant and resistant to
heat, radiation, and many chemical agents)
5
Normal flowers
5
Both toxigenic and nontoxigenic strains of C. difficile can colonize the gut as part
of normal flora
 6
Eating chocolate walnuts
6
C. difficile is transmitted via the fecal-oral route, specifically through ingestion of
bacterial spores
7
First-aid kit
7
C. difficile is primarily a nosocomial (hospital-acquired) infection (increasing # of
cases are community acquired)
8
“Hand wash”
8
C. difficile spores are resistant to alcohol-based hand sanitizers → wash hands with
soap and water instead
9
Gown and gloves
9
To prevent transmission of spores, cases of C. difficile infection are placed on contact
precautions (use of non-sterile gown and gloves while in patient room)
10
Abx candy disrupting worker
10
Most C. difficile infections are precipitated by exposure to antibiotics (disrupts the gut
microbiome by killing commensal gut bacteria → allows C. difficile to grow unchecked)
11
“Keep CLEAN”
11
Antibiotics notorious for causing C. difficile infection include clindamycin,
fluoroquinolones, cephalosporins, and penicillins
12
Flower
12
Antibiotics notorious for causing C. difficile infection include
clindamycin, fluoroquinolones, cephalosporins, and penicillins
13
Cephalopod
13
Antibiotics notorious for causing C. difficile infection include clindamycin,
fluoroquinolones, cephalosporins, and penicillins
14
Purple pencil
14
Antibiotics notorious for causing C. difficile infection include clindamycin,
fluoroquinolones, cephalosporins, and penicillins
15
Prazole parasol
15
Proton pump inhibitors (PPIs) are a risk factor for C. difficile infection (decreased
stomach acidity → ↑ germination of spores into vegetative form)
16
Toxin kid “A”
16
Toxigenic strains of C. difficile produce toxin A (TcdA) and toxin B (TcdB, more
virulent)
17
Larger toxin kid “B”
17
Toxigenic strains of Clostridioides difficile produce toxin A (TcdA) and toxin B (TcdB,
more virulent)
18
Gummy bears
18
C. difficile toxins A & B act on colonic mucosal cells
19
Destroying licorice skeleton
19
C. difficile toxins A & B disrupt the cytoskeleton (via inactivation of Rho proteins)
20
Destruction of gummy junctions
20
C. difficile toxins A & B disrupt intercellular tight junctions (via inactivation of Rho
proteins) → ↑ paracellular permeability
21
Pseudomembrane wrapping
21
C. difficile infection classically causes pseudomembranous colitis (yellow-white
exudates on the surface of colonic mucosal cells)
22
Smelly chocolate waterfall
22
C. difficile infection typically presents with high-volume watery diarrhea that has a
characteristically foul odor
23
White birds
23
C. difficile infection may also present with leukocytosis and fever
24
Toasting mallow bird
24
C. difficile infection may also present with leukocytosis and fever
25
Giant colon pipe
25
C. difficile infection can be complicated by toxic megacolon
26
Gnaats detecting toxin kid in chocolate
26
Diagnose C. difficile infection by testing stool for toxin-producing strains
using NAAT (nucleic acid amplification, usually PCR, detects toxin-encoding
genes) or EIA
27
Antibody stick detecting toxin kid in chocolate
27
Diagnose C. difficile infection by testing stool for toxin-producing strains using NAAT
or EIA (enzyme immunoassay, uses antibodies to detect toxins)
28
Gluten-free mystery box
28
Stool testing for glutamate dehydrogenase via EIA detects all strains of C.
difficile (does not distinguish toxigenic vs nontoxigenic)
29
Van with tongue ramp
29
Oral vancomycin is first-line therapy for Clostridioides difficile infection
30
Fiddler
30
Fidaxomicin is effective for Clostridioides difficile infection
31
Metro with ivy
31
IV metronidazole is effective against severe Clostridioides difficile infection
32
Bacterial plants in colon pipe
32
Fecal microbiota transplant is used in cases of recurrent Clostridioides difficile
infection
Corynebacterium diphtheriae

1
Bull
1
Corynebacterium diphtheriae (a gram-positive bacillus)
2
Purple hues
2
Corynebacterium diphtheriae is a gram-positive bacillus
3
V + Y design
3
Corynebacterium diphtheriae typically forms V- or Y-shaped chains due to its unique
snapping division during cellular replication
4
Red and blue maracas
4
The cytoplasm of Corynebacterium diphtheriae contains metachromatic granules that
demonstrate a characteristic staining pattern with aniline dyes: the granules appear
red, while the remainder of the bacillus stains blue
5
Bowtie + elongated accordion
5
The diphtheria toxin produced by Corynebacterium diphtheriae employs a mechanism
of ADP ribosylation to inhibit elongation factor-2 (EF-2), inhibiting protein synthesis;
this mechanism is shared by exotoxin A produced by Pseudomonas aeruginosa
6
Grey cotton candy + plastic wrap
6
Exposure to the diphtheria toxin leads to cell necrosis and the formation of a dense,
grey pseudomembrane over the tonsils and pharyngeal area
7
Bull's neck
7
Severe laryngeal diphtheria can result in cervical edema and cervical
lymphadenopathy, giving rise to the characteristic "bull neck" appearance
8
Water droplets
8
Corynebacterium diphtheriae is primarily transmitted via respiratory droplets
9
Heart cape
9
Systemic absorption of the diphtheria toxin can result in significant cardiac toxicity,
most commonly manifesting as myocarditis and arrhythmias
10
Myelin sausages + back of throat
10
The diphtheria toxin can induce nerve damage, leading to demyelination and a
paralysis that generally begins in the posterior pharyngeal wall and soft palate
11
Black "TELE"
11
Tellurite agar is a selective medium that allows the growth of Corynebacterium
diphtheriae, which forms gray/black colonies due to the reduction of tellurite
12
Laughing
12
Corynebacterium diphtheriae can be cultivated on Loeffler's medium, which is used
primarily to enhance the bacterium's morphological features, facilitating easier
identification
13
Tongue lick
13
The ELEK test is utilized to differentiate toxigenic from non-toxigenic strains
of Corynebacterium diphtheriae
 14
Toxoid syringes
14
The vaccine against Corynebacterium diphtheriae consists of an inactivated form of
the diphtheria exotoxin and is often given in combination with the tetanus toxoid and
acellular pertussis vaccine (DTaP, DT, Tdap, and Td vaccines provide varying levels of
protection against diphtheria, tetanus, and pertussis, catering to different age groups
and medical needs)
Listeria monocytogenes

1
Santa's list
1
Listeria monocytogenes (a gram-positive bacillus)
2
Purple ornaments
2
Listeria monocytogenes is a gram-positive bacillus
3
Beta light bulb
3
Listeria monocytogenes is beta-hemolytic, but often produce very narrow zones of
hemolysis on blood agar
4
Tumbling ornaments
4
In broth cultures, Listeria monocytogenes exhibits a distinctive tumbling motility
5
Rocket
5
Listeria monocytogenes can form actin "rocket tails" in host cells, facilitating
intracellular movement and cell-to-cell spread
6
Rocket in bag
6
Listeria monocytogenes is a facultative intracellular pathogen, capable of living both
inside and outside host cells
7
Catalase cat
7
Listeria monocytogenes produces catalase, an enzyme that converts hydrogen
peroxide into water and oxygen
8
Icicles
8
Listeria monocytogenes can survive and multiply in cold temperatures, contributing to
its survival and spread in refrigerated foods
9
Milk
9
Outbreaks of listeriosis have been frequently associated with consumption of dairy
products such as milk, soft cheeses, and ice cream
10
Soft cheese
10
Outbreaks of listeriosis have been frequently associated with consumption of dairy
products such as milk, soft cheeses, and ice cream
11
Pregnant woman
11
Pregnant women are significantly more susceptible to listeriosis compared to the
general population due to immunological changes during pregnancy
12
Baby in meningitis helmet
12
Listeria monocytogenes is a significant cause of neonatal meningitis
13
Old Santa Claus
13
Listeria monocytogenes is a significant cause of meningitis in adults over 60 years and
immunocompromised individuals due to its ability to evade and exploit weakened
immune defenses
14
Amp
14
Ampicillin remains the primary antibiotic for treating Listeria monocytogenes infections
GRAM-POSITIVE BRANCHING FILAMENTOUS RODS

Actinomyces israelii

1
Israeli soldier
1
Actinomyces israelii (a gram-positive bacillus)
2
Purple hues
2
Actinomyces israelii is a gram-positive bacillus
3
Branching tree
3
Actinomyces israelii is characterized by its unique filamentous, branching
bacilli structure
4
Anaerobic gasmask
4
Actinomyces israelii is classified as a facultative anaerobe, though optimal growth is
seen under anaerobic conditions
5
Jaw wrap
 5
Actinomyces israelii is a typically a harmless member of the oral flora, but can lead
to cervicofacial actinomycosis in cases where mucosal injury occurs in the oral or
jaw areas, notably during dental procedures
6
Storm drain
6
In cervicofacial actinomycosis, lesions often form sinus tracts extending to the skin,
emitting a purulent discharge containing hard, yellowish "sulfur granules"
7
Yellow rocks
7
In cervicofacial actinomycosis, lesions often form sinus tracts extending to the skin,
emitting a purulent discharge containing hard, yellowish "sulfur granules"
8
Purple pencil
8
Penicillin G is the preferred antibiotic for treating Actinomyces israelii infections, often
requiring extended treatment duration for complete resolution
Nocardia asteroids

1
NO limit CARD game
1
Nocardia asteroides (a gram-positive bacillus)
2
Purple hues
2
Nocardia asteroides is a gram-positive bacillus
3
Branching tree
3
Nocardia asteroides is characterized by its unique filamentous, branching
bacilli structure
4
Aerobic bellows
4
Nocardia asteroides is an obligate aerobic organism, requiring oxygen for its survival
and growth
5
Soil
5
Nocardia asteroides is predominantly found in soil
 6
Mycolic acid tassels
6
Nocardia asteroides exhibits partial acid-fast staining due to the presence of mycolic
acids in its cell wall
7
Pink acid fast gun
7
Carbol fuchsin, utilized in acid-fast staining, helps in identifying bacteria with mycolic
acids in their cell walls, including Nocardia asteroides
8
Catalase cat
8
Nocardia asteroides produces catalase, an enzyme that converts hydrogen peroxide
into water and oxygen
9
Ammonia spray
9
Nocardia asteroides produces urease, an enzyme that hydrolyzes urea into carbon
dioxide and ammonia
10
Immunocompromised cane + man
10
Nocardiosis predominantly affects immunocompromised patients and is more
common in men than women (~2:1-3:1)
11
Dented badge over lungs
11
Pulmonary nocardiosis may manifest with multiple solid nodules and cavities,
resembling tuberculosis
12
Coughing
12
Patients with pulmonary nocardiosis may experience symptoms similar to pneumonia
13
Tuberculosis cactus
13
Pulmonary nocardiosis may manifest with multiple solid nodules and
cavities, resembling tuberculosis
14
Hole in hat
14
CNS nocardiosis is a rare infection that may present with brain
abscesses and multiple ring-enhancing lesions
15
Red cow spots
15
Cutaneous nocardiosis is a a rare manifestation of infection that can result from either
direct bacterial inoculation into the skin or as a secondary manifestation of disseminated
pulmonary infection
16
Sulfa eggs
16
Sulfonamides, specifically trimethoprim-sulfamethoxazole, are the treatment of
choice for Nocardia asteroides infections
GRAM-NEGATIVE COCCI

Neisseria Overview

1
Red curtains
1
Neisseria are gram-negative bacteria
2
Handcuffs
2
Neisseria are gram-negative diplococci
3
Movie candy
3
Both N. meningitidis and N. gonorrhoeae perform glucose oxidation
4
Blue onyx pendant
4
Neisseria are oxidase-positive
5
Chocolate bar
5
Neisseria grow on chocolate agar
6
Vice city Private iNvestigator
6
VPN is a selective growth medium for Neisseria species;
contains Vancomycin, Polymyxin, Nystatin, and trimethoprim
7
Starring Thayer Martin
7
Thayer-Martin growth medium is comprised of VPN (vancomycin, polymyxin, nystatin,
and trimethoprim)
8
MAC, P.I.
8
The membrane attack complex (MAC), a complex of proteins formed at the terminal
stages of the complement pathway, is an essential host defense mechanism
against Neisseria infections
9
5-9 PM
9
Complement factors C5 to C9 deficiency increases susceptibility to
recurrent Neisseria infections
10
Variable pili earrings
10
Pili enable mucosal surface attachment; pili undergo frequent antigenic variation to
evade the immune system
11
Torn Ace card
11
Neisseria express an IgA protease, an enzyme that cleaves the IgA molecule at the
hinge region
12
The LOSt Flame
12
Lipooligosaccharide (LOS) is a proinflammatory molecule expressed by Neisseria
13
Opaque window
13
Opa (opacity) proteins are outer surface proteins which aid in bacterial colonization
Neisseria meningitidis

1
General Mater
1
Neisseria meningitidis, a gram-negative diplococci human pathogen (AKA
meningococcus; cause of bacterial (meningococcal) meningitis)
2
Single MALT whiskey
2
Neisseria meningitidis is a maltose fermenter
3
Pili earring hanging by nose
3
Neisseria meningitidis express pili which promote nasopharyngeal colonization
4
Liquor capsule
4
Neisseria meningitidis possesses a protective capsule which prevents phagocytosis
5
Bourbon in liquor capsule
5
The capsule of meningococcus type B has poor immunogenicity
6
Torn ace card
6
Neisseria meningitidis expresses IgA protease which aid in mucosal adherence
7
The LOSt flame
7
Neisseria meningitidis expresses lipooligosaccharide (LOS),
a proinflammatory compound
8
Spreading sweat droplets
8
Neisseria meningitidis is transmitted by respiratory droplets
9
Military photo + diploma
9
Neisseria meningitidis outbreaks may occur in military quarters and college
dormitories
10
Flowing red fountain
10
Neisseria meningitidis set up infection by invading and spreading hematogenously
11
Burning LOSt flame
11
Neisseria meningitidis causes a proinflammatory response generated by
lipooligosaccharide
12
Spreading embers
12
LOS outgrows the surface area of the bacterium forming blebs, which generate a
massive inflammatory response
13
Red vines overtaking fountain
13
Proinflammatory response → vascular injury (endothelial damage, capillary leakage,
intravascular thrombosis, and hemorrhagic necrosis)
14
Lightning bolt
14
Capillary leakage → fluid extravasation → hypovolemia → shock
15
Fallen plates + stacked firewood
15
Vasoconstriction and endothelial injury → thrombocytopenia and thrombosis
16
Rolled dice
16
Neisseiria meningitidis can cause dysfunction of the coagulation cascade known
as disseminated intravascular coagulation (DIC)
17
Protein C corporal
17
Protein C dysfunction may play a role in the development and progression of
coagulopathy
18
WF Water tower
18
Adrenal involvement in meningococcemia can lead to a syndrome of adrenal
insufficiency known as Waterhouse-Friderichsen syndrome
19
Falling peanuts and candies + hanging bananas
19
Adrenal insufficiency → metabolic derangements
→ hypoglycemia, hyponatremia, HYPERkalemia
20
Meningitis mohawk
20
Neisseria meningitidis are a cause of bacterial meningitis
21
Antibody flame arrow
21
Sequelae of Neisseria meningitidis infection include immune-complex mediated
complications (e.g., pericarditis, arthritis)
22
Flame bandana
22
The prodrome of Neisseria meningitidis infection is a febrile, flu-like illness
23
Pain lines
23
Neisseria meningitidis infection can manifest as intense myalgias
24
Red necktie
24
Neisseria meningitidis infection can manifest as a pharyngitis (resembling ‘strep
throat’)
 25
Red spotted jacket
25
Neisseria meningitidis infection can manifest as a petechial rash
26
2nd place
26
Neisseria meningitidis is the second most common cause of acute bacterial
meningitis
27
Neck brace
27
Meningococcal meningitis can present with fever, headache and neck stiffness
28
Needle cork
28
Performance of a lumbar puncture and cerebrospinal fluid analysis in the setting of
meningococcal meningitis → elevated protein, low glucose, leukocytosis, and
organisms
29
Tri-axe
29
Ceftriaxone is an effective antibiotic against Neisseria meningitidis
30
Purple pencil
30
Penicillin is an effective antibiotic against Neisseria meningitidis
31
Chloroform
31
Chloramphenicol is used for penicillin and beta-lactam allergic patients
32
PPx shield
32
Post-exposure prophylaxis for close contacts (>8 hours in the prior 7 days; rifampin,
ceftriaxone, or ciprofloxacin can be used)
33
Collector’s rifle
33
Rifampin is commonly used for post-exposure prophylaxis against Neisseria
meningitidis
34
Flower
 34
Ciprofloxacin can be used for post-exposure prophylaxis against Neisseria
meningitidis
35
4 syringe shooters under capsule
35
The quadrivalent capsular polysaccharide vaccine contains the capsular
polysaccharides of four serotypes of meningococcus
36
It’s DIPped
36
The conjugate vaccine is comprised of capsular antigens linked to a carrier protein,
the diphtheria toxoid
37
Syringe in Bourbon
37
The vaccine against serotype B consists of recombinant proteins
38
Spleen-shaped hole
38
The vaccine is indicated in special patient populations including asplenic patients
39
MAC’s 5-9
39
The vaccine is indicated in special patient populations including patients with terminal
hypocomplementemia (C5-C9)
Neisseria gonorrhoeae

1
Gonzo’s Bar
1
Neisseria gonorrhoeae are gram-negative diplococci and the cause of gonorrhea
2
2 red cherries in mixed drink
2
Facultative intracellular within PMNs
3
Broken cake capsule
3
Neisseria gonorrhoeae are not encapsulated
4
Embracing couple
4
Gonorrhea is a (reportable) sexually transmitted infection (STI)
5
Care-free workers
5
N. gonorrhoeae can reside in asymptomatic carriers
6
Blindfolded baby cherub
 6
N. gonorrhoeae can be transmitted to the newborn via direct contact in the birth
canal, which causes a neonatal eye infection (aka ophthalmia neonatorum)
7
Leaky tap
7
Gonorrhea can manifest with urethritis, which is often asymptomatic, but may be
associated with WBCs in urine (i.e., pyuria without dysuria)
8
Flaming milk bomb
8
Gonorrhea can manifest with symptomatic urethritis, including dysuria and discharge
9
Apple seat cushion
9
Ascending gonococcal urethritis can involve the prostate, causing prostatitis
10
Orchid
10
Ascending gonococcal urethritis can involve the testis, causing orchitis
11
Neck of chandelier leaking candle wax
11
Gonorrhea can manifest with mucopurulent cervicitis
12
Dripping red wax between calendar dates
12
Intermenstrual bleeding, such as post-coital spotting, is an alarming symptom of
gonococcal cervicitis
13
Arms of chandelier leaking candle wax
13
Ascending pelvic infection (PID) can involve the fallopian tubes (i.e., salpingitis, tubo-
ovarian abscess), which can cause ectopic pregnancy and infertility
14
Fitz, Hugh, & Curtis Trio
14
Fitz-Hugh-Curtis syndrome, a complication of PID, occurs when gonococcal infection
spreads to the liver and peritoneum
15
Violin strings
15
Inflammation of the peritoneum can lead to long and thin, string-like adhesions that
adhere to the capsule of the liver (referred to as ‘violin string’ adhesions)
16
Cracked piano leg
16
Disseminated gonococcal infection includes purulent arthritis
17
Broken bass heel string
17
Disseminated gonococcal infection includes tenosynovitis commonly affecting
the Achilles tendon
18
Red suits
18
Disseminated gonococcal infection includes dermatitis
19
Gnats
19
Nucleic acid amplification testing, or NAAT, is a choice test for diagnosis of Neisseria
gonorrhoeae
20
3 axes in Gonzo’s bar
20
Ceftriaxone is a drug of choice for treating Neisseria gonorrhoeae infections
21
Clam lady + Cycle + Crow
21
Treat for presumptive chlamydia co-
infection with doxycycline or macrolide antibiotics
22
Protective equipment
22
Counsel patients on barrier methods, such as consistent condom use, to prevent
gonorrhea transmission
Moraxella catarrhalis

1
Moray eel-cat
1
Moraxella catarrhalis
2
Glow of red flames
2
M. catarrhalis is a gram negative diplococcus
3
Nose of plane
3
M. catarrhalis can colonize the nasopharynx
4
Blue gem ring
4
M. catarrhalis is an oxidase positive aerobe; can form a biofilm, produces beta
lactamase; + hockey-puck sign
5
Bellows-fish
5
M. catarrhalis is an oxidase positive aerobe; can form a biofilm, produces beta
lactamase; + hockey-puck sign
 6
Algae
6
M. catarrhalis is an oxidase positive aerobe; can form a biofilm, produces beta
lactamase; + hockey-puck sign
7
Broken beta-lactam gyroscope
7
M. catarrhalis is an oxidase positive aerobe; can form a biofilm, produces beta
lactamase; + hockey-puck sign
8
Sliding plane wheel
8
M. catarrhalis is an oxidase positive aerobe; forms biofilms, produces beta lactamase; +
hockey-puck sign
9
Amelia Ear-hurt
9
M. catarrhalis a common cause of bacterial OM in kids
10
Red leaky plane nose
10
M. catarrhalis is a common cause of bacterial sinusitis
11
Blue bloater fish
11
M. catarrhalis is associated with COPD exacerbations and COPD-related
bronchopneumonia
12
Cephalopod
12
M. catarrhalis is sensitive to cephalosporins, amoxicillin-clav, TMP-SMX,
fluoroquinolones
13
Box of “AMMO” + clarinet harpoon
13
Moraxella catarrhalis is sensitive to cephalosporins, amoxicillin-clavulanate, TMP-
SMX, fluoroquinolones
14
Rotten sulfa-eggs
14
Moraxella catarrhalis is sensitive to cephalosporins, amoxicillin-clav, TMP-SMX,
fluoroquinolones
 15
Flower anemones
15
Moraxella catarrhalis is sensitive to cephalosporins, amoxicillin-clav, TMP-
SMX, fluoroquinolones
GRAM-NEGATIVE BACILLI: ENTERIC TRACT

Klebsiella pneumoniae, Enterobacter spp., Serratia marcescens

1
Red hues
1
Enterobacter spp., Serratia marcescens, and Klebsiella pneumoniae are gram-
negative bacilli
2
Oxygen mask
2
Enterobacter spp., Serratia marcescens, and Klebsiella pneumoniae can lead
to pneumonia and urinary tract infections
3
Urine bag
3
Enterobacter spp., Serratia marcescens, and Klebsiella pneumoniae can lead to
pneumonia and urinary tract infections
4
Hospital
4
Enterobacter spp., Serratia marcescens, and Klebsiella pneumoniae are
significant nosocomial pathogens
 5
Pills
5
Enterobacter spp., Serratia marcescens, and Klebsiella pneumoniae commonly
exhibit multidrug resistance
6
Pink milk carton
6
Lactose fermentation by Klebsiella pneumoniae and some Enterobacter species is
typically rapid; Serratia marcescens can appear initially as non-lactose fermenting due
to slow fermentation
7
Pterodactyl
7
Enterobacter spp. (a gram-negative bacillus)
8
Flying pterodactyl
8
Enterobacter spp. are motile bacteria
9
Triceratops
9
Serratia marcescens (a gram-negative bacillus)
10
Triceratops charging
10
Serratia marcescens is a motile bacterium
11
Red triceratops residue
11
Serratia marcescens produces prodigiosin, a distinct red pigment
12
"Kleb" tail
12
Klebsiella pneumoniae (a gram-negative bacillus)
13
3 "A" kleb tail
13
Klebsiella pneumoniae infections are notably common in individuals
with alcoholism and can lead to lung abscesses; these bacteria are also associated
with cases of aspiration pneumonia
14
Spike coverings
 14
Klebsiella pneumoniae bacteria are surrounded by a significant polysaccharide
capsule
15
Currant jelly
15
The sputum in Klebsiella pneumoniae infections is often described as viscous and
resembling "currant jelly"
16
Stuck in jelly
16
Klebsiella pneumoniae bacteria are immotile
17
Cavitary lesion CXR
17
Klebsiella pneumonia can present with pulmonary necrosis and cavitation, resembling
tuberculosis
18
Ammonia bottle
18
Klebsiella pneumoniae produces urease, an enzyme that hydrolyzes urea into carbon
dioxide and ammonia
Salmonella: Intro to Salmonella & NTS

1
Red rod salmon
1
Salmonella is a gram-negative rod
2
Swimming salmon
2
Salmonella utilizes peritrichous flagellar motility
3
Fishbowl capsule
3
Salmonella produces a protective polysaccharide capsule (O-antigen capsule)
4
Open cage
4
Salmonella is capable of surviving and reproducing inside or outside of host
macrophages (facultative intracellular)
5
Salmo crossing M window
5
Invasive Salmonella serotypes (all typhoidal and some NTS bacteria) cross the
intestinal barrier through enterocytes and M cells (specialized epithelial cells that
overly lymphoid tissue of Peyer’s patches)
6
Lemons
6
Salmonella is acid-labile = mechanism of host resistance
7
Farting salmon
7
Salmonella produces hydrogen sulfide gas (H2S) → black colonies on certain growth
media
8
Black plates
8
Production of hydrogen sulfide gas (H2S) → black colonies on certain growth media
9
“Thai Food”
9
Typhoidal Salmonella (TS) serotypes: Salmonella Typhi and Salmonella Paratyphi
10
“Auntie Rita’s” Turmeric
10
Nontyphoidal Salmonella (NTS) includes many serotypes other than S. Typhi
and S. Paratyphi (Salmonella Enteritidis and Salmonella Typhimurium are the most
common)
11
Smorgasbord
11
NTS is associated with water and foodborne illness (including numerous fresh and
processed foods)
12
Chicken and eggs
12
NTS is zoonotic and poultry (e.g. chicken, eggs) are the primary reservoir
13
Turtle handler
13
Animal contact (reptiles, amphibians) can transmit NTS → nontyphoidal Salmonella
infection
14
Queasy kid with flame bandana
14
Self-limited gastroenteritis (fever, nausea, vomiting, abdominal cramps, diarrhea) is
the most common presentation of NTS infection
15
Red river
15
Extraintestinal NTS → bloodstream infection → severe sepsis or death
16
Aorta tree
16
Extraintestinal NTS → bloodstream infection → disseminated infection (endovascular
infection, meningitis, osteomyelitis)
17
Glowing brain tree
17
Extraintestinal NTS → bloodstream infection → disseminated infection (endovascular
infection, meningitis, osteomyelitis)
18
Fish bones
18
Extraintestinal NTS → bloodstream infection → disseminated infection (endovascular
infection, meningitis, osteomyelitis)
19
Sickling guy
19
Osteomyelitis is a complication of disseminated invasive NTS in patients with sickle
cell disease and other underlying conditions.
20
“Don’t touch” Abx
20
NTS gastroenteritis is a self-limited infection; manage with supportive care, as
antibiotics are generally not indicated
21
Flowers
21
Fluoroquinolones are the preferred antibiotic for NTS (to prevent invasive NTS when
indicated and to treat invasive NTS infections)
22
3 axes
22
3rd Generation Cephalosporins (e.g. ceftriaxone) are an alternative antibiotic with
coverage for NTS (to prevent invasive NTS when indicated and to treat invasive NTS
infections)
Salmonella: Typhoidal Salmonella

1
“Thai Food” sign
1
Salmonella Typhi and Salmonella Paratyphi are typhoidal Salmonella (TS) serotypes,
which cause enteric (typhoid) fever in humans
2
Parrot
2
Salmonella Paratyphi
3
“No animals” sign
3
Humans are the exclusive reservoir of TS
4
Outhouse
4
TS infections are acquired through consumption of food or water contaminated by
human feces (fecal-oral route)
5
Parrots in papaya tree
5
TS infections can lead to colonization of the gallbladder → chronic, asymptomatic
carrier state
6
Thai mountains
6
TS infections predominantly occur in developing countries, which may be affected by
poor sanitation (i.e., endemic regions are found within South-Central and East Asia as
well as Southern Africa)
7
Vi-olet punch
7
TS bacteria possess the Vi polysaccharide capsular antigen → resist host
defenses (blunt neutrophilic response: inhibit neutrophil chemotaxis, opsonization, and
oxidative burst)
8
MacroCAGE
8
TS initiates a monocytic immune response: monocytes (i.e, macrophages) get
recruited to areas that harbor TS bacteria, such as Peyer patches)
9
Caged parrots
9
TS bacteria undergo extensive proliferation within macrophages
10
Flaming lanterns
10
Fever is a classic, early sign of TS infection
11
Stepwise rock island
11
Enteric fever begins with a stepwise rising fever with high plateau
12
Fallen heart watch
12
Relative bradycardia (a heart rate lower than expected for a given body temperature)
is a characteristic feature of enteric fever that typically develops in the first week of
illness
13
Red algae
13
Flat, rose-colored macules (“rose spots”) may develop on the chest and abdomen in
enteric fever (typically during the second week of illness)
14
Dugong with liver and spleen spots
14
Sepsis, hepatosplenomegaly, and intestinal bleeding and perforation may develop in
the third week of enteric fever if left untreated
15
Leaking intestine engine
15
Sepsis, hepatosplenomegaly, and intestinal bleeding and perforation may develop in
the third week of enteric fever if left untreated
16
Flowers
16
Enteric fever requires treatment with an antibiotic, typically a fluoroquinolone
17
“LIVE music” sign + syringe mic
17
A live attenuated vaccine is taken orally to protect against enteric fever
18
Skull and Syringe shirt + Vi-olet punch
18
The Vi capsular polysaccharide vaccine is administered as an injection to protect
against enteric fever
19
Rhesus + Vi-olet punch
19
The conjugate vaccine (Vi capsular polysaccharide vaccine linked to Tetanus
toxoid protein) is administered as an injection to provide robust protection against
enteric fever
Shigella spp.

1
She-gorilla
1
Shigella spp. (gram-negative bacilli)
2
Red hues
2
Shigella spp. are gram-negative bacilli
3
Green tutu
3
On Hektoen enteric agar (HE), Shigella spp. often form blue-green colonies because
they do not produce hydrogen sulfide (H_₂S); in contrast, Salmonella spp.
are characterized by black colonies on HE, which result from their ability to generate
H_₂S
4
Chained she-gorilla
4
Shigella spp. are immotile bacteria
5
Protected from acid
5
Shigella spp. have increased resistance to gastric acid compared to many other
bacteria, enabling infection at lower inocula
6
Motion tail
6
Shigella spp. induce apoptosis in host cells and manipulate eukaryotic
cytoskeletal actin filaments to move intracellularly, making them facultative
intracellular bacteria
7
"M" pad
7
Shigella spp. invade M cells within the Peyer’s patches of the gastrointestinal mucosa
8
Red stool
8
The main sign of shigellosis is diarrhea, which often is bloody
9
Inflammatory flames
9
The diarrhea associated with shigellosis is often inflammatory, evidenced by the
presence of leukocytes in the stool
10
Glomerular knot
10
In rare cases, Shiga toxin produced by Shigella dysenteriae type 1 can cause hemolytic
uremic syndrome (HUS) due to cytotoxic effects on endothelial cells of the capillaries
in glomeruli; this damage triggers a series of events including the aggregation of
platelets, leading to thrombocytopenia, microangiopathic hemolytic anemia (MAHA),
and acute kidney injury
11
Popped red balloon
11
In MAHA, a part of HUS, red blood cells are mechanically lysed and fragmented
into schistocytes as they pass through small, damaged blood vessels filled with clots,
leading to a reduction in their overall count
12
Aggregation of plates
12
In rare cases, Shiga toxin produced by Shigella dysenteriae type 1 can cause hemolytic
uremic syndrome (HUS) due to cytotoxic effects on endothelial cells of the capillaries in
glomeruli; this damage triggers a series of events including the aggregation of
platelets, leading to thrombocytopenia, microangiopathic hemolytic anemia (MAHA),
and acute kidney injury due to impaired renal function
 13
Young ringmaster
13
HUS occurs more commonly in children under 5 years of age
14
60S sand timer
14
Shiga toxin produced by Shigella dysenteriae, which is structurally and functionally
similar to Shiga-like toxin of enterohemorrhagic E. coli, acts by inactivating the 60S
ribosomal subunit, leading to inhibition of protein synthesis
15
Turkey baster
15
Shigella spp. possess a type III secretion system, a needle-like apparatus used to
inject effector proteins into host cells; these proteins help the bacteria evade host
immune responses and promote their invasion and intracellular survival
Escherichia coli (ETEC & EHEC)

1
"E cola"
1
Escherichia coli (a gram-negative bacillus)
2
Red hues
2
E. coli is a gram-negative bacillus
3
Pink milk carton
3
E. coli is lactose-fermenting, forming pink colonies on MacConkey agar
4
Glass capsule
4
Many strains of E. coli are surrounded by a polysaccharide capsule
5
K cake + glass capsule
5
Some strains of E. coli express K capsule (K antigen), a key virulence factor
responsible for extraintestinal infections
6
Green coaster
6
E. coli typically forms distinctive metallic green colonies on eosin methylene blue
(EMB) agar
7
Catalase cat
7
E. coli produces catalase, an enzyme that converts hydrogen peroxide into water and
oxygen
8
Fimbrae ribbons
8
The fimbriae of E. coli facilitate adhesion to host cells, an important factor in
pathogenesis
9
"1" bladder cup
9
E. coli is the most common cause of urinary tract infections
10
Blood red shake
10
E. coli is a major causative agent of gram-negative sepsis
11
K cake + baby + meningitis helmet
11
E. coli strains possessing the K1 capsular antigen are associated with neonatal
meningitis
12
Hamburger
12
Enterohemorrhagic E. coli (EHEC) is often transmitted through contaminated,
undercooked meat
13
Red stool
13
EHEC can cause bloody diarrhea due to the damage it inflicts on the lining of the
intestine, primarily through the production of Shiga-like toxins
14
Sorbitol free soda
14
EHEC strains, such as O157:H7, are characterized by their inability to ferment
sorbitol, differentiating them from most other E. coli strains
15
She-gorilla toy
15
EHEC produces a Shiga-like toxin, with effects nearly identical to the Shiga toxin
of Shigella dysenteriae, leading to the inactivation of the 60S ribosomal subunit in host
cells → disruption of protein synthesis
 16
Glomerular straw + plate aggregation
16
Shiga-like toxin can cause hemolytic uremic syndrome (HUS) due to cytotoxic effects on
endothelial cells of the capillaries in the glomerulus; this damage triggers a series of
events including the aggregation of platelets, leading to thrombocytopenia,
microangiopathic hemolytic anemia (MAHA), and acute kidney injury
17
Popped red balloon
17
In MAHA, a part of HUS, red blood cells are mechanically lysed and fragmented
into schistocytes as they pass through small, damaged blood vessels filled with clots,
leading to a reduction in their overall count
18
"$1.57"
18
E. coli O157:H7 is an enterohemorrhagic E. coli serotype that produces Shiga-like
toxin, which can cause bloody diarrhea and hemolytic uremic syndrome (HUS)
19
Water truck
19
Enterotoxigenic E. coli (ETEC) is a common cause of "traveler's
diarrhea," presenting with symptoms such as watery diarrhea, abdominal cramping,
nausea, and vomiting
20
eL Agua
20
Certain strains of ETEC produce a heat-labile toxin (LT), leading to increased adenylyl
cyclase activity → elevated cAMP levels → inhibited absorption of sodium and chloride
and increased secretion of chloride and water → secretory (watery) diarrhea
21
San Gabriel
21
Some strains of ETEC synthesize a heat-stable toxin (ST) that elevates guanylate
cyclase activity → elevated cGMP levels → increased chloride secretion and reduced
sodium absorption → secretory (watery) diarrhea
22
Spilling water
22
ETEC is a common cause of "traveler's diarrhea," presenting with symptoms such
as watery diarrhea, abdominal cramping, nausea, and vomiting
Yersinia enterocolitica & pestis

1
English terrier
1
Yersinia enterocolitica (a gram-negative bacillus)
2
"Yersin's pets"
2
Yersinia pestis (a gram-negative bacillus)
3
Red hues
3
Yersinia pestis and Yersinia enterocolitica are gram-negative bacilli
4
Puppy poop
4
Yersinia enterocolitica is part of the normal intestinal flora of dogs and can be
transmitted via dog feces
5
Daycare-aged
5
Outbreaks of Yersinia enterocolitica can occur in daycare settings due to fecal-oral
transmission
 6
Milk
6
Yersinia enterocolitica can be transmitted through improperly handled or
contaminated milk and dairy products
7
Icicles
7
Yersinia enterocolitica can survive at temperatures approaching and even below
0°C, posing a significant food safety risk
8
Safety pin
8
Yersinia pestis and Yersinia enterocolitica exhibit bipolar staining, resembling a safety
pins under a microscope
9
Glass capsule
9
Yersinia pestis and and Yersinia enterocolitica possess a bacterial capsule
10
Red stool
10
Common symptoms of Yersinia enterocolitica infection include fever, abdominal pain,
and diarrhea, which is often bloody
11
Licking abdomen
11
Yersinia enterocolitica infection can present acute right lower quadrant abdominal pain,
mimicking appendicitis (pseudoappendicitis)
12
Rodent
12
Rodents, including rats and prairie dogs, serve as primary reservoirs for Yersinia
pestis
13
Flea
13
Fleas are the vectors of Yersinia pestis, transmitting the bacteria between animals and
to humans
14
Armpit lumps
14
Intensely painful and swollen lymph nodes (buboes) are characteristic of Yersinia
pestis infection (bubonic plague)
15
Red shirt
15
Disseminated Yersinia pestis infections can lead to severe manifestations like tissue
necrosis, disseminated intravascular coagulation (DIC), septic shock, and multi-
organ dysfunction
16
Turkey baster
16
Yersinia spp. possess a type III secretion system to translocate Yersinia outer
proteins (Yops) directly into host cells
17
Sai
17
Aminoglycosides, particularly streptomycin, are effective against Yersinia spp.
18
Bicycle tire
18
Tetracyclines are effective against Yersinia spp.
19
"Vaccinate + KILLED"
19

1. An inactivated (killed) vaccine against Yersinia pestis is available, though it is

1
Camping bears
1
Campylobacter jejuni (a gram-negative bacillus)
2
Red hues
2
Campylobacter jejuni is a gram-negative bacillus
3
Fire
3
Campylobacter jejuni is a thermophilic bacterium, growing optimally at around 42°C
4
Chicken
4
Animals such as poultry, cattle, sheep, and dogs are common reservoirs
for Campylobacter jejuni
5
Red stool
5
Symptoms of Campylobacter jejuni infection include cramping, abdominal pain, fever,
and diarrhea, which is often bloody
 6
Curved mustache
6
Campylobacter jejuni is a curved bacillus, often described as having a “seagull wing”
shape on microscopy
7
Blue oxidase ring
7
Campylobacter jejuni produces oxidase, an enzyme that plays a vital role in aerobic
respiration
8
Bear invading cooler
8
Campylobacter jejuni invades epithelial cells of the gastrointestinal tract, leading to
diarrhea
9
Slapping knee
9
Campylobacter jejuni infection is associated with reactive arthritis, a condition
characterized by joint pain and swelling that occurs after certain bacterial infections
10
Sausage links around ankle
10
Campylobacter jejuni infection is one of the most common causes of Guillain-Barre
syndrome, a neurological disorder characterized by progressive bilateral ascending
weakness and loss of reflexes
Vibrio spp.

1
Mustache + red coat + blue ring
1
Vibrio bacteria are comma-shaped, gram-negative, oxidase-positive bacilli
2
Bags of rice
2
Vibrio cholerae can cause profuse watery diarrhea, commonly referred to as "rice-
water"
3
Outhouse
3
Transmission of Vibrio cholerae is fecal-oral
4
BASE
4
Vibrio bacteria preferentially grow in alkaline media
5
Lemons
5
Vibrio bacteria are extremely acid-labile, and high number of ingested organisms are
required to cause infection
 6
Raft rope
6
The toxin-coregulated pilus of Vibrio cholerae allows the bacteria to attach to (but do
not invade) the intestinal mucosa
7
GaS lamp
7
Cholera toxin permanently activates Gs protein → overactivation of adenylate cyclase
→ elevated cAMP, increased sodium and chloride efflux → profuse watery diarrhea
8
cAMP
8
Cholera toxin activates adenylate cyclase in epithelial cells of the intestine → elevated
cAMP, increased sodium and chloride efflux → profuse watery diarrhea
9
Drinking water
9
Oral rehydration is the primary treatment of cholera
10
Oysters
10
Vibrio parahaemolyticus and vulnificus infections are associated with consumption
of raw oysters
11
V-shaped anchor + damaged boat
11
Vulnificus can cause severe wound infections
Helicobacter pylori

1
Helicopter
1
Helicobacter pylori (a gram-negative bacillus)
2
Red helicopter
2
Helicobacter pylori is a gram-negative bacillus
3
Helicopter rotor
3
Helicobacter pylori is a motile bacterium
4
Curved mustache
4
Helicobacter pylori is a curved bacillus
5
Ammonia spray
5
Helicobacter pylori produces urease, an enzyme that converts urea to ammonia and
carbon dioxide (H. pylori urea production is the basis of the urea breath test)
6
Oxidase blue ring
6
Helicobacter pylori produces oxidase, an enzyme that plays a vital role in aerobic
respiration
7
Bullet holes
7
Helicobacter pylori infection is strongly associated with gastric and duodenal ulcers
8
Cancer crab
8
Chronic Helicobacter pylori infection significantly elevates the risk of developing gastric
adenocarcinoma and mucosa-associated lymphoid tissue (MALT) lymphomas
9
Mucus-covered tissues
9
Chronic Helicobacter pylori infection significantly elevates the risk of developing gastric
adenocarcinoma and mucosa-associated lymphoid tissue (MALT) lymphomas
10
Proton bomb blocking gas flow
10
Treatment of Helicobacter pylori infection often involves triple therapy, comprising
a proton pump inhibitor, clarithromycin, and either amoxicillin or metronidazole
11
Duodenal gas hose
11
Helicobacter pylori infection is diagnosed in 90%+ of duodenal ulcer cases
12
Ammo
12
Treatment of Helicobacter pylori infection often involves triple therapy, comprising a
proton pump inhibitor, clarithromycin, and either amoxicillin or metronidazole
13
"Keep clear" + macrolide crow
13
Treatment of Helicobacter pylori infection often involves triple therapy, comprising a
proton pump inhibitor, clarithromycin (a macrolide), and either amoxicillin or
metronidazole
Proteus mirabilis

1
Proteus
1
Proteus mirabilis (a gram-negative bacillus)
2
Red hues
2
Proteus mirabilis is a gram-negative bacillis
3
Swarming tentacles
3
Proteus mirabilis demonstrates notable swarming motility on agar culture plates
4
Staghorn helmet
4
Infections with urease-positive bacteria like Proteus mirabilis can lead to the formation
of staghorn calculi (struvite stones) in the urinary tract
5
Ammonia bottle
5
Proteus mirabilis produses urease, an enzyme that hydrolyzes urea into carbon dioxide
and ammonia
 6
Stone
6
Urease activity of Proteus mirabilis raises urine pH, creating an alkaline environment
conducive to the precipitation of struvite stones
7
Peeing
7
Proteus mirabilis is a common causative agent of urinary tract infections, often
associated with complicated cases or abnormal urinary tracts
8
Stinky fish
8
Proteus mirabilis produces a characteristic fishy odor
9
Eggs
9
Trimethoprim-sulfamethoxazole (a sulfonamide) is active against Proteus mirabilis
GRAM-NEGATIVE BACILLI: RESPIRATORY TRACT

1
Boarded soldier
1
Bordetella pertussis (a gram-negative coccobacillus)
2
Red hues
2
Bordetella pertussis is a gram-negative coccobacillus
3
Filamentous streamers
3
Bordetella pertussis bacteria utilize filamentous hemagglutinin as an adhesin for
attachment to the respiratory epithelium
4
Bowtie + GI uniform
4
The pertussis toxin ribosylates inhibitory Gi proteins, inactivating them --> increased
cAMP production
5
Leg cast + wheelchair
5
The pertussis toxin ribosylates inhibitory Gi proteins, inactivating them --> increased
cAMP production
6
Army camp
6
The pertussis toxin ribosylates inhibitory Gi proteins, inactivating them --> increased
cAMP production
7
WBC popcorn
7
The pertussis toxin disrupts chemokine receptor signaling, impairing lymphocyte
migration to lymphoid tissues and leading to their accumulation in the
bloodstream (lymphocytosis)
8
"EF" shield
8
The pertussis toxin (adenylate cyclase toxin), which increases cAMP, has a mechanism
similar to that of Bacillus anthracis's edema factor (EF)
9
Cutting tracheal grass
9
The tracheal cytotoxin of Bordetella pertussis specifically targets and damages
ciliated respiratory epithelial cells
10
"WHOOP!"
10
The paroxysmal stage of Bordetella pertussis infection typically develops 1-2 weeks
after symptoms first start; this stage is characterized by a 'whooping' cough and can
persist for 2-6 weeks or longer
11
"100 Days War!"
11
Pertussis, or whooping cough, can extend over several months, earning the
nickname '100-day cough'
12
Crows
12
Macrolides are effective against Bordetella pertussis and can ameliorate
symptoms when started early after infection onset, before the appearance of
paroxysmal cough
13
Covering beak
13
Whooping cough is transmitted via respiratory droplets
14
Syringe + a cellular phone
14
The DTaP and Tdap vaccines combine acellular Bordetella pertussis antigens with
toxoids for tetanus and diphtheria; DTaP is typically administered to infants and young
children and Tdap is recommended for older children and adults
Haemophilus influenzae

1
Phyllis's chocolates
1
Haemophilus influenzae (a gram-negative coccobacillus)
2
Red hues
2
Haemophilus influenzae is a gram-negative coccobacillus
3
Pink oval candies
3
Haemophilus influenzae is a gram-negative coccobacillus
4
"Chocolate"
4
Chocolate agar, which is enriched with lysed blood cells, is the ideal growth medium
for Haemophilus influenzae, as it supplies necessary nutrients and factors
5
"5¢"
5
Haemophilus influenzae requires NAD+ (factor V) and hemin (factor X) for growth
6
"10¢"
6
Haemophilus influenzae requires NAD+ (factor V) and hemin (factor X) for growth
7
Aerosol spray
7
Haemophilus influenzae is transmitted via respiratory droplets
8
Screaming kid + drool
8
Epiglottitis caused by Haemophilus influenzae, primarily affecting children between
the ages of 2 and 6 years, presents with symptoms such as dysphagia, drooling, and
inspiratory stridor
9
Cherries
9
Epiglottitis caused by Haemophilus influenzae often presents with a 'cherry red
epiglottis' due to its swollen and inflamed appearance
10
Plugging ears
10
Haemophilus influenzae is a common cause of acute and recurrent otitis media
11
Bee + glass capsule
11
Haemophilus influenzae type b (Hib) possesses a polysaccharide capsule that aids
in evasion of the host immune response
12
Meningitis helmet + holding head
12
Hib is a common cause of meningitis in adolescents, which often presents with
meningismus (clinical syndrome of headache, neck stiffness, photophobia, and often
nausea/vomiting)
13
Sickles
13
Patients with sickle cell disease or asplenia are more susceptible to infections from
encapsulated bacteria like encapsulated strains of Haemophilus influenzae
14
Kid with syringe
14
Infants and toddlers should get an Hib vaccine series to prevent serious infections
15
"Sugar DIPped"
15
The capsular polysaccharide of Hib is a poor immunogen in infants; to enhance
immunogenicity, the Hib polysaccharide is covalently coupled to diphtheria toxoid
16
"$2.18"
16
The Hib vaccine is administered in a series of injections between the ages of ~2-18
months
17
3 axes
17
Third-generation cephalosporins, such as ceftriaxone, are the initial antibiotics of
choice for Hib meningitis
18
Rifle
18
Rifampin prophylaxis is recommended for close contacts of patients with invasive Hib
infection
Legionella pneumophila

1
Legion battleship
1
Legionella pneumophila (a gram-negative bacillus)
2
Silver paint over red
2
Legionella pneumophila requires a special silver stain for proper visualization as it
stains poorly with Gram stain
3
Blue oxidase ring
3
Legionella pneumophila is catalase and oxidase-positive
4
Charcoal
4
Legionella pneumophila is optimally cultured on buffered charcoal yeast extract
(BCYE) agar, which is enriched with iron plus cysteine as an essential growth factor
5
S.S. Cysteine + iron anchor
5
Legionella pneumophila requires cysteine and iron for its growth, which are both
incorporated into buffered BCYE agar
6
Steaming pontiac
6
Pontiac fever, caused by Legionella pneumophila, manifests as a brief, self-resolving
respiratory illness with symptoms resembling a mild flu
7
Patchy lower lung blueprint
7
In Legionnaires disease, a severe form of pneumonia caused by Legionella
pneumophila, chest X-rays often reveal patchy consolidation, predominantly in
the mid-to-lower zones
8
Falling salt
8
Legionnaires disease can induce electrolyte disorders, such as hyponatremia,
hypokalemia, and hypophosphatemia
9
Clutching head
9
Neurological manifestations of Legionnaires disease can include symptoms
like headache and confusion
10
Brown paint
10
Diarrhea, nausea, and vomiting are common extrapulmonary symptoms of
Legionnaires disease
11
Burning furnace
11
Patients with Legionnaires disease often present with a significant fever, usually
surpassing 39°C (102.2°F)
12
Cigarette
12
Cigarette smokers are more susceptible to developing Legionnaires disease (as well
as other pulmonary infections)
13
Pee stream
13
The diagnosis of Legionella pneumophila infection is often established through a urine
antigen test, which detects specific bacterial antigens in the patient's urine
 14
Macrolide crows
14
Macrolides, particularly azithromycin, are effective against Legionella pneumophila
15
Flower
15
Fluoroquinolones, including levofloxacin and moxifloxacin, are effective
against Legionella pneumophila
Pseudomonas aeruginosa

1
Pseudo Mona
1
Pseudomonas aeruginosa (a gram-negative bacillus)
2
Red bathtub
2
Pseudomonas aeruginosa is a gram-negative bacillus
3
Water
3
Pseudomonas aeruginosa is commonly found in aquatic environments (e.g., lakes,
rivers, swimming pools)
4
Blue oxidase ring
4
Pseudomonas aeruginosa produces oxidase, an enzyme that plays a vital role in
aerobic respiration
5
Catalase cat
5
Pseudomonas aeruginosa produces catalase, an enzyme that converts hydrogen
peroxide into water and oxygen
6
Blue-green residue
6
Pseudomonas aeruginosa produces characteristic pigments, such as pyocyanin
(blue), pyoveridin (yellow-green), pyomelanin (brown), and pyorubin (red)
7
Aromatic grapes
7
Cultures of Pseudomonas aeruginosa often emit a fruity, grape-like odor
8
Aerobic bellows
8
Pseudomonas aeruginosa is an obligate aerobe, requiring oxygen for growth and
survival
9
Nurse
9
Pseudomonas aeruginosa is a prevalent cause of hospital-acquired infections
10
Chloride + coughing
10
Pseudomonas aeruginosa is a major cause of lung infection and respiratory
failure in cystic fibrosis patients
11
Candy + mortar and pestle + fish
11
Diabetics and intravenous drug users have an increased susceptibility
to Pseudomonas osteomyelitis
12
Glass capsule
12
Pseudomonas aeruginosa produces a capsule-like polysaccharide called alginate
13
Burning fire
13
Burn injuries significantly elevate the risk of wound infections caused
by Pseudomonas aeruginosa
14
Chamber pot
14
Pseudomonas aeruginosa is frequently associated with urinary tract infections,
particularly in the presence of indwelling urinary catheters
15
Bathtub
15
Pseudomonas aeruginosa can cause hot tub folliculitis, characterized by itchy red
bumps around hair follicles
16
Dalmatian spots
16
Ecthyma gangrenosum, characterized by black, necrotic skin lesions, can be a
manifestation of Pseudomonas aeruginosa sepsis
17
Running dalmatian
17
Pseudomonas aeruginosa is a motile bacterium, exhibiting swarming motility on
semisolid surfaces
18
Ear trumpet
18
Pseudomonas aeruginosa is a common causative agent of otitis externa, an infection
of the outer ear canal often referred to as swimmer’s ear
19
Accordion + bowtie
19
The exotoxin A of Pseudomonas aeruginosa inactivates elongation factor-
2 through ADP ribosylation, a mechanism akin to that of diphtheria toxin
20
Piper
20
Piperacillin and ticarcillin are effective against Pseudomonas aeruginosa
21
Flower
21
Fluoroquinolones can be used to treat Pseudomonas aeruginosa infections;
however, P. aeruginosa easily becomes resistant to these drugs
22
Sai
22
Aminoglycosides (e.g., tobramycin, gentamicin, amikacin) are commonly used to
treat Pseudomonas aeruginosa infections
Burkholderia pseudomallei & cepacia complex

1
Burkhold burglar
1
Burkholderia spp. bacteria are gram-negative
2
Red rod-shaped roof
2
Burkholderia spp. bacteria are gram-negative
3
Cat
3
Burkholderia spp. bacteria are catalase-positive
4
Bellows
4
Burkholderia spp. bacteria are obligately aerobic pathogens
5
Blue ring
5
Burkholderia spp. bacteria are oxidase-positive
6
Muddy bath
6
Burkholderia spp. bacteria are transmitted through direct contact with contaminated
soil or water
 7
Running water faucet
7
Peak incidence of burkholderia spp. bacteria during the wet season
8
Melody
8
Burkholderia pseudomallei causes melioidosis
9
Palm tree
9
Melioidosis is seen mostly in tropical areas (e.g. Southeast Asia, South Asia, Australia)
10
Lung armor plates
10
Burkholderia pseudomallei causes pneumonia
11
TB cactus with holes
11
Melioidosis presents similarly to tuberculosis (w/ or w/out cavitary lesions)
12
Lung armor plates
12
Burkholderia cepacia complex causes pneumonia
13
Crutches
13
Burkholderia cepacia complex (BCC) commonly
affects immunocompromised individuals (e.g. patients with cystic fibrosis)
14
Sappy tree branch
14
Burkholderia cepacia complex (BCC) commonly affects immunocompromised
individuals (e.g. patients with cystic fibrosis)
15
Red ball lantern lights
15
Burkholderia spp. bacteria causes abscesses involving the skin and/or organs
16
Pills
16
Burkholderia spp. bacteria commonly exhibit multidrug resistance
GRAM-NEGATIVE BACILLI: ZOONOTICS

Bartonella henselae

1
Bart the leopard
1
Bartonella henselae (a gram-negative bacillus)
2
Leopard
2
Bartonella henselae is the causative agent of cat-scratch disease, a zoonotic infection
typically transmitted through cat scratches or bites
3
Red pillow
3
Bartonella henselae is a gram-negative bacillus
4
Silver Starry Night
4
The Warthin-Starry silver stain is used to visualize Bartonella henselae in tissue
samples
5
Cat scratches
 5
Transmission of cat-scratch disease primarily occurs through cat scratches, bites, or
bites from infected fleas
6
Armpit ruffles
6
A common clinical presentation of cat-scratch disease includes axillary
lymphadenopathy following a cat scratch or bite
7
Healthy young princess
7
Cat-scratch disease predominantly affects immunocompetent individuals; however, it
can also occur in immunocompromised patients, potentially with more severe symptoms
8
Cat scratches + immunocompromised cane
8
Bacillary angiomatosis is a vascular, proliferative form of Bartonella henselae infection
that predominantly affects immunocompromised individuals
9
Red polka dots
9
Skin lesions in bacillary angiomatosis often start as small reddish papules and can
progress to larger, highly vascular nodules
10
Immunocompromised cane
10
Immunocompromised patients, such as those with HIV/AIDS, are at increased risk for
developing bacillary angiomatosis
11
Bicycle wheel
11
Bartonella henselae infection is often treated with doxycycline or erythromycin
12
Macrolide crow
12

Bartonella henselae infection is often treated with doxycycline

1
"Bruce farms"
1
Brucella spp. (gram-negative coccobacilli)
2
Red barn
2
Brucella spp. are gram-negative coccobacilli
3
Cow
3
Brucellosis is a notable zoonotic infection, commonly transmitted to humans through
direct contact with infected animals such as cows, pigs, sheep, and goats
4
Pig
4
Brucellosis is a notable zoonotic infection, commonly transmitted to humans through
direct contact with infected animals such as cows, pigs, sheep, and goats
5
Milk bucket
5
A significant route of Brucellosis transmission is through the consumption
of unpasteurized dairy products from infected animals
6
Open gate
6
Brucella spp. are facultative intracellular bacteria, capable of surviving and replicating
within host macrophages
7
Sweating + thin farmer
7
Acute brucellosis typically presents with nonspecific symptoms including fever, night
sweats, and anorexia
8
Undulating hills
8
Brucellosis is characteristically associated with undulant fever, marked by periodic
intensification and remission of fever over time
9
Liver + spleen spots
9
Brucella spp. preferentially infect organs of the reticuloendothelial system, like
the liver and spleen, often resulting in hepatosplenomegaly
10
Fish bones
10
Musculoskeletal complications, such as osteomyelitis, are among the most common
sequelae of brucellosis
11
Windmill wheel
11
Effective treatment for brucellosis typically involves a combination therapy
of doxycycline and rifampin or doxycycline and streptomycin
12
Rifle
12
Effective treatment for brucellosis typically involves a combination therapy of
doxycycline and rifampin or doxycycline and streptomycin
Francisella tularensis

1
Francis the rabbit
1
Francisella tularensis (a gram-negative coccobacillus)
2
Rabbit
2
Francisella tularensis has a diverse animal reservoir, including rabbits, rodents, and
other mammals
3
Ticks
3
Francisella tularensis is transmitted by various arthropod vectors such as ticks, deer
flies, horse flies, and mosquitoes
4
Red radishes
4
Francisella tularensis is a gram-negative coccobacillus
5
Open cage
5
Francisella tularensis is a facultative intracellular pathogen, surviving and replicating
within macrophages
6
Rabbit holes
6
Tularemia can manifest as painful skin ulcers and necrosis, typically at the site of
infection, such as a tick bite
7
Tunnels to rotting radishes
7
Francisella tularensis can disseminate through the lymphatic system to
the reticuloendothelial organs, causing inflammation and necrosis
8
Mounds around rabbit
8
Tularemia is often characterized by painful regional lymphadenopathy
9
Sai
9
Aminoglycosides, particularly streptomycin and gentamicin, are effective against
tularemia
Pasteurella multocida

1
Louis Pasteur
1
Pasteurella multocida (a gram-negative coccobacillus)
2
Red hues
2
Pasteurella multocida is a gram-negative coccobacillus
3
Labrador
3
Pasteurella multocida, a zoonotic pathogen, is commonly transmitted through animal
bites and scratches, particularly from dogs and cats
4
Inflamed red bite
4
Infections with Pasteurella multocida can lead to rapid-onset cellulitis, often
developing within 24 hours post-bite or scratch
5
Fish bones
5
Pasteurella multocida infection can lead to more severe complications
like osteomyelitis, especially following deeper wound infections
6
Catalase cat
6
Pasteurella multocida produces catalase, an enzyme that converts hydrogen peroxide
into water and oxygen
7
Oxidase blue ring
7
Pasteurella multocida produces oxidase, an enzyme that plays a vital role in aerobic
respiration
8
Glass capsule
8
Pasteurella multocida bacteria are surrounded by a polysaccharide capsule
9
Sheep's blood
9
Pasteurella multocida grows readily on 5% blood agar
10
Safety pin
10
Pasteurella multocida exhibits bipolar staining, resembling a safety pin under a
microscope
11
Purple pencil
11
Penicillin G is the treatment of choice for Pasteurella multocida infections
Anaplasma phagocytophilum & Ehrlichia chaffeensis

1
Indoor saloon
1
Anaplasma phagocytophilum and Ehrlichia chaffeensis are obligate
intracellular bacteria
2
Red checkered tablecloths
2
Anaplasma phagocytophilum and Ehrlichia chaffeensis are gram negative bacteria
3
Ana
3
Anaplasma phagocytophilum
4
Black leg chaps
4
Transmission of Anaplasma phagocytophilum = black-legged tick (Ixodes spp.); also
causative agent of Lyme disease and Babesiosis
5
Mouse running under Ana
5
Reservoir host of Anaplasma phagocytophilum = white-footed mouse
 6
Deer taxidermy between Ana and Earl
6
Reservoir hosts of Anaplasma phagocytophilum and Ehrlichia chaffeensis = white-
tailed deer
7
Earl licking chops
7
Ehrlichia chaffeensis
8
Texas flag shirt
8
Transmission of Ehrlichia chaffeensis = lone star tick (Amblyomma americanum)
9
Red face + fanning self
9
Anaplasmosis and ehrlichiosis may present with flu-like symptoms (e.g. fevers, chills,
headache, myalgias, fatigue)
10
Bloated belly
10
Anaplasmosis and ehrlichiosis may present with GI symptoms (e.g. nausea/vomiting,
abdominal pain)
11
Empty pans
11
Pancytopenia
12
Mulberry pie on serving dish
12
Peripheral blood smear with Wright-Giemsa stain = leukocytes with
morulae (anaplasma → granulocytes; ehrlichia → monocytes)
13
Bicycle
13
Treatment of anaplasmosis and ehrlichiosis = doxycycline
MYCOBACTERIA

1
Tuberculosis cactus
1
Mycobacterium tuberculosis (an acid-fast bacillus)
2
Mycolic acid tassels
2
Mycobacterium tuberculosis stains acid-fast due to the high mycolic acid content in its
cell membrane
3
Fuschia gun and holster
3
The Ziehl-Neelsen method uses carbol fuchsin stain to detect acid-fast bacteria, such
as Mycobacterium tuberculosis
4
"Lowenstein General Store"
4
Mycobacterium tuberculosis is cultured on Lowenstein-Jensen agar, a selective
medium designed for its growth
5
Aerobic bellows
5
Mycobacterium tuberculosis is an obligate aerobe, requiring high oxygen levels for
growth and survival
6
Jail cage
6
Mycobacterium tuberculosis can evade host defenses by surviving and replicating
within macrophages
7
Cord-like lasso + cage
7
Cord factor of Mycobacterium tuberculosis is a membrane glycolipid that
inhibits macrophage function, prevents phagolysosomal fusion, induces an
inflammatory response, and contributes to granuloma formation
8
Spurs + phagosome-lysosome dust clouds
8
Sulfatides in Mycobacterium tuberculosis are crucial for evading the host's immune
system, particularly by inhibiting phagosome-lysosome fusion in macrophages and
modulating immune responses
9
Bullet holes in middle lung cactus
9
In primary tuberculosis (TB), the areas most often seen affected on a CXR are
the middle and lower parts of the lungs
10
Swollen cacti flowers
10
Primary TB often manifests with enlarged hilar lymph nodes in the mediastinum
11
Gun Complex
11
The Ghon complex, a distinctive radiographic sign of primary TB, consists of
a calcified lung lesion (Ghon focus) and nearby enlarged lymph nodes
12
Necrotic cage wagons
12
TB is known for forming caseous necrotic granulomas, which are composed of a
collection of immune cells, predominantly macrophages; these caseating granulomas
feature a central region of necrotic cell death, resulting in a soft, "cheese-like" core
within the granuloma
13
Sleeping kid
13
Latent TB is characterized by the dormancy of Mycobacterium tuberculosis within the
body, wherein the bacteria are contained and suppressed but not completely eradicated
14
Burlap sack + kid
14
Primary TB often resolves through fibrosis and calcification, especially in children,
encapsulating Mycobacterium tuberculosis within lung tissue
15
Shovel in dirt mound
15
The purified protein derivative (PPD) skin test for TB measures induration following
an intradermal injection of Mycobacterium tuberculosis antigen; according to the CDC,
a positive result depends on risk factors: 5 mm induration for high-risk individuals like
those with HIV or recent TB exposure, 10 mm for those from high TB prevalence areas
or certain medical conditions, and 15 mm for individuals with no known TB risk factors
16
"BCG" syringe in dirt mound
16
Prior Bacille Calmette-Guerin (BCG) vaccination for TB can cause false-positive
reactions in the purified protein derivative test
17
Millet seed
17
Miliary TB, marked by widespread hematogenous dissemination, is a severe and
potentially fatal manifestation of tuberculosis
18
Skull on millet seed
18
Miliary TB, marked by widespread hematogenous dissemination, is a severe and
potentially fatal manifestation of tuberculosis
19
Tied to "TNF" barrels
19
Reactivation of latent TB is associated with the use of TNF-alpha inhibitors (TNF-
alpha is important for granuloma formation and maintenance)
20
Bullet holes in top of cactus
20
Reactivation (secondary) TB is associated with upper lobe disease and cavitation
21
Coughing blood + sweating
21
 Reactivation TB often presents with cough, hemoptysis, night sweats, anorexia, and
weight loss
22
Cracked vertebral pots
22
Pott disease, or TB of the spine, is the most common extrapulmonary manifestation of
TB
23
Bullet hole in hat
23
TB in the CNS mainly presents as tuberculous meningitis, but can also appear as
localized masses called tuberculomas
24
"RIPE taters"
24
The combination of rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE) is the
standard regimen for treating TB
25
"RI"
25
Rifampin and isoniazid are used in cases of latent tuberculosis to prevent reactivation
Mycobacterium leprae

1
Leaping amadillo
1
Mycobacterium leprae (an acid-fast bacillus)
2
Icicles
2
Mycobacterium leprae prefers cooler temperatures, often affecting the skin and the
extremities
3
Mycolic acid tassels
3
Mycobacterium leprae stains acid-fast due to the high mycolic acid content in its cell
membrane
4
Fuschia gun and holster
4
The Ziehl-Neelsen method uses carbol fuchsin stain to detect acid-fast bacteria, such
as Mycobacterium leprae
5
Armadillo
5
Armadillos are the only known natural hosts of Mycobacterium leprae outside of
humans
6
Jail cell 1
6
Tuberculoid leprosy elicits a Th1 cell-mediated immune response, resulting in
macrophage activation and containment of the bacteria
7
Prisoner in jail cell 1
7
A strong Th1 cell-mediated immune response induces macrophage
phagocytosis of Mycobacterium leprae bacteria, resulting in the tuberculoid variant of
leprosy
8
Bald prisoner
8
Tuberculoid leprosy typically presents with a small number of skin lesions that are flat or
mildly elevated, often lacking hair
9
Shovel in dirt mound
9
The lepromin skin test, which involves injecting inactivated Mycobacterium
leprae under the skin, is a diagnostic tool that helps classify the type of leprosy in a
person already diagnosed with the disease; a positive result, where a nodule forms, is
typically associated with a stronger cellular immune response, more common in
tuberculoid leprosy; a negative result, where no nodule forms, is associated with
lepromatous leprosy, a more severe form of the disease characterized by a weaker
immune response, more widespread lesions, and a higher bacterial load
10
Jail cell 2
10
Lepromatous leprosy, characterized by a weaker Th1 response and a dominant Th2
humoral response, fails to contain Mycobacterium leprae, leading to more
disseminated disease
11
Laughing escapee from cell 2
11
A Th2 humoral immune response in lepromatous leprosy is correlated with a weak or
nonexistent Th1 cell-mediated immune response, preventing the containment
of Mycobacterium leprae bacteria within macrophages
12
Touching hands
12
Human-to-human transmission is a route for lepromatous leprosy, typically requiring
close contact over many months
13
Gloves and socks
13
Lepromatous leprosy often presents with stocking and glove neuropathy,
characterized by loss of sensitivity to temperature and pain in the extremities
14
Long John lesions
14
Lepromatous leprosy often manifests with poorly demarcated erythematous papules,
macules, nodules, and plaques
15
Lion face bandana
15
Leonine facies deformity seen in lepromatous leprosy often involves thickening of the
skin, loss of eyebrows and eyelashes, collapse of the nose, and formation of nodular
earlobes
16
Deputy with rifle + 1 jail
16
A 6-month regimen of dapsone and rifampin is commonly used in the treatment
of tuberculoid leprosy
17
Deputy with rifle and cloth + 2 jail
17
For lepromatous leprosy, a longer treatment course (often 2-3 years)
including dapsone, rifampin, and clofazimine, is typically needed
Mycobacterium avium intracellulare, Mycobacterium scrofulaceum,
Mycobacterium marinum

1
Quick draw fuschia gun and holster
1
Carbol fuchsin stain detects acid fast mycobacteria such as mycobacterium avium
complex
2
Tassels
2
Mycobacteria stain acid fast due to high mycolic acid content in the cell wall
3
Tower of macrocages
3
Mycobacteria invade macrophages and form granulomas to escape immune system
detection
4
Bird in cage
4
Mycobacterium avium complex (M. avium + M. intracellulare)
5
Lung vest
5
Clinical presentation of MAC infections in patients with symptomatic lung disease = TB-
like symptoms (e.g. cough, fatigue, night sweats, shortness of breath, weight loss)
6
Pink puffer prisoner
6
Clinical presentation of MAC infections in patients with symptomatic lung disease (e.g.
bronchiectasis, COPD) = TB-like symptoms
7
Body covered in burs
7
Mycobacterium avium complex infections usually present with disseminated disease in
immunocompromised patients (e.g. advanced HIV with CD4 count < 50)
8
Crutches
8
Mycobacterium avium complex infections usually present with disseminated disease
in immunocompromised patients (e.g. advanced HIV with CD4 count < 50)
9
Ring of pill bottles
9
MAC bacteria commonly exhibit multidrug resistance
10
Crow
10
MAC infections are treated with a macrolide (e.g. clarithromycin, azithromycin) plus
ethambutol; consider third agent like rifabutin
11
“Ethel”
11
MAC infections are treated with a macrolide (e.g. clarithromycin, azithromycin)
plus ethambutol; consider third agent like rifabutin
12
Rifle
12
MAC infections are treated with a macrolide (e.g. clarithromycin, azithromycin) plus
ethambutol; consider third agent like rifabutin
13
Crow sitting <50 mph sign
13
Give a macrolide (e.g. azithromycin) to HIV patients who are not on ART and have
a CD4 count <50 for prophylaxis; remember to make sure patient is started on ART
14
Puppy’s scruff
 14
Mycobacterium scrofulaceum causes cervical lymphadenitis in children
15
Horse trough filled with dirty water
15
Mycobacterium marinum
16
Dirty water + fish
16
Transmission of mycobacterium marinum = direct contact of contaminated water
(aquarium fish tanks) or infected animals like fish
17
Fish biting hand
17
Mycobacterium marinum causes skin infections in aquarium handlers
SPIROCHETES

Borrelia burgdorferi

1
Bow
1
Borrelia burgdorferi (a spirochete bacterium)
2
Spiraled arrow
2
Borrelia burgdorferi is a spirochete bacterium
3
"Northeast archery competition"
3
Lyme disease is predominantly reported in the northeastern regions of the United
States
4
Robin of Ixodes + tick
4
Borrelia burgdorferi is primarily transmitted by the blacklegged tick (Ixodes
scapularis)
5
White-footed mouse
 5
The white-footed mouse serves as a primary reservoir for Borrelia burgdorferi and is
the host for the larval and nymphal stages of Ixodes scapularis ticks
6
White-tailed deer
6
The white-tailed deer is the obligatory host of adult Ixodes scapularis ticks
7
Sir Wright
7
Borrelia burgdorferi takes up the stains used in the Gram strain technique poorly, but
can be visualized using Wright's or Giemsa stain
8
Sir Giemsa
8
Borrelia burgdorferi takes up the stains used in the Gram strain technique poorly, but
can be visualized using Wright's or Giemsa stain
9
Stage 1 + bullseye
9
Early localized (stage 1) of Lyme disease is often marked by the appearance
of erythema migrans, a distinctive “bull’s-eye” rash
10
Stage 1 + sweat
10
Patients with stage 1 Lyme disease may exhibit flu-like symptoms,
including fever and chills
11
Stage 2 + heart shield
11
Early disseminated (stage 2) Lyme disease can involve cardiac complications, including
myocarditis leading to heart block
12
Stage 2 + bilateral bells
12
Stage 2 Lyme disease may result in bilateral Bell’s palsy and other forms of facial
paralysis
13
Stage 3 + moving dummy + arrow in knee
13
Late disseminated (stage 3) Lyme disease can manifest as migratory polyarthritis,
typically affecting large joints
14
Arrow in head
14
Neurological complications such as encephalopathy can occur in stage 3 of Lyme
disease
15
Unicycle
15
Doxycycline is recommended for the treatment of early-stage Lyme disease
16
3 axes shield
16
Ceftriaxone is used for the treatment of late-stage or severe cases of Lyme disease
Borrelia recurrentis

1
Bow
1
Borrelia recurrentis (a spirochete bacterium)
2
Recurring nightmare
2
Borrelia recurrentis causes louse-borne relapsing fever (LBRF)
3
Spiral-shaped bed posts
3
Borrelia recurrentis is a spiral-shaped spirochete
4
Illuminating stars + dark ceiling
4
Borrelia recurrentis can be visualized using dark field microscopy
5
Sir Wright + Sir Giemsa
5
Borrelia recurrentis can be visualized on a peripheral blood smear using
a Wright or Wright-Giemsa stain
6
Variable color lights
6
Borrelia recurrentis has variable surface antigens in its outer membrane that help
evade immune system detection
7
Pile of stuffed animals
7
Risk factors for developing LBRF = living in poor resource countries affected
by overcrowding (e.g. refugee camps), war, and famine
8
Louse stuffed toy
8
Vector = Pediculus humanus corporis (human body louse)
9
Scratching + rubbing eyes
9
Infected lice can transmit Borrelia recurrentis through a bite or when someone crushes
a louse by scratching their skin or rubbing their eyes
10
Person suffering recurring nightmare
10
Reservoir host = humans
11
Flame bandana hanging from spinning mobile
11
Borrelia recurrentis causes relapsing fever, which is characterized by cyclical high
febrile episodes followed by a crisis phase
12
“Crisis Part 1 - Fire Frenzy”
12
Crisis part # 1 = “hot” signs/symptoms (e.g., hyperthermia, tachycardia,
hypertension)
13
“Crisis Part 2 - Cold Crash"
13
Crisis phase #2 = “cold” signs/symptoms (hypothermia, hypotension)
14
Yellow pajamas
14
Louse-borne relapsing fever presents with jaundice
15
Fallen white plates
15
Louse-borne relapsing fever presents with thrombocytopenia
16
Purple pencil
16
Treatment = Penicillin G or doxycycline; closely monitor pt for Jarisch-Herxheimer
reaction
17
Bicycle
17
Treatment = Penicillin G or doxycycline; closely monitor pt for Jarisch-Herxheimer
reaction
Leptospira interrogans

1
Spiral wave
1
Leptospira interrogans (a spirochete bacterium)
2
Question mark + spiral leash
2
Leptospira interrogans has a unique helical shape resembling a question mark or
a tight coil when observed under dark-field microscopy
3
Yellow water
3
Leptospira interrogans can survive in water environments contaminated
with urine from infected animals
4
Sweat
4
Fever is a typical initial symptom of leptospirosis, often accompanied by other
nonspecific flu-like symptoms
5
Pink glasses
5
Non-suppurative (without pus formation) conjunctivitis is frequently observed in the
early stages of leptospirosis
6
Whale
6
Weil's disease is a serious and potentially life-threatening manifestation of
leptospirosis, characterized by jaundice, hemorrhage, renal failure, and respiratory
distress
7
Disseminated red floaties
7
Leptospirosis can disseminate hematogenously, leading to multi-organ involvement
8
Kidney dinghy
8
Both acute kidney failure and liver failure are significant complications associated with
Weil's disease
9
Yellow wetsuit
9
Both acute kidney failure and liver failure are significant complications associated with
Weil's disease
Treponema pallidum

1
Spiral galaxy
1
Treponema pallidum (a spirochete bacterium)
2
Spiral staircase
2
Treponema pallidum is a spirochete bacterium
3
"Darkfield galaxy"
3
Dark-field microscopy is needed for direct visualization of Treponema pallidum, the
causative agent of syphilis
4
"VDRL" on screen
4
The Venereal Disease Research Laboratory (VDRL) test is a non-specific screening
tool for syphilis
5
"MONO, RF, SLE, LEP, DRG"
5
Conditions that can lead to false positives in the VDRL test include mononucleosis,
rheumatoid factor, systemic lupus erythematosus, leprosy, and IV drug use
6
"Field Telescope A-Ab"
6
A positive VDRL test is usually followed by a more specific treponemal test (like the
fluorescent treponemal antibody absorption test (FTA-ABS test)) to confirm a diagnosis
of syphilis
7
Poked in butt + 1st level
7
During the primary stage of syphilis, painless sores called chancres typically appear
on the genitals or anus
8
Solar system model + 2nd level
8
The secondary stage of syphilis is typically a systemic disease and often presents
with a range of symptoms
9
Red gloves and boots + 2nd level
9
A widespread maculopapular rash, often involving palms and soles, is characteristic
of secondary syphilis
10
Bumpy planet + 2nd level
10
Condyloma lata are flat-topped cutaneous lesions that sometimes develop on the
genitals during the secondary stage of syphilis
11
Looking at bumpy planet with telescopes
11
Live Treponema pallidum spirochetes can be visualized within condyloma
lata using dark-field microscopy
12
Cratered moon + outside
12
Gummas are soft growths with firm, necrotic centers that form during the tertiary
(late) stage of syphilis
13
Aortic tree + outside
13
Syphilitic aortitis, which occurs during the tertiary stage of syphilis, presents with
“tree-barking” of the aorta and may result in an aortic root aneurysm
 14
Tree roots
14
The destruction of the vasa vasorum (the small blood vessels that supply the wall of
the aorta and other large vessels) by Treponema pallidum is the cause of syphilitic
aortitis seen in the tertiary stage of syphilis
15
Damaged spinal columns + outside
15
Tabes dorsalis, a complication of late-stage syphilis, is a demyelinating condition of
the spinal cord's dorsal columns
16
Argyle sweater+ light in eyes + outside
16
Argyll Robertson pupils, which display accommodation but do not react to light, is a
highly specific sign of late-stage syphilis
17
Sabre by shins
17
Anterior bowing of the tibia, known as saber shins, can occur in congenital syphilis
18
Saddle
18
Saddle nose, collapse of the nasal bridge due to destruction of cartilage, is a feature
of congenital syphilis
19
Chattering teeth
19
Hutchinson’s teeth (blunted, notched incisors) and Mulberry molars (enamel growth
on cusps of molars) are possible complications of congenital syphilis
20
Earmuffs
20
Congenital syphilis may cause both early and late sensorineural hearing loss
21
Purple pencils
21
IM benzathine penicillin G is the preferred antibiotic treatment for syphilis
22
"Jarisch-Herxheimer comet viewing"
22
The Jarisch-Herxheimer reaction is triggered by the rapid lysis of Treponema
pallidum following initiation of antibiotic therapy
 23
Fiery + icy comet
23
The Jarisch-Herxheimer reaction is characterized by fever and chills
GRAM-INDETERMINATE BACTERIA

Chlamydia trachomatis, Chlamydophila pneumoniae, Chlamydophila psittaci

1
Clams
1
Chlamydia spp. (gram-indeterminate bacteria)
2
Ship on island
2
Chlamydia spp. are obligate intracellular pathogens, requiring a host cell to replicate
3
White island
3
Chlamydia spp. exhibit weak gram-negative staining due to their unique cell wall
structures, and are often classified as gram-indeterminate
4
"No mermaids"
4
The cell wall of Chlamydia spp. lacks muramic acid, a typical component of
peptidoglycan
5
Pearls outside of clam
 5
Elementary bodies are the infectious, non-replicating, extracellular form
of Chlamydia that form in the first of two developmental stages
6
Pearls inside of clam
6
Reticulate bodies are the the intracellular, replicating form of Chlamydia formed in the
second of two developmental stages
7
Pearls outside of clam again
7
Following replication, Chlamydia reticulate bodies undergo transformation into
elementary bodies, which are then released to infect new host cells
8
Piles of pearls
8
Intracytoplasmic reticulate bodies of Chlamydia can be seen as intracellular inclusion
bodies on microscopy
9
Pink gems
9
Giemsa stain can be used to visualize Chlamydia intracytoplasmic inclusion bodies
10
Gnats
10
Nucleic acid amplification tests (NAATs) are the gold standard for
detecting Chlamydia infections
11
Sexy mermaid
11
Chlamydia trachomatis serovars D-K and L1-L3 cause sexually transmitted infections
(STIs)
12
Water leak
12
Infection with Chlamydia trachomatis serovars D-K often presents with watery or
mucopurulent vaginal or urethral discharge
13
Uterus + fallopian tubes flag
13
STIs caused by Chlamydia trachomatis serovars D-K may lead to pelvic inflammatory
disease (PID) if left untreated
14
Mermaid baby + covered eyes + clam bra
14
Chlamydia trachomatis serovars D-K can be vertically transmitted during childbirth,
causing neonatal conjunctivitis or pneumonia, the latter of which is characterized by
a repetitive staccato cough
15
Barnacle belt
15
Chlamydia trachomatis serovars L1-L3 cause lymphogranuloma venereum (LGV),
which is characterized by tender inguinal or femoral lymphadenopathy
16
Eye patches
16
Chlamydia trachomatis serovars A-C are the causative agents of trachoma, the leading
cause of infectious blindness globally
17
Hand near eye
17
Trachoma is predominantly transmitted through direct contact with eye and nasal
discharge from infected individuals, and through contact with fomites such as
contaminated towels/washcloths
18
Slapping knee
18
Reactive arthritis, which develops in response to infections caused by certain bacteria,
such as Chlamydia trachomatis, is characterized by a triad of symptoms: uveitis,
urethritis, and arthritis
19
Can't see
19
Reactive arthritis, which develops in response to infections caused by certain bacteria,
such as Chlamydia trachomatis, is characterized by a triad of symptoms: uveitis,
urethritis, and arthritis
20
Can't pee
20
Reactive arthritis, which develops in response to infections caused by certain bacteria,
such as Chlamydia trachomatis, is characterized by a triad of symptoms:
uveitis, urethritis, and arthritis
21
Can't climb tree
21
Reactive arthritis, which develops in response to infections caused by certain bacteria,
such as Chlamydia trachomatis, is characterized by a triad of symptoms: uveitis,
urethritis, and arthritis
22
Algae on bra
22
Chlamydophila pneumoniae is associated with atypical pneumonia
23
Bird pooping on bra
23
Chlamydophila psittaci, which is contracted from birds, can lead to atypical pneumonia
24
Macrolide crows
24
Macrolide antibiotics, especially azithromycin, are effective in treating chlamydial
infections
25
Mac's detective hat
25
The standard treatment for suspected chlamydial infection often presumes a Neisseria
gonorrhoeae co-infection; ceftriaxone targets Neisseria gonorrhoeae, while
azithromycin or doxycycline targets Chlamydia trachomatis
26
Bicycle tire wheel
26
Tetracycline antibiotics, particularly doxycycline, are effective in treating chlamydial
infections
27
3 axes flag
27
The standard treatment for suspected chlamydial infection often presumes a Neisseria
gonorrhoeae co-infection; ceftriaxone targets Neisseria gonorrhoeae, while
azithromycin or doxycycline targets Chlamydia trachomatis
Coxiella burnetii

1
Curly Q
1
Coxiella burnetii (a gram-negative or gram-variable bacterium that causes Q fever)
2
Red barn
2
Coxiella burnetii can sometimes exhibit atypical staining characteristic due to its unique
cell wall properties, which may lead to variability in gram-staining results; despite this, it
is generally classified as a gram-negative organism
3
White fur
3
Unlike other similar zoonotic genera (e.g. Rickettsia, Ehrlichia, Orientia) Q fever
typically does not present with rash
4
"Q" horn
4
Coxiella burnetii is the cause of Q fever, which typically presents with mild flu-like
symptoms
5
Locked indoors
 5
Coxiella burnetii is an obligate intracellular organism, surviving and multiplying within
host cells, notably macrophages
6
Walnuts
6
Coxiella burnetii forms spore-like structures, facilitating its transmission and allowing it
to withstand harsh environmental conditions
7
Inhaling dust clouds
7
Aerosol transmission is the primary route for Coxiella burnetii infection, often involving
inhalation of contaminated particulates from animal waste
8
Coughing + hitting head
8
Q fever commonly presents with symptoms such as headache, dry cough, high fever,
and myalgia
9
Sweating
9
Fever is a consistent and defining symptom in the clinical presentation of Q fever
10
Cow
10
Domestic farm animals, particularly cattle, sheep, and goats, are significant reservoirs
for Coxiella burnetii
11
Liver-shaped spot
11
In chronic cases, Q fever can lead to granulomatous hepatitis, characterized by
granulomatous inflammation in the liver
Gardnerella vaginalis

1
"Fish garden"
1
Gardnerella vaginalis (a gram-indeterminate coccobacillus that causes bacterial
vaginosis (BV))
2
Purple and pink graffiti
2
Despite having a thin, gram-positive cell wall, Gardnerella vaginalis is categorized
as gram-variable because its thin cell wall results in inconsistent staining, resulting in a
gram-positive or gram-negative appearance
3
Overgrowth of Venus flytraps
3
Disruption of the normal vaginal flora, which is primarily composed of acid-
producing Lactobacillus spp., can lead to an increased vaginal pH, providing a suitable
environment for Gardnerella vaginalis proliferation
4
Venus flytrap discharge
4
BV often presents with a thin, grey-white discharge with a distinctive “fishy” odor
5
"p 4.5 and up"
5
The pH of vaginal discharge in BV exceeds 4.5, often ranging from 5.0 to 6.5
6
Sniffing dog + "KOH" hat
6
The whiff test, which is used to diagnose BV, involves adding a 10% KOH solution to
the vaginal discharge; a positive result is indicated by a strong, fishy odor
7
Spotted fish + looking for clues
7
Microscopic examination of a wet mount preparation of discharge in BV often
reveals vaginal epithelial cells heavily coated with Gardnerella vaginalis bacteria,
otherwise known as clue cells
8
Metro
8
Treatment for BV typically involves metronidazole or clindamycin
Mycoplasma pneumoniae

1
Walking on ice
1
Mycoplasma pneumoniae (a gram-indeterminate pleomorphic bacterium)
2
No wall
2
Mycoplasma pneumoniae lacks a cell wall and thus cannot be visualized with use of
Gram stain
3
Sterol net pattern
3
Cholesterol is a key component of the cell membrane of Mycoplasma pneumoniae
4
Patchy clouds
4
In Mycoplasma pneumoniae infections, CXR often reveal a reticulonodular or patchy
infiltrate, presenting more severely in imaging than clinical symptoms suggest
5
Walking
5
Mycoplasma pneumoniae infection is known for causing "walking
pneumonia," characterized by its relatively mild pulmonary symptoms
6
Camo jersey
6
Mycoplasma pneumoniae infection is common in military recruits living in close
quarters
7
"<30" jersey
7
Mycoplasma pneumoniae frequently affects adults under 30, with a higher incidence in
this age group
8
IgM snowflakes connecting RBC pucks
8
Infections with Mycoplasma pneumoniae can lead to the production of IgM cold
agglutinins, which may cause red blood cell agglutination at low temperatures and
subsequent hemolysis
9
"Don’t EAT ON ice"
9
Eaton’s agar is a specialized medium for cultivating Mycoplasma pneumoniae
10
Macrolide crows
10
Macrolides such as azithromycin, are effective in treating Mycoplasma
pneumoniae infections
Rickettsia Overview

1
"Rickett's tires"
1
Rickettsia spp. (weakly gram-negative coccobacilli)
2
Indoor stadium
2
Rickettsia spp. are obligate intracellular pathogens, requiring host cells for replication
and survival
3
Colorless crowd
3
Though the cell wall of Rickettsia spp. is chemically similar to that of gram-negative
bacteria, they take up Gram stain poorly; instead, Rickettsia spp. can be visualized
using the Giemsa or Gimenez stain
4
CoAch
4
Rickettsia spp. depend on host cells for coenzyme A (CoA), a critical factor for their
metabolic processes, as well as nicotinamide adenine dinucleotide (NAD+), which is
essential for energy production and growth
5
"NAD+" water bottle
5
Rickettsia spp. depend on host cells for coenzyme A (CoA), a critical factor for their
metabolic processes, as well as nicotinamide adenine dinucleotide (NAD+), which is
essential for energy production and growth
6
Light pink tennis balls
6
Rickettsia spp. are characterized as weakly gram-negative coccobacilli
7
Weil and Felix
7
The Weil-Felix test, an agglutination assay, was the primary diagnostic tool for
rickettsial diseases, but has largely been replaced by modern serological methods;
however, this test is still used in areas with limited resources where advanced
diagnostic options are not accessible
8
Holding head + sweating
8
Common initial symptoms of rickettsial infections include headache and fever
9
Broken red strings
9
Rickettsial infections lead to small-vessel vasculitis, often causing a maculopapular or
petechial rash
10
Broken strings + bumpy ground
10
Rickettsial infections lead to small-vessel vasculitis, often causing a maculopapular or
petechial rash
11
Bicycle tires
11
Doxycycline is the drug of choice for the treatment of rickettsial infections
Rickettsia prowazekii

1
"PRO bootcamp"
1
Rickettsia prowazekii (a weakly gram-negative coccobacillus that causes epidemic
typhus)
2
Indoor stadium
2
Rickettsia prowazekii is an obligate intracellular pathogen, requiring host cells for
replication and survival
3
Colorless crowd
3
Though the cell wall of Rickettsia prowazekii is chemically similar to that of gram-
negative bacteria, it takes up Gram stain poorly; instead, Rickettsia prowazekii can be
visualized using the Giemsa or Gimenez stain
4
CoAch
4
Rickettsia prowazekii depends on host cells for coenzyme A (CoA), a critical factor for
its metabolic processes, as well as nicotinamide adenine dinucleotide (NAD+), which is
essential for energy production and growth
5
"NAD+" water bottle
5
Rickettsia prowazekii depends on host cells for coenzyme A (CoA), a critical factor for
its metabolic processes, as well as nicotinamide adenine dinucleotide (NAD+), which
is essential for energy production and growth
 6
Bicycle tires
6
Doxycycline is the drug of choice for treatment of Rickettsia prowazekii infections
7
Outward football play
7
The characteristic rash of epidemic typhus typically originates on the
trunk and extends to the limbs, usually sparing the face, palms, and soles
8
Red clothes + white helmet, gloves, and shoes
8
The characteristic rash of epidemic typhus typically originates on the trunk and extends
to the limbs, usually sparing the face, palms, and soles
9
Military coach
9
Epidemic typhus is associated with war (e.g., military recruits, prisoners of war),
refugee camps, poverty, homelessness, crowding, and unsanitary conditions
10
Lice footballs
10
Transmission of Rickettsia prowazekii occurs through louse feces
11
"The outbreak" play
11
Epidemic typhus, also called louse-borne typhus, is caused by Rickettsia prowazekii
12
Painful tackle
12
Myalgias and arthralgias are common manifestations of epidemic typhus
13
Tackling chest
13
Some patients with epidemic typhus
develop pulmonary complications including bacterial pneumonia
14
Holding head + confused
14
In some cases, epidemic typhus may progress to encephalitis, characterized by fever,
dizziness, and confusion
Rickettsia rickettsii

1
Rickett's rock climbing
1
Rickettsia rickettsii (a weakly gram-negative coccobacillus)
2
Rock climbing holds
2
Rocky Mountain spotted fever, a serious tick-borne illness, is caused by Rickettsia
rickettsii
3
Indoor arena
3
Rickettsia rickettsii are obligate intracellular pathogens, requiring host cells for
replication and survival
4
Colorless crowd
4
Though the cell wall of Rickettsia rickettsii is chemically similar to that of gram-negative
bacteria, it takes up Gram stain poorly; instead, Rickettsia spp. can be visualized
using the Giemsa or Gimenez stain
5
CoAch
5
Rickettsia rickettsii depends on host cells for coenzyme A (CoA), a critical factor for its
metabolic processes, as well as nicotinamide adenine dinucleotide (NAD+), which is
essential for energy production and growth
6
"NAD+" water bottle
6
Rickettsia rickettsii depends on host cells for coenzyme A (CoA), a critical factor for its
metabolic processes, as well as nicotinamide adenine dinucleotide (NAD+), which is
essential for energy production and growth
7
Bicycle tire
7
Doxycycline is the drug of choice for the treatment of Rickettsia rickettsii infection
8
Tick climbing holds
8
The Dermacentor tick is the primary vector for Rickettsia rickettsii, facilitating the
transmission of Rocky Mountain spotted fever to humans
9
"Derma-Center" arena
9
The Dermacentor tick is the primary vector for Rickettsia rickettsii, facilitating the
transmission of Rocky Mountain spotted fever to humans
10
No spots
10
The rash of Rocky Mountain spotted fever typically develops 2-5 days after the onset
of symptoms
11
Spots on wrists and ankles
11
The rash of Rocky Mountain spotted fever initially appears on the wrists and
ankles before spreading centrally to the trunk
12
Spots on whole body
12
The rash of Rocky Mountain spotted fever initially appears on the wrists and ankles
before spreading centrally to the trunk
13
Grabbing head + sweating + soreness + rash
13
Rocky Mountain spotted fever typically manifests with headache, fever, myalgias,
and rash