WEBVTT

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For this video, we'll combine

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two separate species of the Strep genus.

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Strep pneumoniae

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and the viridans streptococcal species.

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This illustration is titled
"The Alpha Knight Tournament"

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and takes place at
a medieval jousting tournament.

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So we'll start by drawing
the jousting arena.

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It's called the Alpha Knight Tournament

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because both of these species
are alpha-hemolytic.

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Remember, both group A and
group B strep are beta-hemolytic.

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So this is one of the first
distinguishing features.

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Alpha means it's a partial hemolysis

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in which the surrounding zone
of hemolysis is a green hue.

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This green comes from
the oxidation of hemoglobin.

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We've made the alpha on the sign green

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to help with that association.

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First, we'll draw our defending champ.

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Strep pneumo-knight.

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He's somewhat of a badass.
He's defeated all other knights

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so he's known as the number 1 knight.

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Or strep pneumo is numero uno
if you will.

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Pneumo, numero uno.
See what we did there.

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Well like any knight worth his salt

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he's encapsulated in some
pretty sweet armor.

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So strep pneumo is encapsulated.

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It's actually a polysaccharide capsule
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which is its major virulence factor.

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Ser Pneumo takes safety very seriously.

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So he wears a helmet.

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So you see he's super secured
and protected everywhere.

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Everywhere except for one weakness.

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And that's his chin.

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His chin is the only part of his body

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that you see that's exposed.

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So his chin is sensitive.

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Use this to remember that strep pneumo
is Optochin-sensitive.

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Optochin is a chemical

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that inhibits the growth of strep pneumo

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and as you'll see

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viridans is Optochin-resistant.

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Strep pneumo has a characteristic shape
under high power microscopy.

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It's said to look like a lancet-shaped,
gram-positive diplococci.

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To visualize this, we're gonna give
Numero Uno a second lance

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so you remember diplococci

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and the lance will remind you
of the lancet shape.

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Another identifying attribute you may be
given on a question stem

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is that strep pneumo is bile soluble.

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It cannot grow on bile.

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Try thinking of all this mud here
as bile.

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We're gonna put mud all over
the horse's legs

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and as it struggles to walk through it

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and gets all mixed up in the mud,

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this should remind you that
strep pneumo is bile soluble.
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Now we'll move on to cover some clinical
findings in a strep pneumo infection.

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Strep pneumo causes pneumonia.

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It's actually the number one cause of
community-acquired pneumonia in adults.

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It's characteristically
a lobar pneumonia

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that generally infiltrates
the lower lobes.

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It's also said to lead to the production
of rust-colored sputum.

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And to remember both of these,

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we'll draw one lobe of the armor
on the knight's chest covered with rust.

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Again, this is rust-colored sputum
in lobar pneumonia.

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Strep pneumo is the number one
cause of a lot of different diseases.

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Rather than coming up with
a separate cue for every disease,

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we thought it would be better
if added a visual reminder

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for a popular mnemonic that
you guys already might know.

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And this mnemonic is MOPS.

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Where M stands for Meningitis,

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O stands for Otitis media,

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P stands for Pneumonia,

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and S stands for Sinusitis.

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Again, strep pneumo is the most common
bacterial cause of all of these.

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So we'll give Ser Strep Pneumo a squire.

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And we'll have the squire mopping up
this muddy mess.

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This mop will remind you
to use the MOPS mnemonics.

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We'll also draw one of
Ser Numero Uno's fans

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pulling up a number 1 sign.

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This will remind you that it's

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the number one cause of
all of these diseases.

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Strep pneumo has another
virulence factor

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other than its capsule

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that helps it invade our immune system.

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It's a protease that cleaves IgA.

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which is important for it to be able
to colonize and invade our mucosa.

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To remember this IgA protease,

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we'll give Ser Numero Uno a shield

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with the symbol of
an IgA dimer molecule.

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The shield looks cracked and damaged

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which in general should make you think
of reducing host defenses.

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A recurring theme in microbiology
is that

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individuals who have had a splenectomy

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or an autosplenectomy as in the case
of sickle cell disease
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have a greater risk of being infected
by encapsulated organisms.

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This is because the spleen
plays a major role

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in the removal of encapsulated
organisms from the body.

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To help you remember that patients
with sickle cell disease

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are particularly susceptible
to strep pneumo infections,

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we'll strap a sickle onto
Ser Numero Uno.

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So as far as treatment goes,
there are really two first line choices.

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Most pneumococcal infections
are susceptible to erythromycin,

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a macrolide.

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We'll remember the macrolide
with our macrolide symbol,

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these crows.

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Crows and MA-CRO-LIDE.

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We'll draw them up here hanging out
and watching the event.

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Another option would be to use

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a third generation cephalosporin
like Ceftriaxone.

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We also have a special symbol
for Ceftriaxone

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which we'll incorporate
in future stories.

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It's this.

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Three axes or our tri-axe symbol.

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Tri-axe will remind you of
CEF-TRI-AX-ONE.

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I think the symbol fits pretty
conveniently in this picture.

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Prevention is a really important topic
for Strep pneumo.

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There are two pneumococcal vaccines
you really need to know.

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One vaccine is for adults
and the other is for children.

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The adult vaccine is
a 23-valent polysaccharide vaccine

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and the children vaccine is 7-valent

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however it's conjugated to a protein.

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Since the adults are given
a polysaccharide without a protein,

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our immune system generates
a T-cell independent response.

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Which only really creates IgM.

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IgM, as you know, does not provide
a long-lasting protection.

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By conjugating the polysaccharide
to a protein

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as in the children's vaccine,

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becomes more energetic and generates
a more robust T-cell response

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which leads to the production of IgG.

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So overall, one more time,
the 23-valent adult vaccine

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only causes an IgM response.

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The 7-valent vaccine for children
causes an IgG response.

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We'll remember this by
drawing the sign here

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telling where people to sit.

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Adults are on the mezzanine
and children on the ground.

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M in Mezzanine will remind you of IgM

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and G in Ground will remind you of IgG.

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And as soon as you remember
which produces the IgG and which is IgM,

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you'll be able to work backwards
and pick the appropriate answer

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for one of the more immunology-related
questions on strep pneumo.

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Alright, that's it for Strep pneumo.

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But we still need to learn
about the challenger.

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And that's going to be Strep viridans.

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And he'll be on the right side.

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We decided to go for the jester theme
for Strep viridans

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just to really make sure
that they're distinct.

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Strep viridans is alpha-hemolytic

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that's why he's in this tournament.

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But there are ways to differentiate
viridans from Strep pneumo.

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First, as you can see,
the jester has no armor on.

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So a Strep viridans stares down

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Strep pneumo who has
a full coat of armor

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uses contrast to help you remember
that Strep viridans has no capsule.

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The second major point of contrast
to Strep pneumo

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is that Strep viridans is
Optochin-resistant.

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Remember, pneumo is Optochin-sensitive.

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So to remember this,
we'll have our jester

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protecting his face with a jester's mask

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and really exaggerate the chin
to show that it's protected by the mask.

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And finally the last point of comparison

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you'll notice how relaxed and
confident this donkey looks.

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It's because he isn't fazed at all
by the competition

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nor by the mud under him.

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The mud isn't bothering him

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because he has these snazzy green
bile-resistant boots on.

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Remember Strep pneumo is bile-soluble

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and viridans is bile-insoluble.

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And keep these bile-resistant boots
at the back of your mind

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because they're gonna show up again
in the next video.

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The viridans group, specifically
Strep mutans and Strep sanguinis,

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are commonly associated
with dental caries.

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To remember dental caries,

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we're gonna give this donkey
some really foul yellow teeth.

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And if a viridans like Strep sanguinis
steps into the blood,

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it can cause subacute endocarditis

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and damaged heart valves.

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This most commonly occurs
in the mitral valve.

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But before we give you an easy mnemonic

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to remember that it's the mitral valve
that's most commonly affected

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let's think about why
it's the mitral valve.

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I said it commonly affects
damaged heart valves.

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Which valve is most likely to be damaged
in the general population?

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The mitral valve.
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First, there's mitral valve prolapse
which is a very common condition

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affection 2-3% of the population.

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And there's also rheumatic fever
which we discussed earlier.

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So now that you really understand it,

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we'll add the same mitre hat
or pope's hat

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we used in the Strep pyogenes video.

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Mitre for mitral valve

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and we made it look a little damaged too

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to remember that viridans only affects
previously damaged valves.

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Now I'm going to walk through
the pathogenesis of how Strep viridans

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is able to infect damaged heart valves.

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Let's say someone with a previously
damaged heart valve

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like mitral valve prolapse

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has their teeth cleaned and now
a bunch of viridans group strep

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enter the bloodstream causing
a transient bacteremia.

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Strep viridans is able to adhere to any

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fibrin platelet aggregate
at damaged tissue

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by creating dextrans from glucose.

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To remember this, instead of giving
the jester a shield to defend himself,

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we'll just stick a plate to his arm.

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So this adhering plate will remind us

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that viridans adheres to platelets

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and the jester holding the deck of cards

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will remind us of DEX-TRANS.

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Or dextrans that are the actual glue

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that makes them stick to platelets.

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That's all we have for viridans
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And with that, we wrap up
the Strep pneumo and viridans combo.

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A two for one.

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Hopefully, by putting them side by side,

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we'll help you remember the differences

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so that you'll really be able to
distinguish them on test day.

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In the next video,
we'll talk about Enterococcus.