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# WEBVTT

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Now we'll move on to a different genus

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the Streptococcus genus.

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Unlike the Staph genus

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which form clusters,

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Streptococci grow along a single axis

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and form long chains or pairs.

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The first group of Streptococcus

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that we'll cover is Strep pyogenes

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also known as Group A Strep.

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So watch as we transform pyogenes

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into a scene we'll call

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"The Pie Genies Bakery."

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Let's get started.

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We've got a lot to cram into this video.

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So the backdrop will be pretty simple

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and I'll also try to keep

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as brief as possible.

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The pie genies specialize

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So let's start by drawing a pie.

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And we'll cover it in

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that bakers would use

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This glass capsule-looking dome

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is going to represent that Group A Strep

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You'll notice we specify that this is

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hot apple pie.

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The H and A in hot and apple

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actually stand for hyaluronic acid.

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Strep pyogenes is made out

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And we also actually produce
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in our connective tissue.

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And this is good to know because

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everywhere in our body,

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this means that the pyogenes capsule

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cannot be immunogenic

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or else our own immune system

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Now we're drawing a heating lamp

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Notice anything special about the bulb?

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Yep, that B in the bulb's filaments

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means that its our

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So Group A Strep

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is beta-hemolytic.

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Let's dive into some clinical features

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and discuss the pyogenic infections

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Theyll all be represented
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by our first pie genie baker

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There are three main ones

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The first is impetigo;

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a pyogenic skin infection

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that is said to look honey crusted.

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This is represented by our

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But remember, impetigo

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by Staph aureus.

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So if somebody has impetigo,

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it doesn't necessarily mean

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they have a Group A Strep infection.

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The second pyogenic infection

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is pharyngitis

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or more commonly known as strep throat.

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We'll represent this by drawing

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So when you see it,

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erythematous and inflamed throat.

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Again, that's for pharyngitis.

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The third condition is really

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cellulitis and erysipela

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but they're very similar.

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All erysipela is basically

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a very superficial cellulitis infection

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with well-demarcated borders.

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Strep pyogenes is the most common

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so we'll represent this two

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by drawing big red mittens

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which indicates erythema of the skin.

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So we've just covered

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Now we're going to move on

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to infections caused by

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The toxin is referred to as

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Streptococcal pyrogenic exotoxin

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or SPE.

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The first condition is scarlet fever.

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And there are three main symptoms

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that we want you to know.

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The first is reddening and

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And this is referred to as

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And we'll represent this

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sticking out his tongue

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And the second symptom of

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We'll represent this the same way

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with a red handkerchief around his neck.
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And the third and final symptom

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that spares the face.

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We'll represent this by having the chef

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smearing this gingerbread

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that covers everywhere except the face.

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Another condition caused by this toxin

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is very similar to Staph aureus'

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toxic shock syndrome.

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And it's referred to as

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or TSLS.

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This toxin behaves as a superantigen

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just as it does for Staph aureus

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so we'll use the same cape.

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The super cape with a lightning bolt

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where "super"
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stands for superantigen and

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Now there are three toxigenic syndromes

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caused by the exotoxin.

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We've covered two: scarlet fever

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and toxic shock-like syndrome.

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So the last one is a very scary one.

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It's been referred to in the press as

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And this is necrotizing fasciitis

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which can be caused by the toxigenic

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It invades the fascia

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and spreads very rapidly.

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So it's a true surgical emergency.

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We'll represent this by having

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with his leg falling off.

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The burn looks like necrotic tissue

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and the leg is missing because

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to amputate the affected region.

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So in a very organize manner,

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we've covered all of

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caused by pyogenes in this corner

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Again, there are scarlet fever,

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toxic shock-like syndrome and

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And as I mentioned earlier,

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by Strep pyrogenic exotoxin or SPE.

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However, there are three

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and those are A, B, and C.

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And I don't believe they're

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but you may wanna know them.

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SpeA and SpeC

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are superantigen toxins

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that cause scarlet fever and TSLS.

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The SpeB

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is a protease that causes

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To make this easy,

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that the B causes nec fasc

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by elimination A and C

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cause the other two syndromes.

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So you can apply this to our story

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by remembering that our gingerbread man

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representing nec fasc is burnt;

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which starts with B.

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So we'll write this B on the nec fasc

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And that should be good enough.

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We'll move on to cover
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two highly tested conditions

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pertaining to Strep pyogenes.

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And probably the most important things

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These are rheumatic fever

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and poststreptococcal glomerulonephritis

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or PSGN.

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Since these are very

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of infections with Group A Strep,

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the boards may try to get you

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We'll do our best to make sure

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so that you get all of these

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First, we'll cover rheumatic fever.

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Since this is arguably the most

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we're gonna make this character

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He'll be the master chef.
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So we'll go ahead and right an "M"

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In the story, "M" stands for

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But for us, "M" actually has

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It stands for M protein.

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M protein is a highly antigenic protein

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in the Group A Strep cell wall.

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And it's a main virulence factor

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And there are two ways it really acts

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First, in interferes with opsonization

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thus it is antiphagocytic.

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We'll demonstrate this by having

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reaching behind them

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and eat one of this cupcakes.

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While the master chef

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swats him away thus

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or having an antiphagocytic action.

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And the other aspect of

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is that it's very antigenic

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and elicits a very strong

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Because of the strong response,

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there's a great chance that

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to a very similar self-antigen

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which is the myosin in

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And this whole process is called

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And again, just because this is

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the M protein

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mimics the myosin in our heart

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and causes our own antibodies

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And when this happens,

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especially for our heart valves.

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You'll notice that this hat

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is a little bit different from

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Well, we've chosen this hat

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This type of hat is called a mitre hat.

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Or it's a hat that the pope wears.

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And actually, mitral valves

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because when they open, their two flaps

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kind of look like these mitre hats.

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So anyway, we've given him

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to remind you of the mitral valves

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which are the valves most commonly

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specifically causing a mitral stenosis.

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Rheumatic fever starts after

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but it does not happen
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It also doesn't happen if pharyngitis

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which is why you see it more

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who have little access to health care.

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We'll draw the red handkerchief

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pharyngitis precipitates RF.

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Now the symptoms of rheumatic fever

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categorized into five major criteria

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called the JONES criteria.

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And each letter of JONES

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stands for one of the criterion.

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So this is a really nice mnemonic

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But we're going to elaborate it

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Because that's what we do

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The first letter J stands for joints.

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It causes polyarthritis
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which is actually why it was

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rheumatic fever in the first place.

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We'll draw the baker

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having accidentally just bumped

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Notice the frosting on his elbow?

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This just reinforces joints.

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Then there is O

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which isn't actually an O.

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It's meant to be a shape of a heart.

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So we've drawn a nice heart-shape here

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and this signifies that it

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The heart problems are valvular damage

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myocarditis, and pericarditis.

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Next, we have N.

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N stands for nodules

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specifically subcutaneous nodules

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that most commonly appear on

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or on elbows and knees.

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We'll draw these nodules

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sitting on top of the cupcake.

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E stands for erythema marginatum,

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a rash with really nice thick

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We did our best to illustrate

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on top of this cupcake

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but it was a small canvass

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so I recommend that you google it

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seeing more accurate representations.

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Finally, we have S

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which stands for Sydenham's chorea

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which are rapid, involuntary movements

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especially of the hands and face.

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And that's really it

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We'll move on to the other

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poststreptococcal glomerulonephritis.

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And I think this is very highly tested

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it has a very strong tie into pathology.

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Like rheumatic fever,

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by our own immune system

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However, unlike RF,

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the damage isn't a type II

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It's a type III.

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Which means that the damage is from

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circulating antibody antigen

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that eventually deposit
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To represent glomerular damage,

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we'll draw this chef talking

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and you'll notice that its cord

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into a little ball.

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And it looks a lot like a glomerulus.

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The two main symptoms that

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are dark brown

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or cola-colored urine

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and facial swelling or puffiness

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Since this chef is eating,

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to represent the facial puffiness

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and we'll draw a bottle of cola

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to remind you of cola-colored urine.

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You'll need to remember that PSGN occurs

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two weeks after the onset of
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We've illustrated two weeks

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by circling in red a date

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that is two weeks from today.

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I'm gonna cover two major differences

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between rheumatic fever and PSGN

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that are commonly tested by examiners

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and somewhat tricky.

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But I think we do a really good job

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The first is that RF only occurs

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after pharyngitis.

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Whereas PSGN

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can occur after pharyngitis

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or a superficial infection

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To show this,

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we, of course, have our

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on both of these chefs

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but we'll only have the honey crusted

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on the chef's face that represents PSGN.

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The second major point of confusion

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treatment and complication prevention.

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Early diagnosis and treatment

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can prevent RF but it will not prevent

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poststreptococcal glomerulonephritis.

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The treatment for strep infections

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So we'll have our chef with

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holding a pencil

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which represents penicillin.

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And the way I want you

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so that there's no confusion

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even though the chef has

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he still has symptoms of PSGN

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denoted by the puffy face

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That should keep things

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We still got three more virulence

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that we want to cover.

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Sorry, I know this is a lot.

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It's kind of a marathon session.

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You can blame the microbiologist

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It's their fault for discovering

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But I'll try to be fast.

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We'll illustrate all three of them

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surrounding this baker over here

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First is streptolysin O

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which is the virulence factor
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to lyse red blood cells and

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We'll represent streptolysin O

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with some O-shaped donuts

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and leaking as if they were just lysed.

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It's important to know

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because we generate antibodies

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called ASO antibodies.

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And I'll get back to those in a second.

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Next virulence factor is streptokinase.

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Kinase means simply to put

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So we have little muffins with

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Streptokinase is important to know

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because it converts plasminogen

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Plasmin is fibrinolytic.

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So streptokinase is actually
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to lyse clots during, say, MI

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or ischemic strokes.

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Finally, we have our twists.

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These are twisted in

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This is because they represent DNAses

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or dornases

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which depolymerize DNA

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and really this is the least

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In fact, I'm even starting to wonder

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we just included it

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so that we could show off

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Okay now on to something that's

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This is a Basset hound.

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He's going to teach us

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Group A Strep from Group B Strep.

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Group A Strep is bacitracin-sensitive.

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Whereas Group B Strep is

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You see that our Basset hound

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or "basset-tracin" hound is able

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and munch on our DNA twists?

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Well this means that they're sensitive

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So Strep pyogenes is

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You'll see in our next video

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is bacitracin-resistant.

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So I promise we only have

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and we'll be super quick.

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Let's draw this lady

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and she's checking a box of donuts

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that she just purchased.

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Notice she's using similar tongs

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to this baker over here on the right.

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Well these tongs are supposed

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She just purchased the box

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and she's checking their amount

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or their titers

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with ASO antibodies.

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These ASO titers can tell us

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if we've recently had

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which is particularly helpful

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when trying to diagnose

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acute rheumatic fever

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or poststreptococcal glomerulonephritis.

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Okay now we're gonna talk about

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the ten different chemicals
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in the wall of Strep pyogenes.

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I'm just kidding.

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Onto the next one.