1. Pathogens (lower respiratory tract)
1.1. Smooth, white/cream color, stellating
1.1.1. Urease neg, germ tube pos, trehalose neg Candida albicans
1.1.2. Urease neg, germ tube neg, trehalose Pos Candida glabrata
1.2. small, round, white, mucoid, glistening, alpha hemolysis
1.2.1. GPC (lancet shape) Catalase neg, coagulase neg, optochin S Bile Solubility pos Strep pneumoniae
1.3. translucent, tannish, smooth, convex growth on CHOC, no growth on BAP
1.3.1. Pleomophic GNCB, catalase pos, oxidase pos Requires X and V factor, Beta hemolytic on horse blood agar Haemophilius influenzae
1.4. large mucoid, non-hemolytic, LF
1.4.1. GNR, LDC pos, citrate pos, non-motile ODC pos (Klebsiella aerogenes) ODC neg: Indole pos (Klebsiella oxytoca) Indole neg (Klebsiella pneuomiae)
1.5. golden, creamy, beta hemolytic, round, smooth
1.5.1. GPC in clusters, Catalase pos, coagulase pos Staph aureus
1.6. flat, spreading, beta hemolytic
1.6.1. GNR, oxidase pos, glucose oxidizer, NLF, grape smell, green pigment, ADH pos, LDC neg, ODC neg Pseudomonas aeruginosa
1.7. smooth, opaque, grey-white, "hockey puck" No growth on TM
1.7.1. GNDC, oxidase pos, butyrate esterase pos (DNase pos) glucose, maltose, sucrose neg Moraxella cararrhalis
1.8. anaerobic organism, special request culture (mycobacteria spp, nocardia spp, legionella pneumophila)
2. Normal flora (upper respiratory tract)
2.1. small, non-hemolytic, pink/yellow colonies
2.1.1. GPC in tetrads, Catalase pos, coagulase, neg, bacitracin S (modified oxidase pos) Micrococcus spp
2.2. small, grey-white colonies, non-hemolytic sometimes alpha hemolytic
2.2.1. GPC in chains, Catalase neg, PYR pos Enterococcus spp
2.3. small, round, glistening, dome-shaped, alpha hemolytic
2.3.1. GPC in pairs (lancet shaped), catalase neg, PYR neg, LAP pos, optochin R, bile esculin neg Strep spp viridans grp
2.4. small, grey-white, irregular shaped colonies, non-hemolytic, opaque (confused with coagulase-neg staph spp)
2.4.1. Pleomorphic GPR pallisading, catalase pos Corynebacterium spp
2.5. translucent, tannish, smooth, convex colonies Grow on CHOC but not BAP
2.5.1. Pleomorphic GNCB, catalase pos, oxidase pos, need X factor only Haemophilis spp, not influenzae
2.6. small, grey-white, non hemolytic colonies
2.6.1. GPC in clusters, catalase pos, latex coagulase neg Coagulase Negative Staph spp
2.7. grey-white colonies
2.7.1. GNR, oxidase neg (except plesiomonas), nitrate reducing, glucose fermenters Enteric GNR
2.7.1.1. TDA/LDA pos, ONPG neg, urease pos, H2S pos, NLF Indole pos, ODC neg (proteus vulgaris) Indole neg, ODC pos (proteus mirabilis)
2.7.1.2. Indole pos, citrate neg, VP neg, beta hemolytic, LF Esch. coli