Hypernatremia affects up to 9% of critically ill patients upon hospital admission, especially in elderly patients with thirst impairment. However, hypernatremia is not entirely explained by fluid imbalance. Recent studies suggest that sodium is an important enhancer of the immune system, raising the question of whether inflammatory states such as sepsis may contribute to hypernatremia. Although sepsis patients with hypernatremia face a greater mortality rate, there is a lack of studies examining a potential association between hypernatremia and sepsis. Motivated by the frequent concurrence of hypernatremia and sepsis observed at an eastern Pennsylvanian community hospital, the current study was conducted to evaluate whether hypernatremia on admission may serve as a potential surrogate marker for sepsis. The medical records of 153 patients with hypernatremia on admission (serum sodium > 145mEq/L) were retrospectively analyzed. The mean age of patients was 81.1. Sepsis was observed in 77.1% of patients, of which 86.2% had dementia. This study demonstrated a positive correlation between hypernatremia on admission and the presence of sepsis. We suggest that the existence of hypernatremia should prompt clinicians to further investigate for sources of infection, especially in the elderly and patients with dementia.

Lactobacillus species are a group of anaerobic or facultatively anaerobic, catalase-negative, gram-positive non–spore-forming rods that are usually considered benign commensal organisms present in the human mouth and gastrointestinal and genital tracts. Given their indolent nature, the presence of Lactobacillus species in cultures is often considered contaminants. In rare occasions, however, Lactobacillus species have been reported as pathogens causing a broad range of clinically significant conditions including bacteremia, endocarditis, dental abscesses, meningitis, and intra-abdominal infections such as peritonitis, endometritis, and splenic and liver abscesses. Pyelonephritis has only been seldomly reported in literature, and perinephric abscess has never been reported in literature to date. When infection happens, it usually occurs in immunosuppressed individuals such as those with cancer, transplant recipients, chronic steroid use, or human immunodeficiency virus/AIDS. Despite being gram-positive, the bacteria are usually resistant to vancomycin, and treatment with a penicillin-based regimen is preferred. We describe a case of a diabetic and morbidly obese, but otherwise healthy man, who developed bacteremia and perinephric abscess due to Lactobacillus species.

Mycobacterium kansasii is the second most commonly occurring Non-Tuberculous Mycobacteria (NTM) in the United States. Infection is typically seen in middle aged males, and the risk of infection is greatly increased in immunocompromised hosts. Pulmonary infection presents in clinical parallel to that of Mycobaterium tuberculosis (TB) and is therefore often misdiagnosed. A combination of clinical, radiological, and microbiological evidence of infection is generally required to clinch the diagnosis. Treatment of such cases include prolonged courses of rifampin in combination with 2 other antimicrobial agents. The overall prognosis with appropriate treatment is good with the exception of disseminated disease in severely immunocompromised hosts. In patients who are misdiagnosed or undertreated, there is progressive destruction of the lung parenchyma with distortion of lung architecture. This can in-turn lead to bronchiectatic changes leaving the airways exposed to devastating superimposed bacterial pneumonia. We describe a case of a patient with untreated M. kansasii infection who developed superimposed necrotizing pneumonia and respiratory failure requiring prolonged ventilatory support.

Lung abscesses are most commonly polymicrobial, being caused by both anaerobic and aerobic bacteria, usually from the oral flora. A particular pathogen present in the oral flora, Streptococcus intermedius, has been known to cause aggressive pyogenic infections such as abscesses, most often on the soft tissues, liver and brain. Though less common, these infections can also occur in the lungs of immunocompetent individuals without preceding risk factors. In such cases, a presentation with productive cough and fever can be misdiagnosed as tracheobronchitis or pneumonia. We present the case of an immunocompetent patient without significant underlying risk factors, who was initially misdiagnosed as recurrent sinusitis, that was found to have a lung abscess due to S. intermedius infection.