Staphylococcus lugdunensis (S. lugdunensis) is a coagulase negative staphylococcus (CoNS) that can cause destructive infective endocarditis. S. lugdunensis, unlike other CoNS, should be considered to be a pathogen. We report the first case of S. lugdunensis endocarditis causing ventricular septal defect and destruction of the aortic and mitral valves.A 53-year-old male with morbid obesity and COPD presented with intermittent fever and progressive shortness of breath for 2 weeks.Chest examination showed bilateral basal crepitations, and a grade 2 systolic murmur along the right sternal border. The leukocyte count was 26,000 cells/μl with 89% neutrophils. He was treated with intravenous vancomycin and ceftriaxone. Blood cultures grew Staphylococcus lugdunensis. Transthoracic echocardiogram, which was limited by body habitus, showed no definite valvular vegetations. Repeat transthoracic echocardiogram performed one week later revealed a large aortic valve vegetation Vancomycin was switched to daptomycin on day 4 because of difficulty achieving therapeutic levels of vancomycin and the development of renal insufficiency.Open heart surgery on day 10 revealed aortic valve and mitral valve vegetations with destruction, left ventricular outflow tract (LVOT) septal abscess and ventricular septal defect (VSD). Bio-prosthetic aortic and mitral valve replacement, LVOT and VSD repair were done. Intraoperative cultures grew Staphylococcus lugdunensis. The patient was discharged home with daptomycin to complete 6 weeks of treatment.S. lugdunensis can cause rapidly progressive endocarditis with valve and septal destruction. Early diagnosis and therapy are essential, with consideration of valve replacement.

Mycobacterium abscessus, which is ubiquitous environmental organism, is more likely to cause pulmonary infection in the presence underlying lung disease and immunosuppression. We report a case of pulmonary disease due to coinfection of Mycobacterium tuberculosis (MTB) and Mycobacterium abscessus (M. abscessus) in an immunocompetent patient without underlying lung disease.Healthcare professionals should be aware of co-infection with MTB and M. abscessus, and treatment should be based on clinical suspicion and/or epidemiological circumstances.

Background Lactobacillus are low virulence commensal organisms which are commonly found in the human oral cavity, gastrointestinal and genitourinary tracts. Although Lactobacillus bacteremia (LB) is rare, evidence aggregating from case reports has implicated LB in several medical conditions. As such, there is reason to suggest that the presence of these organisms in blood cultures may not be due to spurious contamination, but rather, indicative of clinically meaningful events capable of inducing serious illnesses. The purpose of this study is to characterize the risk factors, clinical significance and outcomes of patients with LB. Methods We retrospectively reviewed the medical records of patients presenting to a large urban teaching hospital between January 1, 2017 and December 31, 2018, who were found to have LB. Identified individuals were grouped into two mutually exclusive case categories: true LB cases or non-true cases (i.e., contamination). Individuals with ≥1 positive blood and were started on appropriate antibiotics were considered true cases. Those with positive cultures not started on appropriate antibiotics were considered contaminants. Results A total of 14 patients were identified during our study period, with majority considered true LB cases [71.4%; n = 10]. These 14 individuals were mostly males [64.2%; n = 9] and reported no use of Lactobacilli probiotics [78.6%; n = 11] or antacids [57.1%; n = 8]. On average, true LB cases were older (mean [SD]): 80.1 [±10.9]vs. 54.0 [±19.1] years) and required longer hospitalization (38.5 [(±27.6] vs. 8.0 [(±6.2] days) compared to non-LB cases, respectively. Among the 10 true LB cases, the suspected source of infection included gastrointestinal system [50%; n = 5], infective endocarditis [10%; n = 1], genitourinary system [10%; n = 1]; and could not be determined in 3 [30%] cases. Concurrent infection with candida and gastrointestinal microbes were noted in four (40%) of the true LB cases, respectively. Overall, five deaths were observed, with 4 [80%] occurring in true LB cases and one in a non-LB case. Conclusion LB should not be dismissed as contaminants particularly in at-risk patients for LB, such as the elderly or immunocompromised individuals. Disclosures All Authors: No reported disclosures

Malaria is a serious and sometimes fatal disease caused by an intraerythrocytic parasite, and is commonly seen in developing countries. Approximately 1500 cases of malaria are diagnosed in the United States each year, mostly in travelers and immigrants returning from endemic areas [1]. There are many different regimens used to treat malaria, some of which are not approved in the USA. The side effects of these medications may not be familiar to physicians in the USA. We report a case of a returning traveler from Nigeria presenting with fever and hemolytic anemia caused by a delayed response to artesunate given 3 weeks earlier while in Nigeria. To our knowledge, there are few cases reported in the United States of hemolytic anemia secondary to artesunate therapy [2].

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