We report a rare case of native tricuspid valve infective endocarditis caused by Neisseria mucosa/sicca, a gram-negative diplococcus which colonizes the upper respiratory tract. A female in her late 20 s with a history of injection drug use (IDU) who recently completed treatment for methicillin-sensitive Staphylococcus aureus (MSSA) native tricuspid valve infective endocarditis presented to the hospital with a 6-week history of increasing chest pain, shortness of breath and night sweats. Blood cultures grew Neisseria mucosa/sicca species in 3 of 3 sets. Transthoracic echocardiogram showed a large 3 cm × 2.2 cm vegetation on the tricuspid valve with severe regurgitation. The patient was initially treated with ceftriaxone and gentamicin. Her case was complicated by ongoing septic pulmonary emboli ultimately require pulmonary endarterectomy and repair of her tricuspid valve. We hope this case highlights a rare but known cause of infective endocarditis especially in patients with a history of IDU who may lick their needles, which predisposes those individuals to intravenous introduction of oral bacteria.

Micromonas micros is an oral anaerobic Gram-positive coccus and is a commensal of the mouth, and it is rarely isolated in prosthetic joint infections (PJIs) and even less frequently related to a preceding dental procedure with eventual hematogenous seeding of the prosthetic joint. Here, we present a case of a 56-year-old male with a prosthetic hip joint who developed Micromonas micros prosthetic hip joint infection with symptoms starting a few days after a dental procedure and not having received periprocedural antibiotic prophylaxis. He recovered well with surgical intervention and antimicrobial therapy. We conducted a literature review of prosthetic hip joint infections caused by Micromonas micros as well as briefly discuss current guidelines on antibiotic prophylaxis in patients with prosthetic joints undergoing dental procedures and some knowledge gaps.

Cytomegalovirus (CMV) is a DNA hepadnavirus, commonly implicated in reactivation disease after immunosuppression, especially in solid-organ and stem cell transplant patients. Bendamustine is an alkylating chemotherapeutic agent introduced into the management of hematological malignancies within the last decade. Few reports have raised potential concern for CMV reactivation disease after bendamustine therapy involving, but not limited to, the gastrointestinal tract, lungs, retina, and viremia. Cytomegalovirus reactivation in such instances should be added to the differential diagnoses for febrile nonneutropenic immunocompromised patients. Here, we report a case of an elderly gentleman recently diagnosed with mantle cell lymphoma who was started on chemotherapy with rituximab, bendamustine, and dexamethasone and developed CMV colitis and viremia after just 2 cycles of chemotherapy.

Borrelia burgdorferi is a spirochete that can cause Lyme disease from an infected tick bite causing a myriad of syndromes ranging from erythema migrans to oligoarticular arthritis and/or atrioventricular conduction block in the heart. It can also infect the central nervous system (CNS) and peripheral nervous system (PNS) causing cranial neuropathy, radiculoneuropathy as well as myelopathy. It has rarely been reported to involve the phrenic nerve presenting as dyspnea from diaphragmatic paralysis. Here, we present a case of a patient presenting with orthopnea and dyspnea on exertion who was diagnosed with Lyme disease causing unilateral diaphragmatic paralysis with resolution after treatment.

Fever and deranged transaminases with liver mass(es) on imaging mandates further evaluation of the mass(es) and should be followed radiologically and clinically. In the absence of a definitive diagnosis, repeat biopsy should be done.

Men who have sex with men (MSM) are at greater risk for human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). Several studies have demonstrated that HIV pre-exposure prophylaxis (PrEP) for MSM can lower rates of HIV acquisition. However, PrEP may lead to risk compensation and higher rates of non-HIV STIs. We hypothesized that PCPs’ knowledge of CDC recommendations for STIs and PrEP in MSM would be low. To assess knowledge of CDC STI screening and PrEP recommendations we emailed an anonymous questionnaire, to 314 primary care physicians and mid-level practitioners employed by Baystate Medical Center, a 716-bed academic medical center in Springfield, MA. Knowledge scores were calculated as the number of correct items, divided by the total number of items. One-way analysis of variance and Fisher’s exact test was used to test for knowledge differences between groups. P < 0.05 was considered statistically significant. One hundred and thirty of 314 invited clinicians opted in and 109 completed the survey (35% effective response rate). Most respondents (89%, n = 97) were physicians, the remainder (n = 12, 11%) were mid-level practitioners. Thirty-seven respondents (34%) reported having been trained in MSM-specific care. The mean ± SD knowledge score was 49% ± 29% (range: 0% to 100%). Knowledge was low whether respondents reported receiving previous training in MSM-specific care or not (knowledge score 49% if yes vs. 48% if no, P = 0.87) or receiving specific STD screening education (knowledge score = 51% if yes vs. 41% if no, P = 0.14). Seventy-two respondents (66%) reported providing care for MSM patients of which 29 (40%) reported having discussed PrEP with at least a few patients in the last year. Among the 29 who discussed PrEP at least once, 13 (45%) correctly answered the PrEP indication question compared with 8 (24%) of those who did not discuss PrEP. PCP knowledge of STI screening guidelines and PrEP indications for MSM is low, even among those PCPs who reported receiving MSM-specific training. In light of studies demonstrating PrEP can lead to lower HIV transmission rates among MSM while potentially increasing STI rates, efforts to educate clinicians on PrEP and STI screening should be a priority. All authors: No reported disclosures.

Abstract We report a case of Moraxella lacunata bacteremia and sepsis associated with ecthyma gangrenosum in a patient with a hematologic malignancy and successful treatment with antimicrobial therapy. Ecthyma gangrenosum, although classically associated with Pseudomonas aeruginosa, can occur with any bacterial, viral, or fungal infection. In this case report, we review the literature on Moraxella lacunata infections and conclude that it should be considered as a viable contender as a cause of ecthyma gangrenosum in any immunocompromised patient who presents with skin lesions and gram-negative rod bacteremia.

We report a case ofMoraxella lacunata bacteremia and sepsis associated with ecthyma gangrenosum in a patient with a hematologic malignancy and successful treatment with antimicrobial therapy. Ecthyma gangrenosum, although classically associated with Pseudomonas aeruginosa, can occur with any bacterial, viral, or fungal infection. In this case report, we review the literature onMoraxella lacunata infections and conclude that it should be considered as a viable contender as a cause of ecthyma gangrenosum in any immunocompromised patient who presents with skin lesions and gram-negative rod bacteremia.

Listeria monocytogenes is a non–spore-forming nonbranching facultative anaerobic gram-positive bacillus. It is widely distributed in nature and can cause serious infections including bacteremia, endocarditis, meningitis, rhombencephalitis, and, in rare instances, brain abscesses. Clostridium perfringens is a spore-forming nonbranching obligate anaerobic gram-positive bacillus. It is ubiquitous, found in soil, decaying vegetation, and the human intestinal tract. It can cause diseases that range from skin and soft tissue infections and abscesses to gas gangrene and bacteremia and has been associated with thrombosis. Recommended treatment of choice for L. monocytogenes is ampicillin/penicillin or trimethoprim/sulfamethoxazole. Clostridium perfringens is usually susceptible to penicillin, penicillin/β-lactamase inhibitor combinations, clindamycin, carbapenems, and metronidazole.

AbstractLactobacillus species are facultative gram-positive, catalase-negative anaerobic bacilli that are part of the normal bacterial flora of the human gastrointestinal mucosa. They are rarely considered a pathogen but have been reported to cause bacteremia with or without endocarditis among other infections including vertebral osteomyelitis, liver or pelvic abscesses, meningitis, and pneumonia. They can cause disease in patients who are immunocompetent and immunocompromised. Recommended treatment of choice for severe infections due to Lactobacillus species endocarditis is high-dose penicillin in combination with an aminoglycoside.

Eikenella corrodens is an anaerobic gram-negative rod that usually does not cause infections of the skin and the soft tissue. It should be suspected as being the causative organism when such infections are not responding to typical antibiotic coverage in a patient's wounds, and there is an antecedent history to suggest that the wound may have been contaminated by saliva. Penicillin G and ampicillin are the drugs of choice for treating infections caused by E. corrodens. It is highly resistant to clindamycin and metronidazole.