Staphylococcus lugdunensis is a species of coagulase-negative staphylococci (CNS) that induces a variety of infectious diseases, including skin and soft tissue infection (SSTI), infective endocarditis (IE), and bone and PJI. This review article underscores the important points in the literature about S. lugdunensis infections, including its epidemiology, diagnosis, and treatment, as well as specific types of infections it can cause. Anatomical and age-related distributions of S. lugdunensis SSTIs have been noted, though they most commonly occur as abscesses. S. lugdunensis can also manifest as an aggressive form of IE presenting with valve destruction and abscess formation, frequently requiring surgery and with a high mortality rate. Bone and joint infections caused by S. lugdunensis are also more invasive than infections by other species of CNS. The clinical presentation of S. lugdunensis infection in SSTI, IE, and bone/joint infection is frequently more similar to that of S. aureus infection than that of other CNS infections, necessitating species-level differentiation of CNS for proper diagnosis. Though historically, this depended upon biochemical tests that were neither routine nor reliable, the implementation of matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) in clinical laboratories has made identification of CNS species such as S. lugdunensis more practical. Imaging modalities, especially the fluorodeoxyglucose (FDG) with positron emission tomography (PET), are another important emerging trend in the diagnosis of infectious diseases such as S. lugdunensis infection. S. lugdunensis remains highly susceptible to a wide gamut of antibacterial therapies, which is uncharacteristic of other CNS. Infections can usually be treated by antibiotics traditionally used for CNS such as oxacillin. The breakpoints for S. lugdunensis are higher than those of other CNS and similar to S. aureus breakpoints. In the case of aggressive IE or bone/joint infection by S. lugdunensis, it is recommended to treat with a βlactam agent. Further study is needed to understand the diversity, virulence, and population structure of this species, as well as its role in other infections, such as urinary tract infections (UTIs), respiratory infections, peritonitis, and bacteremia.

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Although formic acid (FA) poisoning is rare, it is usually fatal. Many FA poisoning cases commonly involve rubber plantation workers in which these workers ingest FA accidentally or with suicidal intentions. This is a case presentation of FA poisoning by a 73-year-old man. Additionally, the patient's old age likely contributed to his severe prognosis.

Left ventricular assist device (LVAD) is used in end-stage heart failure that is refractory to medical treatment. However, there is a paucity of data looking at the rates of sepsis and severe sepsis (SSS). Therefore, this study was conceived with the purpose of analyzing the SSS burden and outcomes associated with LVAD implantation. The national inpatient sample database was queried from 2010 to 2014 using ICD-9 procedure code for LVAD use among patients 18 years or older and 2359 patients were identified. During the five-year study period, the average incidence of SSS was 11.8% and it was noted that cases with SSS were associated with an increased likelihood of mortality, greater length of hospital stay (LOS), and higher hospitalrelated charges (p < .001) compared to controls. Controlling for age, sex, and LOS, hierarchical multivariate logistic regression revealed that significant predictors of SSS were acute kidney injury [Adjusted odd's ratio (AOR) = 2.75, 95% CI = 1.87, 4.14)], mechanical ventilation (AOR = 2.34, 95% CI = 1.70, 3.23), venous thromboembolism (AOR = 1.76, 95% CI = 1.12, 2.75), gastrointestinal bleed (AOR = 1.77, 95% CI = 1.12, 2.76), chronic obstructive pulmonary disease (COPD) (AOR = 0.55, 95% CI = 0.40, 0.77), acute myocardial infarction (AOR = 0.54, 95% CI = 0.36, 0.80) and mild liver disease (AOR = 2.18, 95% CI = 1.55, 3.06). The rate of incidence of sepsis has remained constant and is often associated with a worse clinical outcome. This provides a basis to identify high-risk groups and helps argue for earlier detection of such patients and better patient selection so as to reduce infectious complications.

INTRODUCTION: Hypertension in young adults may be due to several causes such as structural, renal, thyroid or adrenal abnormalities. An uncommon structural cause in adults is interrupted aortic arch (IAA), a clinical entity often seen in children. We present a case of IAA in a young female who survived to adulthood with no medical or surgical treatment. CASE PRESENTATION: A 32-year-old female presented with a chief complaint of palpitations for 2 months. On examination, vitals were stable with a pulse of 82 bpm and blood pressure of 156/84 mmhg in the upper limbs. However, lower extremity blood pressure was found to be 112/70 mmHg. Systemic examination revealed no further abnormalities. In light of our findings, our patient was further evaluated for secondary causes of hypertension. Renal artery doppler, thyroid function tests, twenty-four-hour free urine cortisol excretion, plasma renin activity, and aldosterone concentration were within normal limits. An electrocardiogram and transthoracic echocardiography revealed features of left ventricular hypertrophy. A cardiac catheterization was performed via the left radial artery which showed a complete occlusion of the aortic arch distal to the origin of the left subclavian artery. A multi-slice computed tomography (CT) showed a 6 mm aortic interruption distal to the subclavian artery with multiple collateral vessels seen. This network of arterial bypass of the aortic arch interruption was further supplemented with multiple intercostal collaterals seen arising from the 3rd to 10th intercostal spaces from the vertebrobasilar system, extending to the posterior chest wall and spine. Based on the clinical findings and the CT study result, the patient was diagnosed with an interrupted aortic arch type A, with a break in the aortic arch seen after the left subclavian artery.The patient subsequently underwent surgical correction of the IAA with a single stage repair by extra anatomical approach. DISCUSSION: IAA is a rare congenital malformation that occurs at a frequency of 3 cases per million live births (1) and involves a loss of luminal continuity between the ascending and descending aorta. As compared to neonates and infants, IAA is very rare in adults and only a limited number of cases have been reported in the literature. The possibility of survival to adulthood is due to the formation of extensive collateral network to maintain distal blood flow. The ability to survive the initial years of infancy when collateral circulation is yet to develop may be due to the fact that the initial defect may have been a coarctation of the aorta which subsequently progressed to a complete obstruction of the vessel lumen thereby resulting in an interruption (2). CONCLUSIONS: IAA may often be overlooked. It is important to keep a broad differential and conduct a thorough investigation to identify this structural abnormality.