False Localization of Site of Endocarditis by Cardiac Catheterization with Quantitative Cultures

Michael Bennish, Robert A. Weinstein, Sherwin A. Kabins, Mukesh C. Jain
1985 American Journal of Clinical Pathology  
The authors present a patient with relapsing Pseudomonas aeruginosa endocarditis in whom cardiac catheterization with quantitative cultures falsely localized the infection to the tricuspid valve, probably because the patient was having intermittent rather than continuous bacteremia. After catheterization the patient developed mitral insufficiency and congestive heart failure. This experience suggests that quantitative cultures during cardiac catheterization may give misleading results and that
more » ... g results and that the procedure may have significant complications. (Key words: Cardiac catheterization; Infective endocarditis; Blood cultures) Am J Clin Pathol 1985; 83: 130-131 CARDIAC CATHETERIZATION with quantitative blood cultures from various intravascular sites is discussed in standard references as a means of identifying the site of valvular involvement in selected cases of infective endocarditis. 56 Published experience with this procedure is limited to two patients. 3 In each of those cases, there was an increase in bacterial colony counts when cultures were obtained just distal to the infected valve. We report a patient with relapsing Pseudomonas aeruginosa endocarditis in whom cardiac catheterization with quantitative cultures, done when noninvasive means had failed to locate the site of infection, gave misleading data and was followed by the abrupt development of mitral insufficiency. Report of a Case A 31-year-old man was admitted with a six-day history of fever and myalgia. He denied parenteral drug use. His temperature was 39.4 °C. Osier nodes and Janeway lesions were seen on his palms and soles. A grade II/VI short systolic murmur was heard at the lower left sternal border. The remainder of the examination was normal. A chest x-ray was normal. M-mode and two dimensional echocardiograms showed no evidence of vegetations. Each of five blood cultures grew P. aeruginosa. We treated the patient with intravenous tobramycin and ticarcillin for six weeks. He became afebrile within 48
doi:10.1093/ajcp/83.1.130 pmid:3966433 fatcat:vpenalthu5h3hlzjqogfqlnmxm