Diagnosing catheter associated blood-stream infection by transesophageal echocardiogram

Excerpt

A 65-year-old man with known mitral valve prolapse and myeloproliferative disease was admitted for streptococcal mitis infective endocarditis complicated by pulmonary edema, severe mitral regurgitation and embolic phenomenon. Mechanical mitral valve replacement was performed. He had a prolonged stay in the Intensive Care Unit and had a permanent dialysing catheter inserted. He then developed Candida parapsilosis fungaemia 10 days after the valvular surgery. With a remote suspicion of catheter-related sepsis, a transesophageal echocardiogram was done to initially rule out prosthetic valve infective endocarditis—which was of the higher priority given the context. Instead, it showed vegetation over the tip of the permanent dialysing catheter located in the right atrium. The catheter was removed and subsequent culture of its tip confirmed catheter-related blood stream fungal infection (Fig. 1).

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