Pseudomonas Endocarditis

To the Editor.—  In the article by Borow et al, "Transient Pseudomonas Bacteremia in a Heroin Addict: Resemblance to Right-Sided Endocarditis" (240:560, 1978), the authors describe an intravenous heroin user with transient Pseudomonas bacteremia whose temperature defervesced within ten hours of admission, before gentamicin sulfate therapy was begun. This patient otherwise almost fulfilled all criteria for a presumptive diagnosis of right-sided bacterial endocarditis.^1,2 These major requirements are "persistent" P aeruginosa bacteremia and absence of an obvious source for the bacteremia other than the heart. Supportive findings include (1) intravenous use of heroin, (2) cardiac murmur(s), (3) septic emboli, and (4) fever.In the series of 23 patients with P aeruginosa bacterial endocarditis reported by us in 1973,¹ histological documentation of right-sided bacterial endocarditis at either surgery or autopsy was possible in ten of 16 patients who fulfilled the aforementioned criteria. Five of the remaining six patients unaccounted for