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ALL / Cardiology
Infective endocarditis: Modified Duke criteria
Infective endocarditis: Modified Duke criteria
Infective endocarditis diagnosed if- pathological criteria positive, or
- 2 major criteria, or
- 1 major and 3 minor criteria, or
- 5 minor criteria
Pathological criteria
Positive histology or microbiology of pathological material obtained at autopsy or cardiac surgery (valve tissue, vegetations, embolic fragments or intracardiac abscess content)
Major criteria
Positive blood cultures
- two positive blood cultures showing typical organisms consistent with infective endocarditis, such as Streptococcus viridans and the HACEK group, or
- persistent bacteraemia from two blood cultures taken > 12 hours apart or three or more positive blood cultures where the pathogen is less specific such as Staph aureus and Staph epidermidis, or
- positive serology for Coxiella burnetii, Bartonella species or Chlamydia psittaci, or
- positive molecular assays for specific gene targets
Evidence of endocardial involvement
- positive echocardiogram (oscillating structures, abscess formation, new valvular regurgitation or dehiscence of prosthetic valves), or
- new valvular regurgitation
Minor criteria
- predisposing heart condition or intravenous drug use
- microbiological evidence does not meet major criteria
- fever > 38ºC
- vascular phenomena: major emboli, splenomegaly, clubbing, splinter haemorrhages, Janeway lesions, petechiae or purpura
- immunological phenomena: glomerulonephritis, Osler's nodes, Roth spots
Splinter haemorrhages in a patient with infective endocarditis
Janeway lesions on the palm of a patient with infective endocarditis
Extensive Osler
+PassMedicine Notes
Infective endocarditis diagnosed if
- pathological criteria positive, or
- 2 major criteria, or
- 1 major and 3 minor criteria, or
- 5 minor criteria
Pathological criteria
Positive histology or microbiology of pathological material obtained at autopsy or cardiac surgery (valve tissue, vegetations, embolic fragments or intracardiac abscess content)
Major criteria
Positive blood cultures- two positive blood cultures showing typical organisms consistent with infective endocarditis, such as Streptococcus viridans and the HACEK group, or
- persistent bacteraemia from two blood cultures taken > 12 hours apart or three or more positive blood cultures where the pathogen is less specific such as Staph aureus and Staph epidermidis, or
- positive serology for Coxiella burnetii, Bartonella species or Chlamydia psittaci, or
- positive molecular assays for specific gene targets
- positive echocardiogram (oscillating structures, abscess formation, new valvular regurgitation or dehiscence of prosthetic valves), or
- new valvular regurgitation
Minor criteria
- predisposing heart condition or intravenous drug use
- microbiological evidence does not meet major criteria
- fever > 38ºC
- vascular phenomena: major emboli, splenomegaly, clubbing, splinter haemorrhages, Janeway lesions, petechiae or purpura
- immunological phenomena: glomerulonephritis, Osler's nodes, Roth spots
