Diagnostic criteria, Duke Criteria

Developed in 1994 at Duke University,standardised

criteria for assessing patients with suspected
endocarditis Include;
• Predisposing Factors
• Blood culture isolates or persistence of bacteremia
• Echocardiogram findings with other clinical,
laboratory findings
Clinical criteria
Major criteria
• Blood culture(s) positive for a characteristic
organism or persistently positive for an unusual
organism
• Echocardiographic identification of a valve-related
or implant-related mass or abscess, or partial
separation of artificial valve
• New valvular regurgitation
Clinical criteria
Minor criteria
• Predisposing heart lesion or intravenous drug use
• Fever
• Vascular lesions, including arterial petechiae, subungual/splinter
hemorrhages, emboli, septic infarcts, mycotic aneurysm, intracranial
hemorrhage, Janeway lesions
• Immunological phenomena, including glomerulonephritis, Osler nodes,
Roth spots, rheumatoid factor
• Microbiologic evidence, including a single culture positive for an unusual
organism
• Elevated C reactive protein (CRP) or erythrocyte sedimentation rate (ESR)
• Echocardiographic findings consistent with but not diagnostic of
endocarditis, including worsening or changing of a preexistent murmur
Pathologic Criteria
• Microorganisms, demonstrated by culture or
histologic examination, in a vegetation, embolus
from a vegetation, or intracardiac abscess
• Histologic confirmation of active endocarditis in
vegetation or intracardiac abscess
Cont...
Diagnosis requires either pathologic or clinical criteria;
Definite
• 2 major, or 1 major + 3 minor, or 5 minor criteria are required for
diagnosis
• pathology/histology findings
Possible
• 1 major and 1 minor criteria
• 3 minor criteria
Rejected
• Firm alternate diagnosis
• resolution of manifestations of IE with 4 days antimicrobial therapy
or less
Complications of IE
These begin within the first few weeks of onset, and includes
• Cardiac
congestive cardiac failure-valvular damage, more common
with aortic valve endocarditis, infection beyond valve→ CCF.
• Systemic emboli
Risk depends on valve (mitral>aortic), size of vegetation,
(high risk if >10 mm), 20-40% of patients with endocarditis,
(risk decreases once appropriate antimicrobial therapy
started)
• Glomerular antigen antibody complex deposition causing
glomerulonephritis