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Criteria of endocarditic

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  • 1. Criteria of EndocarditicDone by : Abdulrahman Al-Otaiq
  • 2. Diagnosis• Traditionally based upon “positive blood cultures in the presence of a new or changing heart murmur”, or persistent fever in the presence of heart disease.• Shortcomings include culture-negative endocarditis, lack of typical echocardiographic findings, etc.
  • 3. Duke Criteria• Based on pathological and clinical criteria.• Utilizes microbiological data, evidence of endocardial involvement, and other phenomenon associated with infective endocarditis to estimate the probability of infective endocarditis in a given patient.• Has been shown to be valid and reproducible in childrenDurack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis:utilization of specific echocardiographic findings. AM J Med 96:200, 1994Stockheim JA, Chadwick EG, Kessler S, et al. Are the Duke Criteria superior to the Beth Israelcriteria for the diagnosis of infective endocarditis in children? Clin Infect Dis 27:1451, 1998
  • 4. Duke criteria• Definitive ▫ Pathological criteria  Microorganisms, or  Pathologic lesions ▫ Clinical criteria  2 major criteria, or  1 major and 3 minor criteria, or  5 minor• Possible ▫ Findings consistent with infective endocarditis that fall short of “definitive” but are not “rejected”• Rejected ▫ Firm alternative diagnosis, or ▫ Resolution of manifestations of endocarditis with antibiotic therapy of 4 days or less, or ▫ No pathological evidence of endocarditis at surgery or autopsy with antibiotic therapy of 4 days or less
  • 5. Duke criteria: Major criteria• Positive blood culture ▫ Typical microorganism consistent with IE, from two separate blood cultures  S. viridans, S. bovis, HACEK  community-acquired S. aureus or enterocci (no primary focus) ▫ Persistently positive cultures  at least two positive cultures, drawn 12 hours apart  all of three, or a majority of four or more cultures (with first and last sample drawn at least one hour apart• Evidence of endocardial involvement ▫ Positive echocardiogram  oscillating intracardiac mass on valve or supporting structures, or  myocardial abscess, or  new partial dehiscence of prosthetic valve ▫ New valvar regurgitation
  • 6. The echocardiogram in IE
  • 7. Duke criteria: Minor criteria• Predisposition ▫ Predisposing heart condition or IV drug abuser• Fever ▫ > 38.0º C• Vascular phenomena ▫ arterial emboli, septic pulmonary infarct, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhage, Janeway’s lesion• Immunologic phenomena ▫ glomerulonephritis, Osler’s nodes, Roth’s spots, rheumatoid factors• Microbiologic evidence ▫ positive blood culture but does not meet major criteria as noted• Echocardiographic evidence ▫ consistent with IE but does not meet major criteria as noted
  • 8. References• Bayer AS, Bolger AF, Taubert KA, Wilson W, Steckelberg J, Karchmer AW, et al. Diagnosis and Management of Infective Endocarditis and Its Complications. Circulation. 1998;98:2936-2948.• Berkowitz, FE: Infective endocarditis. IN Nichols EG, Cameron DE, Greeley WJ, et al (eds): Critical Heart Disease in Infants and Children. St. Louis, Mosby-Year Book, 1995.• Cetta F, Graham LC, Lichtenberg RC, Warnes CA. Piercing and tattooing in patients with congenital heart disease. J Adolesc Health 1999;24:160