Criteria of EndocarditicDone by : Abdulrahman Al-Otaiq
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.
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
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
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
The echocardiogram in IE
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
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