Thread: What is criteria for the diagnosis of infective endocarditis?

What is criteria for the diagnosis of infective endocarditis?


Complete Answer
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1. Definitive diagnosis
a. Pathology/microbiology of vegetations obtained at surgery or autopsy
b. Two major criteria
c. One major/three minor criteria
d. Five minor criteria

2. Possible diagnosis: Findings consistent with but fall short of definitive diagnosis of endocarditis

3. No endocarditis: No pathology at surgery or autopsy or clinical resolution with 3 days of antimicrobial therapy; firm alternate diagnosis

Major Criteria

1. Blood culture
a. 2 separate blood cultures positive for:
# Viridans streptococci, S. bovis, HACEK ( Haemophillus species, Actinobacillus,Cardiobacterium, Eikenella, and Kingella)
# Community-acquired S.aureus or enterococci, in absence of primary focus
b. Positive blood cultures >12 hours apart
c. Positive blood cultures: 3 of 3, majority of more or equal than 4 with 1st and last with more or equal than 1 hour apart

2. Echocardiography: Oscillating intracardiac mass on valve or supporting structure or in path of jet stream, valve ring abscess, new dehiscence of prosthetic valve, or new valvular regurgitation

Minor Criteria
1. Predisposing heart condition, or intevenous drug user
2. Fever more or equal than 38 degree Centigrade
3. Systemic or pulmonary emboli, mycotic aneurysm
4. Immunologic phenomena: glomerulonephritis, Roth's spot, Osler's node, Janeway lesion, rheumatoid factor
5. Echocardiography finding consistent with bur not definitive of endocarditis
6. Microbiologic/serologic findings consistent with but not definitive of endocarditis
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dukes criteria including the clinical ,laboratory n echocardiographic findings .
it ha s minor n major criteria.

Duke criteria for the diagnosis of infective endocarditis

Major criteria

1. Positive blood cultures (
2) with microbe typical for infective endocarditis,
or persistently positive blood cultures with compatible microbe
2. Evidence of endocardial involvement: new regurgitant murmur or
positive echocardiogram for oscillating mass, abscess, or prosthetic valve dehiscence

Minor criteria

1. Predisposing cardiac condition or intravenous drug use
2. Fever
38.0C (100.4F)
3. Vascular phenomena
4. Immunologic phenomena
5. Echocardiogram consistent with endocarditis, but not meeting major criteria
6. Positive blood culture, but not meeting major criteria, or positive serology or molecular
test for compatible microbe

Diagnosis

Definite endocarditis

1. Positive histology, or positive culture from vegetation, or
2. Two major criteria, or
3. One major and three minor criteria, or
4. Five minor criteria

Rejected

1. Firm alternative diagnosis established
2. Resolution after 4 days of antibiotic treatment
Possible endocarditis (neither definite nor rejected)