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
children
Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis:
utilization of specific echocardiographic findings. AM J Med 96:200, 1994
Stockheim JA, Chadwick EG, Kessler S, et al. Are the Duke Criteria superior to the Beth Israel
criteria 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
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
