Infective endocarditis#Modified Duke criteria

If you suspect the presence of infective endocarditis (IE) is between

  • The definitive,
  • The probable and
  • The exclusion of IE

Distinguished. The Duke criteria (named after the Duke University, Durham, North Carolina) help provide safe and timely diagnosis of IE in patients. They were formulated in 1994 by the research group led by David T. Durack and have been modified in 2000.

  • 2.2.1 predisposition
  • 2.2.2 fever
  • 2.2.3 vascular findings
  • 2.2.4 Signs of systemic immune response
  • 2.2.5 echocardiography
  • 2.2.6 Microbiology
  • 3.1 Notes and references

Pathology

The diagnosis of IE is unique if the following pathological criteria are met:

Detection of microorganisms by

  • Blood culture ( two independently positive) or
  • Histology in a vegetation or
  • In an embolized vegetation or
  • In an abscess of the heart or
  • A pathological lesion, a vegetation, or an abscess of the heart with histological features of active endocarditis.

The definitive diagnosis of IE is thus hardly otherwise than by surgery or autopsy possible.

Clinic

For all other patients, the clinical criteria apply according to Duke to make the diagnosis of IE. The diagnosis of IE in vivo is always difficult and not, for example, by echocardiography alone possible. It must either

  • Two major criteria or
  • A major criterion and three minor criteria, or
  • Five minor criteria must be met.

Duke - the main criteria

Positive blood cultures

  • Microorganisms which can cause IE typically from two separate blood cultures Streptococcus viridans, S. bovis, HACEK group or
  • Staphylococcus aureus, or
  • Enterococcus in the absence of any primary outbreak
  • Persistently positive blood cultures with microorganisms that can typically cause IE Blood cultures with more than 12 hours time interval or
  • Three or a majority of at least four different blood cultures, wherein the first and last temporal spacing of at least one hour was taken out.

Morphological evidence of involvement of the endocardium / heart valves

  • Positive echocardiography ( cardiac ultrasound image ) for infective endocarditis means that the following criteria are met: floating mass on a valve or
  • The holding apparatus or
  • Toward the Regurgitationsjets
  • Or on a iatrogenic material ( such as a pacemaker lead ) in the absence of an alternative anatomic explanation, or

Duke minor criteria

Predisposition

  • Predisposing heart disease or
  • Intravenous drug use

Fever

  • Fever > 38.0 ° C

Vascular findings

  • Arterial embolism,
  • Septic pulmonary infarcts,
  • Mycotic aneurysms,
  • Cerebral hemorrhage,
  • Bleeding of the mucous membranes,
  • Janeway lesions

Signs of systemic immune response

  • Glomerulonephritis,
  • Löhlein - Herdnephritis,
  • Osler 's nodes,
  • Roth spots of the fundus,
  • Rheumatoid factor

Echocardiography

  • Note without being a main criterion for infectious endocarditis

Microbiology

  • Positive blood cultures, but not according to the main criteria, or
  • Serological indication of active infection with an organism consistent with infective endocarditis

Exclusion of infective endocarditis

One IU can be excluded,

  • If a clear alternative diagnosis is identified,
  • When, after a four-day antibiotic treatment, the disease has been completed, or
  • If no evidence of infective endocarditis can be rendered at surgery or autopsy within the first four days after the start of antibiotic treatment.

Probable Infective endocarditis

Findings that do not correspond to those of the so called definitive endocarditis, but also not an exclusion

HACEK endocarditis Wound dehiscence Digital Object Identifier
295336
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