Wednesday, 17 July 2013

Dukes Criteria

The Duke Criteria for Infective Endocarditis requires that a certain minimum criteria be present.
Infective endocarditis can be diagnosed based upon any of the following:
1. Two major criteria being met OR
2. One major and three minor criteria being met OR
3. Five minor criteria being met
Major criteria:
A. Positive blood culture for Infective Endocarditis (IE)
Typical microorganism that can cause IE from 2 separate blood cultures [Typical organisms include Streptococcus viridans, Streptococcus bovis, Haemophilus (parainfluenzae, aphrophilus, paraphrophilus), Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae), OR Community acquired Staphylococcus aureus or enterococci, in the absence of a primary focus OR Microorganisms consistent with IE from "persistently positive" blood cultures meeting criteria of: 2 positive cultures with blood samples drawn >12 hours apart OR 3 of 3 or 3 of 4 separate blood cultures being positive (with first and last sample drawn 1 hour apart)
B. Evidence of endocardial involvement with either:
Positive echocardiogram for IE (with at least one of the items below) oscillating intracardiac mass on valve or supporting structures, in the path of regurgitant jets, or on implanted material in the absence of an alternative anatomic explanation OR Abscess OR New partial dehiscence of prosthetic valve New valvular regurgitation (worsening or changing of preexisting murmur not sufficient)
Minor criteria:
A. Predisposition to IE (Predisposing heart condition or intravenous drug use)
B. Fever (T> 38.0°C or >100.4°F)
C. Vascular phenomena [Major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, or Janeway lesions (non-tender, small erythematous or haemorrhagic macules or nodules in the palms or soles)]
D. Immunologic phenomena [Glomerulonephritis, Osler's nodes (small papule that is tender on the palmar finger pads or plantar toes), Roth's spots (Retinal hemorrhages with white or pale centers) and positive rheumatoid factor testing]
E. Microbiological evidence [Positive blood culture that does not meet a major criterion as noted above (however a single blood culture for coagulase negative staphylococci, diphtheroids or organisms that do not usually cause endocarditis does not count for this criteria) or serological evidence of active infection with an organism that is consistent with IE
F. Echocardiographic findings that are consistent with IE but do not meet the major criteria echocardiographically

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