Dukes Criteria for Infective Endocarditis

The modified Duke’s criteria is used to diagnose infective endocarditis and includes the following major and minor criteria

Major criteria include:

1. Positive blood culture with typical IE microorganism, defined as one of the following:

• Typical microorganism consistent with IE from 2 separate blood cultures - E.g. Viridans-group streptococci, S. bovis, HACEK group, S. aureus, or community-acquired enterococci
• Microorganisms consistent with IE from persistently positive blood cultures defined as-
• Two positive cultures of blood samples drawn >12 hours apart, or
• All of 3 or a majority of 4 separate cultures of blood (with the first and last sample drawn 1 hour apart)
• Coxiella burnetii detected by at least one positive blood culture or antiphase I IgG antibody titer >1:800

2. Evidence of endocardial involvement with positive echocardiogram defined as

• Oscillating intracardiac mass on the 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 or new valvular regurgitation (not worsening of an existing murmur)

Minor criteria include:

• Predisposing factor: known cardiac lesion, recreational drug injection
• Fever >38°C
• Evidence of embolism: arterial emboli, pulmonary infarcts, Janeway lesions, conjunctival hemorrhage
• Immunological problems: glomerulonephritis, Osler's nodes, Roths spots
• Positive blood culture (that doesn't meet a major criterion) or serologic evidence of infection with organism consistent with IE but not satisfying major criterion

Pathological criteria

• Positive culture of the typical organism or positive histology from the specimen obtained from cardiac surgery or autopsy
• Definite endocarditis - Positive pathology or 1 major + 2 minor criteria or 5 minor criteria

Here is a video of a young 35 year old patient with severe AR from a bicuspid valve endocarditis.



References

1. Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG, Jr., Ryan T, Bashore T, Corey GR.
Proposed  modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 2000;30:633–638
2. European Society of Cardiology Task Force Members. Guidelines on Prevention, Diagnosis and Treatment of Infective Endocarditis.
Eur Heart J 25: 267-276