Duke criteria for infective endocarditis

The Duke criteria are a set of clinical criteria set forward for the diagnosis of infective endocarditis

For diagnosis the requirement is 

• 2 major and 1 minor criteria or
• 1 major and 3 minor criteria or
• 5 minor criteria

Major criteria

• positive blood cultures for infective endocarditis
• typical microorganism for infective endocarditis from 2 separate blood cultures
  • Viridans streptococci, Streptococcusbovis, and HACEK group or 
  • community-acquired Staphylococcusaureusor enterococci in the absence of a primary focus or
  • persistently positive blood cultures, defined as recovery of a microorganism consistent with infective endocarditis from : 
    • 2 blood cultures drawn 12 hours apart or all of 3 or most of 4 or more separate blood cultures, with first and last drawn at least 1 hour apart
• evidence of endocardial involvement
  • positive echocardiogram for infective endocarditis
    • oscillating intracardiac mass on valve or supporting structures or in the path of regurgitant jets or on implanted material in the absence of an alternative anatomical explanation or
    • abscess or
    • new partial dehiscence of prosthetic valve or
  • new valvular regurgitation 

Minor criteria

• predisposing heart condition or intravenous drug use
• fever : 38°C 
• vascular phenomena : major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, and Janeway lesions
• immunologic phenomena : 
  • glomerulonephritis
  • Osler nodes
  • Roth spots
  • rheumatoid factor
• microbiologic evidence : positive blood culture but not meeting major criterion as noted previously or serologic evidence of active infection with organism consistent with infective endocarditis 
• echocardiography findings consistent with infective endocarditis but not meeting major criterion as noted previously