The Duke criteria are a set of clinical criteria set forward for the diagnosis of infective endocarditis.
For diagnosis of definite infective endocarditis by clinical criteria the requirement is 4:
2 major criteria or
1 major and 3 minor criteria or
5 minor criteria
For diagnosis of possible infective endocarditis by clinical criteria the requirement is 4:
1 major and 1 minor criterion
3 minor criteria
For adequate diagnostic sensitivity, transesophageal echocardiography is the preferred modality used in patients designated "high-risk" or those in whom transthoracic echocardiography would likely be difficult. Examples of high-risk patients are those with 3:
past medical history of endocarditis
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physical exam significant for:
signs of heart failure
a new heart murmur
stigmata of infective endocarditis
history of prosthetic heart valve implantation
Major criteria
positive blood cultures for infective endocarditis
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typical microorganism for infective endocarditis from 2 separate blood cultures
Viridans streptococci, Streptococcus bovis, and HACEK group or
community-acquired Staphylococcus aureus or enterococci in the absence of a primary focus or
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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 one hour apart
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evidence of endocardial involvement
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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
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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
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immunologic phenomena:
glomerulonephritis
Osler nodes
Roth spots
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 criteria as noted previously