Master the board step 3

Infectious Diseases
Duke’s Criteria for Endocarditis
Major
Two positive blood cultures with
• Staphylococcus aureus
• Viridans streptococci, Streptococcus bovis/epidermis, enterococci,
gram-negative rods, Candida
HACEK organisms are generally culture-negative.
• Haemophilus aphrophilus/parainfluenzae
• Actinobacillus actinomycetemcomitans
• Cardiobacterium hominis
• Eikenella corrodens
• Kingella kingae
Abnormal echocardiogram:
• Intracardiac mass or valvular vegetation
OR
• Abscess
OR
• New partial dehiscence of prosthetic valve
Minor
Fever (> 38.0 o C)
Presence of risk factors:
• IV drug use (IDU)
• Presence of structural heart disease
• Prosthetic heart valve
• Dental procedures involving bleeding
• History of endocarditis
Vascular findings:
• Janeway lesions
• Septic pulmonary infarcts
• Arterial emboli
• Mycotic aneurysm
• Conjunctival hemorrhage
Immunological findings:
• Roth spots
• Osler’s nodes
• Glomerulonephritis
Microbiologic findings
• Positive blood culture but does not meet
major criteria
Look for a patient with a risk such as the following:
··
Prosthetic heart valve
··
Injection drug use
··
Dental procedures that cause bleeding
··
Previous endocarditis
··
Unrepaired or recently repaired cyanotic heart disease
Fever + Murmer = Possible
endocarditis. Do blood
cultures.
2 positive blood cultures +
Positive echo = Endocarditis.
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