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| '''Positive Blood Culture for Infective Endocarditis'''<BR>
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| * Typical microorganism consistent with infective endocarditis from 2 separate blood cultures, in the absence of a primary focus:<BR>
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| :❑ [[Viridans streptococci]], [[streptococcus bovis]]<BR>
| | <table class="wikitable"> |
| :❑ [[HACEK organism|HACEK group]]<BR>
| | <tr class="v-firstrow"><th>Probability of infective endocaritis</th><th> Characteristics </th></tr> |
| :❑ Community-acquired [[staphylococcus aureus]]
| | <tr><td>Definite diagnosis by pathological criteria</td><td>Microorganisms demonstrated by culture or histological examination of a vegetation, OR <br> |
| :❑[[Enterococci]]<br>
| | Pathological lesions; vegetation or intracardiac abscess confirmed by histological examination showing active endocarditis </td></tr> |
| <br> | | <tr><td>Definite diagnosis by clinical criteria</td><td>2 major criteria; OR <br> |
| OR | | 1 major criterion and 3 minor criteria; OR <br> |
| <br> | | 5 minor criteria </td></tr> |
| * Microorganisms consistent with infective endocarditis from persistently positive blood cultures defined as:<BR>
| | <tr><td>Possible</td><td>1 major criterion and 1 minor criterion; OR <br>3 minor criteria</td></tr> |
| | <tr><td>Rejected</td><td>Firm alternative diagnosis explaining evidence of IE, OR <br> |
| | Resolution of IE syndrome with antibiotic therapy for 4 days, OR <br> |
| | No pathological evidence of IE at surgery or autopsy, with antibiotic therapy for 4 days, OR <br> |
| | Does not meet criteria for possible IE as above</td></tr> |
| | </table> |
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| :❑ At least 2 positive cultures of blood samples drawn >12 hours apart, or<BR>
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| :❑ All of 3 or a majority of 4 separate cultures of blood (with first and last sample drawn 1 hour apart)<BR>
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| * Single positive blood culture for Coxiella burnetii or anti–phase 1 IgG antibody titer >1:800
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| '''Echocardiographic evidence of endocardial involvement'''<BR>
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| :❑ 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
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| :❑ Abscess, or<BR>
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| :❑ New partial dehiscence of prosthetic valve, or<BR>
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| :❑ New valvular regurgitation
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| Minor criteria:
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| *'''Predisposition:'''
| | {|class="wikitable" |
| :❑ Predisposing heart condition or intravenous drug use<BR>
| | ! Criteria!! Definite Infective Endocarditis According to Modified Duke Criteria |
| *'''Fever:'''
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| :❑ Temperature > 38.0° C (100.4° F)<BR>
| | | '''Pathological Criteria'''|| |
| *'''Vascular phenomena:'''
| | :Microorganisms demonstrated by culture or histological examination of a vegetation |
| :❑ [[Embolism|Major arterial emboli]]
| | :Pathological lesions; vegetation or intracardiac abscess confirmed by histological examination showing active endocarditis |
| :❑ Septic pulmonary infarcts | | |- |
| :❑ [[Mycotic aneurysm]] | | | '''Clinical Criteria''' || |
| :❑ [[Intracranial hemorrhage]]
| | :2 major criteria; or |
| :❑ [[Conjunctival hemorrhage]]
| | :1 major criterion and 3 minor criteria; or |
| :❑ [[Janeway lesions]]<BR>
| | :5 minor criteria |
| *'''Immunologic phenomena:'''
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| :❑ [[Glomerulonephritis]] | |
| :❑ [[Osler's nodes]]
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| :❑ [[Roth spot]]s
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| :❑ [[Rheumatoid factor]]<BR> | |
| *'''Microbiological evidence:'''
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| :❑ Positive blood culture but does not meet a major criterion as noted above, or
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| :❑ Serological evidence of active infection with organism consistent with infectious endocarditis<BR> | |
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| {| style="cellpadding=0; cellspacing= 0; width: 600px;"
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| | style="padding: 0 5px; font-size: 100%; background: #F5F5F5;" align=center | '''Major criteria'''||style="padding: 0 5px; font-size: 100%; background: #F5F5F5;" align=center | '''Minor criteria'''
| | | '''Possible IE''' || |
| | :1 major criterion and 1 minor criterion; or |
| | :3 minor criteria |
| |- | | |- |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |'''''1- Positive Blood Culture for Infective Endocarditis'''''<br>
| | | '''Rejected''' || |
| ❑ Typical microorganism consistent with infective endocarditis from 2 separate blood cultures, in the absence of a primary focus:<BR>
| | :Firm alternative diagnosis explaining evidence of IE; or |
| :❑ [[Viridans streptococci]], [[streptococcus bovis]]<BR>
| | :Resolution of IE syndrome with antibiotic therapy for 4 days; or |
| :❑ [[HACEK organism|HACEK group]]<BR>
| | :No pathological evidence of IE at surgery or autopsy, with antibiotic therapy for 4 days; or |
| :❑ Community-acquired [[staphylococcus aureus]] | | :Does not meet criteria for possible IE as above |
| :❑[[Enterococci]] <br>
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| <br>OR<br><br>
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| ❑ Microorganisms consistent with infective endocarditis from persistently positive blood cultures defined as:<BR>
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| :❑ At least 2 positive cultures of blood samples drawn >12 hours apart, or<BR>
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| :❑ All of 3 or a majority of 4 separate cultures of blood (with first and last sample drawn 1 hour apart)<br> | |
| <br>OR<br><br>
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| ❑ Single positive blood culture for Coxiella burnetii or anti–phase 1 IgG antibody titer >1:800|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left <br>
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| <br>
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| -----
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| '''''2-Echocardiographic evidence of endocardial involvement''''' <br>
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| ❑ 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
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| ❑ Abscess, or<BR>
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| ❑ New partial dehiscence of prosthetic valve, or<BR>
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| ❑ New valvular regurgitation
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''1- Predisposition'''''<br>
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| ❑ Predisposing heart condition or intravenous drug use<BR>
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| <br>
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| ----
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| '''2- Fever'''<br>
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| ❑ Temperature > 38.0° C (100.4° F)<BR>
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| <br>
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| ----
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| '''''3- Vascular phenomena'''''<br>
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| ❑ [[Embolism|Major arterial emboli]] <br>
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| ❑ Septic pulmonary infarcts <br>
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| ❑ [[Mycotic aneurysm]] <br>
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| ❑ [[Intracranial hemorrhage]] <br>
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| ❑ [[Conjunctival hemorrhage]] <br>
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| ❑ [[Janeway lesions]]<BR>
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| <br>
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| ----
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| '''''4- Immunologic phenomena''''' <br>
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| ❑ [[Glomerulonephritis]] <br>
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| ❑ [[Osler's nodes]] <br>
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| ❑ [[Roth spot]]s <br>
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| ❑ [[Rheumatoid factor]]<BR>
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| <br>
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| ----
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| '''''5- Microbiological evidence''''' <br>
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| ❑ Positive blood culture but does not meet a major criterion as noted above<br>
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| <br>OR<br><br>
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| ❑ Serological evidence of active infection with organism consistent with infectious endocarditis<BR>
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| |- | | |- |
| |} | | |} |